Placebo injection for Cardiac Arrest Patients to replace Adrenaline Shot

[golden]

http://www.dailymail.co.uk/news/art...placebo-instead-adrenaline-heart-stopped.html


Interesting.

Adrenaline shots for cardiac arrest are an unproven therapy. So there will be a study beginning this autumn until 2016 at a cost of £2.75 million.

The paramedics wont know if they are injecting salt water or adrenaline. There will be local advertising in the experimental areas to give people the choice to opt out.

Out of 50,000 cardiac arrests each year only 6% survive.

" Adrenalin injections have been given as part of the Cardiopulmonary Resuscitation process or CPR since the 1960s, but recently doubts have been raised over their effectiveness.

Research from Japan in 2012 on 417,000 patients found that although it initially restarted their hearts,

*****Adrenalin actually reduced their survival odds and increased the likelihood of them suffering brain damage.****

The study, published in the Journal of the American Medical Association, examined adrenalin use in people going into cardiac arrest before they arrived at the hospital.

Data showed that patients who were given adrenalin were less likely to survive a month, and if they were to survive, were more likely to suffer neurological problems.

There are significant concerns the Adrenaline shots cause brain damage for those who Survive"


Golden

 

[golden]

http://www.medscape.com/viewarticle/760612

 

[alex3619]

There are serious ethical questions. Who can opt out if they never hear of the opt out? Who can opt out if unconscious? Sometimes an RCT is not necessary as proof if the effect size is unambiguous. Large effect sizes do not usually require a large RCT to test them.

 

[Esther12]

Yeah, but:

Research from Japan in 2012 on 417,000 patients found that although it initially restarted their hearts,

*****Adrenalin actually reduced their survival odds and increased the likelihood of them suffering brain damage.****

How can people be said to have opted in to adrenalin shots when it's standard practice, despite lacking much of an evidence base?

I'm not sure if placebo control is the right way to go (seeing as death will be the primary outcome, response bias is not a concern, and spending time injecting something that will do no good could distract from other interventions), but it sounds like some sort of trial is needed.

 

[Martial]

Why even bother with a placebo? If they don't use adrenaline then why even inject them? It definitely is a touchy subject that I could see causing a lot of law suits.

 

[taniaaust1]

wow, this is shocking read but why does hearing that they are doing something unproven not surprise me.

I agree with Martial, I cant see the placebo effect helping much in those who are having a cardiac arrest.

Out of 50,000 cardiac arrests each year only 6% survive

Well that certainly sounds like treatment they give doesnt work.

 

[golden]

Why even bother with a placebo? If they don't use adrenaline then why even inject them? It definitely is a touchy subject that I could see causing a lot of law suits.

Its unclear whether the families of the dead relatives will even be told they participated in the trial making law suits impossible. I think this is probably right on balance - provided the option was there to opt out

But after hearing of the Japan study, a law suit for giving me adrenalin seems more appropriate.

Whilst i normally am all for informed consent, I think this is all very well thought out.

Its again flawed animal models and testing which have created this situation. Plus 'custom' and not science which is rife in allopathic medicine.

Its the same with Doctors still dishing out Anti biotics willy nilly as a placebo despite their new training to stop because of the extremely serious consequences of doing so.

At least 85% of all treatments have not been properly scientifically tested. These sorts of trials are going to be needed to get rid of all that.

Giving a placebo will:

*stop any potential effect from the mysterious nocebo ( if not directly with the conscious patient, through the subconscious, and surrounding people administering it)

*compares like with like

*takes the ethical dilemma from paramedics etc. who may feel they are witholding a valuable treatment, especially since the belief is no doubt deeply ingrained.

*stops them getting a punch from the public if they think they their family member is not getting adequate treatment

But there are issues that maybe just a little bit of adrenaline could be of use.

But has any of this been studied on people with M.E/CFS anyway ? No. I suspect I would do better without the adrenalin shot. Which at 6% survival, the odds arent great anyway.

The data will be reviewed at set point intervals andcif it is clear there is a significant increase of death from the placebo, the trial will be halted immediately.

 

[golden]

There are serious ethical questions. Who can opt out if they never hear of the opt out? Who can opt out if unconscious? Sometimes an RCT is not necessary as proof if the effect size is unambiguous. Large effect sizes do not usually require a large RCT to test them.

Advertising in the local areas should not be the only avenue. I dont know if they are sending letters out too etc. But this is an important aspect, I agree.

Many people have so much faith in drugs that they feel more safe and secure with them, even if they are told they do not help, are causing harm etc.

I believe this has come from deliberate indoctrination of people, over many generations, from a young age, to obey and become subservient to the medical profession.

Therefore asking people to opt in to receiving a placebo shot instead of adrenaline wouldnt work easily i dont think.

 

[snowathlete]

There are serious ethical questions. Who can opt out if they never hear of the opt out? Who can opt out if unconscious? Sometimes an RCT is not necessary as proof if the effect size is unambiguous. Large effect sizes do not usually require a large RCT to test them.

UK mate, can't let a little word like ethics get in the way of, well, anything.

 

[Martial]

Ok that makes sense, did not know it was a blind study test. I thought the EMTs and medical staff would know that it was a placebo. It definitely helps to avoid backlash until more evidence is found to prove they are better off without it. If it is that ineffective and can cause neurological damage or other issues I don't know why anyone would want it though. My unconscious self certainty would not agree to that.

 

[golden]

The Rogue Medic has some good info on this subject, with relevant links etc.

This is Tim Noonan, an experienced paramedic.

There are more up-to-date links than this one.

http://roguemedic.com/2012/03/killing-patients-just-to-get-a-temporary-pulse-with-epinephrine/


http://roguemedic.com/

 

[barbc56]

Found this on another forum.

http://www.legislation.gov.uk/ukpga/2005/9/part/1/crossheading/research

I would think your heart stopping would qualify you for this.

How in the heck did this study get approved? .

Barb

 

[Esther12]

Found this on another forum.

http://www.legislation.gov.uk/ukpga/2005/9/part/1/crossheading/research

I would think your heart stopping would qualify you for this.

How in the heck did this study get approved? .

Barb

That legislation would seem to mean that it's impossible to run trials in this sort of situation, and that smells a bit odd to me. The law can be so full of sub-clauses and bits that over0ride one another that it's often hard to know exactly how it ends up being applied.

 

[heapsreal]

They tried to do a study in Queensland. Paramedics refused to be involved.
That being said the most important thing in cardiac arrest is immediate cpr with minimal time with hands off not doing compressions, previously compression interrupted doing other things such as pulse checks, artificial airways and ivs.

Next is electricity which is important to resync the rhythm if it's the appropriate rhythm.

Adrenaline can keep a patient in a shock able rhythm longer but it's not always a favorable outcome. It's said to possibly help improve cpr but that's debatable.

So good uninterrupted cpr and defibrillation is the stuff that saves lives in cardiac arrest. And has to probably be a witnessed cardiac arrest with cpr straight away. IVs and artificial airways as well as drugs like adrenaline aren't even started until a good 6 minutes into the cardiac arrest.