EMS World

DEC 2018

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EMSWORLD.com | DECEMBER 2018 61 a fea sible option for ground EMS. A 10% decrease in mortality would be a very good thing. Summary In order to summarize the findings of these important studies, the initial use of a supra- glottic airway in out-of-hospital cardiac arrest is a safe and reasonable approach. It is easier to maintain competence with SGAs than endotra- cheal intubation, and that's likely the approach most U.S.-based EMS agencies should adopt. We don't yet know the effect of competently performed intubation on cardiac arrest. Epinephrine in cardiac arrest, as we cur- rently us e it, do e s not benefit patient s . Epinephrine increa se s ROSC and shor t- term sur vival, but it comes with the cost of increased neurologic devastation. We have to stop this. Unfortunately, while we now know what doesn't work, we don't yet know what does. We'll likely see an ongoing role for epi in car- diac arrest, but only for a select group of patients and likely at lower doses spread further apart. The use of plasma products in severely injured, hypotensive trauma patients can decrea se mor talit y by up to 10% with a number needed to treat to save one life of 10. Logistical dif ficulties currently limit its adoption, but a freeze-dried plasma under regulator y rev iew could b e fea sible for ground-based EMS. REFERENCES 1. Wang HE, Schmicker RH, Daya MR, et al. Ef fect of a strategy of initial laryngeal tube insertion vs. endotracheal intubation on 72-hour survival in adults with out-of-hospital cardiac arrest: A randomized clinical trial. JAMA, 2018 Aug 28; 320(8): 769–78. 2. Benger JR, Kirby K, Black S, et al. Ef fect of a strategy of a supraglottic airway device vs. tracheal intubation during out-of- hospital cardiac arrest on functional outcome: The AIRWAYS-2 randomized clinical trial. JAMA, 2018 Aug 28; 320(8): 779–91. 3. Perkins GD, Ji C, Deakin CD, et al.; PARAMEDIC2 collaborators. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med, 2018 Aug 23; 379(8): 711–21. 4. Sperry JL, Guyette FX, Brown JB, et al.; PAMPer study group. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med, 2018 Jul 26; 379(4): 315–26. ABOUT THE AUTHOR Jeffrey L. Jarvis, MD, MS, EMT-P, FACEP, FAEMS, is EMS medical direc tor for the Williamson Count y EMS system and Marble Falls Area EMS and an emergenc y physician at Baylor Scott & White Hospital in Round Rock, Tex. He is board-cer tified in emergenc y medicine and EMS. Which would you choose? It's time to expect MORE. STANDARD BATTERY 36 C YCLES WITH 250 LB PATIENT PER CHARGE 69% MORE POWER 113 C YCLES * WITH 250 LB PATIENT PER CHARGE P O W E R S Y S T E M ™ FERNOEMS.COM/POWERX1 | 877.733.0911 FERNO ® * One cycle equals one full lift and one full lower All data gathered through industry standard testing in a simulated environment. Power-PRO XT is a trademark and product of Stryker Corporation. FERNO is not associated with Stryker Corporation. Elevate your expectations. Landmark studies published in 2018 are helping to inform evidence-based decisions in EMS.

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