Journal Jam 7 - Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial. In our most popular EM Cases episode to date - ACLS Guidelines Cardiac Arrest Controversies, we boldly stated, that there has never been an antiarrhythmic medication that has shown any long term survival benefit in cardiac arrest. The use of medications in cardiac arrest has been one of those things that we all do, but that we know the evidence isn’t great for. Yet Amiodarone is still in the newest AHA adult cardiac arrest algorithm for ventricular fibrillation or pulseless ventricular tachycarida – 300mg IV after the 3rd shock with the option to give it again at 150mg after that. Anti-arrhythmics have been shown in previous RCTs to increase the rate of return of spontaneous circulation and even increased survival to hospital admission, however none of them have been able to show a decrease in mortality or a favourable neurological outcome at hospital discharge. In other words, there has never been shown a long term survival or functional benefit - which is a bit disconcerting. But now, we have a recent large randomized, controlled trial that shines some new light on the role of anti-arrythmics in cardiac arrest - The ALPS trial: Amiodarone vs Lidocaine vs placebo in out of hospital cardiac arrest. In this Journal Jam podcast, Justin Morgenstern and Anton Helman interview two authors of the ALPS trial, Dr. Laurie Morrison a world-renowned researcher in cardiac arrest and Dr. Paul Dorian, a cardiac electrophysiologist and one of Canada's leading authorities on arrhythmias about what we should take away from the ALPS trial. It turns out, it's not so simple. We also discuss the value of dual shock therapy for shock resistant ventricular fibrillation and the future of cardiac arrest care.
Dr. Andrew Worster and the BEEM (Best Evidence in Emergency Medicine) group from McMaster University has teamed up with EM Cases, Justin Morgenstern (@First10EM) and Rory Spiegel (@EMNerd_) to bring you a blog that blends the BEEM critical appraisals in a case-based, interactive, practice-changing format. In each post we choose the most important literature on a given topic and run through a case, learning how to apply evidence based medicine to our practice. Welcome to BEEM Cases! And here's BEEM Cases 1 - Pediatric Minor Head Injury... Written by Justin Morgenstern (@First10EM), edited by Anton Helman (@EMCases), adapted from the BEEM Course, Jan 2016 Pediatric Minor Head Injury - Decision Rules, Isolated LOC & Strict Rest The Case... With seconds left in the game, Melissa, an 11 year old girl, drives hard to the basket for a layup. She gets knocked to the ground, and doesn’t see the winning shot pass through the net, because it appeared as though she briefly lost consciousness. She quickly gets back up and celebrates with her friends, but after the celebrations, her parents bring her to your community emergency department to get checked. You confirm that she [...]