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R O Cummins

Publications and source records attributed to R O Cummins.

At least 19 recordsLinked to original sources
PubMed2001

Heart-to-heart talk. Roundtable discussion.

This past August the American Heart Association (AHA) released a major revision of its recommendations for emergency cardiovascular care (ECC). The 2000 guidelines simplify CPR techniques for the layperson and strongly promote the use of community early defibrillation. What repercussions can we expect from these changes? We asked five experts to join a roundtable discussion of the BLS aspects of these new guidelines. Their conversation follows.

Cardiopulmonary Resuscitation↗
PubMed2000

The most important changes in the international ECC and CPR guidelines 2000.

Many people involved with resuscitation have specific interests and enthusiasm. They will review the new guidelines to see how their favorite interventions fared. This essay lists a number of the new guidelines that merit special attention: support for family presence at resuscitations, pronouncing death at the scene rather than after futile transport efforts, honoring advance directives, comparable effectiveness of bag-mask ventilation versus tracheal intubation, revision of compression rates and compression-ventilation ratios, and devices to confirm tracheal intubation and prevent tube dislodgment. Even more important are the new principles and concepts that the International Guidelines 2000 endorse: international guideline science, international guideline development, evidence-based guidelines, training by objectives, expanded scope of ECC to first aid and periarrest conditions, avoidance of false-negative (type II) errors, video-mediated instruction, and a philosophy to 'do no harm.' The number and magnitude of these new guidelines reflect the dynamic nature of resuscitation at the start of the 21st century. There is great optimism that these new and revised guidelines will help achieve our ultimate objective. This objective is to be ready when fate brings some lives to a premature end. If we are, we can restore more of these people to a high-quality life, ready for many more years of living.

Humans↗
PubMed2000

Guidelines based on the principle 'First, do no harm'. New guidelines on tracheal tube confirmation and prevention of dislodgment.

In summary, this editorial and the one on pulse check point out another area in which a total reliance on evidence-based guidelines amy do our patients a disservice. The debate over dropping the pulse check hinged less on the strength of the evidence and more on the widespread clinical principle of fear of false-negative errors. The discussion of secondary confirmation of tracheal tube placement also lacks a strong base of evidence that identifies the one best technique of tube confirmation for patients with a pulse versus those without a pulse. The principles of the zero-risk intervention and first, do no harm come into play in this situation. We must deal with the growing awareness of the fact that tracheal intubation is not only a potentially lethal intervention but now is also a confirmed lethal intervention, and at a much higher death rate than has ever been suspected. Factors that contribute to the transformation of the tracheal tube from a life-saving to a death-causing intervention are being identified by honest and open researchers. National societies in emergency medicine are responding appropriately. We strongly recommend shifting from making an evidence-based recommendation to instead making a principle-based recommendation--killing our patients is unacceptable; we must act on the widespread concept regarding errors in medicine. We must adopt zero-risk interventions in all possible situations.

Humans↗
PubMed1999

Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation.

BACKGROUND: Whether antiarrhythmic drugs improve the rate of successful resuscitation after out-of-hospital cardiac arrest has not been determined in randomized clinical trials. METHODS: We conducted a randomized, double-blind, placebo-controlled study of intravenous amiodarone in patients with out-of-hospital cardiac arrest. Patients who had cardiac arrest with ventricular fibrillation (or pulseless ventricular tachycardia) and who had not been resuscitated after receiving three or more precordial shocks were randomly assigned to receive 300 mg of intravenous amiodarone (246 patients) or placebo (258 patients). RESULTS: The treatment groups had similar clinical profiles. There was no significant difference between the amiodarone and placebo groups in the duration of the resuscitation attempt (42+/-16.4 and 43+/-16.3 minutes, respectively), the number of shocks delivered (4+/-3 and 6+/-5), or the proportion of patients who required additional antiarrhythmic drugs after the administration of the study drug (66 percent and 73 percent). More patients in the amiodarone group than in the placebo group had hypotension (59 percent vs. 48 percent, P=0.04) or bradycardia (41 percent vs. 25 percent, P=0.004) after receiving the study drug. Recipients of amiodarone were more likely to survive to be admitted to the hospital (44 percent, vs. 34 percent of the placebo group; P=0.03). The benefit of amiodarone was consistent among all subgroups and at all times of drug administration. The adjusted odds ratio for survival to admission to the hospital in the amiodarone group as compared with the placebo group was 1.6 (95 percent confidence interval, 1.1 to 2.4; P=0.02). The trial did not have sufficient statistical power to detect differences in survival to hospital discharge, which differed only slightly between the two groups. CONCLUSIONS: In patients with out-of-hospital cardiac arrest due to refractory ventricular arrhythmias, treatment with amiodarone resulted in a higher rate of survival to hospital admission. Whether this benefit extends to survival to discharge from the hospital merits further investigation.

Aged↗
PubMed1998

Automated external defibrillators: skill maintenance using computer-assisted learning.

OBJECTIVE: To determine whether computer-assisted learning (CAL) can maintain the automated external defibrillation (AED) skills of emergency medical technicians (EMTs). METHODS: The authors conducted a 1-year prospective comparison of an AED-skill training software program, running on desktop computers, with traditional instructor-led training. The subjects were experienced EMT-Ds (EMT-defibrillation), already trained in automated defibrillation (n = 105) employed as full-time professional EMT-D/firefighters. Two of the 3 groups (groups A and C) in the study were assigned to use the CAL program for 6 months. The third group (group B) remained on the normal, instructor-led training regimen. Pre- and poststudy skill levels were measured using a skills performance test. RESULTS: A secular trend of improved mean treatment scores was observed across all 3 groups [mean rise of 0.49 point (p = 0.01), repeated-measures analysis of variance]. There were no differences between training groups in the increase in performance scores (p = 0.3). The 1-time cost of supplying the CAL program to the 105 EMT-Ds was $1,575, significantly less than the $3,240-per-year cost associated with instructor-led training. CONCLUSIONS: The authors observed satisfactory AED skill maintenance for experienced EMT-Ds using CAL to replace 2 of 4 quarterly instructor-led skills reviews. CAL has cost and convenience advantages over instructor-based skill maintenance and is an acceptable alternative.

Clinical Competence↗