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Emergency Treatment Cuts Cardiac Arrest and Death Rates in Half

Discussion in 'The Okie Corral' started by lethal tupperwa, Apr 3, 2012.

  1. lethal tupperwa

    lethal tupperwa

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    Health Research
    Emergency Treatment Cuts Cardiac Arrest and Death Rates in Half




    Paramedics can reduce someone’s chances of having a cardiac arrest or dying by 50 percent by immediately administering a mixture of glucose, insulin and potassium (referred to as ”GIK”) to people having a heart attack, according to research presented March 27 at the American College of Cardiology’s 61st Annual Scientific Session.

    The study showed that patients who received GIK immediately after being diagnosed with acute coronary syndrome — which indicates a heart attack is either in progress or on the way — were 50 percent less likely to have cardiac arrest (a condition in which the heart suddenly stops beating) or die than those who received a placebo, although the treatment did not prevent the heart attack from occurring. Over the first month following the event, patients who receivedGIK were 40 percent less likely to have cardiac arrest, die or be hospitalized for heart failure.

    The effect was even more striking for patients with ST-elevation heart attacks, which require immediate treatment. For those patients, immediate GIK was associated with a 60 percent reduction in cardiac arrest or death.




    "The effect was even more striking for patients with ST-elevation heart attacks, which require immediate treatment. For those patients, immediate GIK was associated with a 60 percent reduction in cardiac arrest or death."


    “When started immediately in the home or on the way to the hospital — even before the diagnosis is completely established — GIK appears to reduce the size of heart attacks and to reduce by half the risk of having a cardiac arrest or dying,” said Harry P. Selker, MD, MSPH, executive director of the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, who led the study with Joni Beshansky, RN, MPH, co-principal investigatorand project director. “Acute coronary syndromes represent the largest cause of death in this country. GIK is a very inexpensive treatment that appears to have promise in reducing those deaths and morbidity.”

    The cost of the treatment is about $50.

    “Because the trial is the first to show GIK is effective when used by paramedics in real-world community settings, it could have important implications for the treatment of heart attacks,” Dr. Selker said. Previous clinical trials have shown no consistent effect, likely because the GIK was given too late to help. This study, the “IMMEDIATE Trial,” was the first to test the effectiveness of administering GIK at the very first signs of a threatening heartattack, in the community, rather than waiting hours until the diagnosis was well-established at a hospital, as done in previous clinical trials.

    “We wanted to do something that is effective and can be used anywhere,” said Dr. Selker. “We’ve done a lot of studies of acute cardiac care in emergency departments and hospitals, but more people die of heart attacks outside the hospital than inside the hospital. Hundreds of thousands of people per year are dying out in the community; we wanted to direct our attention to those patients.”







    The researchers trained paramedics in 36 Emergency Medical Services systems in 13 cities across the country to administer GIK after determining that a patient was likely having a threatened or already established heart attack using electrocardiograph-based ACI-TIPI (acute cardiac ischemia time-insensitive predictive instrument) and thrombolytic predictive instrument decision support that prints patient-specific predictions on the top of an electrocardiogram. The paramedicsused these predictions to decide if a patient would likely benefit from treatment. There were 911 patients randomized to receive either the GIK treatment or a placebo.

    Administering GIK immediately also reduced the severity of the damage to the heart tissue from the heart attack. On average, 2 percent of the heart tissue was destroyed by the heart attack in people receiving GIK, compared with 10 percent in those who received the placebo. Although a significant proportion of suspected heart attacks are later determined to be false alarms (23 percent in this study), administering GIK does not appear to cause any harmful effects in suchpatients.

    The research team will follow up with study participants at six and 12 months to evaluate the longer-term benefit of the GIK treatment. This study was funded
     
  2. certifiedfunds

    certifiedfunds Cosmopolitan Bias

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    In before the usual suspects whine about the cost of GIK and how this study was funded by Big Glucose or how this is just another thing for doctors to bill for.
     

  3. Bren

    Bren NRA Life Member

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    Then the rest will whine about how they gave half the people placebos and let them die and somebody should go to prison...overlooking that we wouldn't have the treatment at all, without that.
     
  4. P99er

    P99er AKA PPQ'er

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    Not necessarily. If not for the overbearing federal bureaucracy known as the FDA, it might be a matter of using the procedure without FDA approval, then asking the patient if they want the treatment in the field. As the treatment shows more and more success in the field, it could become a standard treatment.

    Too many people are addicted to big government and don't realize or care that there are always alternatives.

    Just because big government likes their processes, doesn't mean the processes are always necessary.
     
  5. NeverMore1701

    NeverMore1701 Fear no Evil Platinum Member

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    Will be interesting to see how it turns out. Field trials can be pretty rough on the personnel involved.
     
  6. tadbart

    tadbart duuuuude.

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    interesting.

    better electical impulse (K+) = better squeeze = better perfusion = less ischemia?
     
  7. schild

    schild

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    Big pharma will have to find a way to increase the price from from $50 to $500.
     
  8. NeverMore1701

    NeverMore1701 Fear no Evil Platinum Member

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    Would that make it not worth it (assuming research bears out it's effectiveness)?
     
  9. Brucev

    Brucev

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    Re: OP. Good. Implement it. If someone objects, send them to time out and let them scream to their hearts content.
     
  10. NeverMore1701

    NeverMore1701 Fear no Evil Platinum Member

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    Sounds plausible, plus a bit of extra glucose to provide immediate short-term energy supply?
     
  11. NeverMore1701

    NeverMore1701 Fear no Evil Platinum Member

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    :whistling:
     
  12. DScottHewitt

    DScottHewitt EMT-B

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    And insulin to make sure the glucose gets used.
     
  13. schild

    schild

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    It's worth it and I wish it was available eight years ago when I was in an ambulance after having an M.I. and all I got was nitro and a shot for the pain.
     
  14. dotsun

    dotsun Shark Stomper

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    I just want to go ahead and let it be known of my wishes to not receive the placebo. :rofl:
     
  15. nursetim

    nursetim

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    When someone has high potassium blood levels you can give insulin and glucose IV, regardless of diabetic or not. It forces potassium back into cells temporarily. Maybe by adding extra potassium to the mix it put extra potassium in the bank for latter use. Problem with that idea is that we fight potassium build up in cardiac arrest. With cell death you get a bunch of potassium dumped in the system which causes electrical disruption.
     
  16. Paul53

    Paul53 All in all I'm just another brick in the wall.

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    Great post but wish they'd explain the mechanism or theory behind the combination. Maybe just a roundabout way for Calcium channel blocker? Mimic the well established benefit of beta blockers?

    Found a study theorizing that cardiac ischemia (muscle not getting adequate blood supply) changes from Aerobic to anaerobic metabolism. Byproducts of anaerobic metabolism are consider toxic and harmful during an MI, so the GIK treatment protects cardiac tissue by increasing the availability of carbohydrate (glucose) for metabolism and supports aerobic metabolism.

    Another study hypothesized that hyperglycemia (high glucose) was the culprit. Geesh, make up your mind guys!
     
    Last edited: Apr 4, 2012
  17. mixflip

    mixflip

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    I was an EMT and a firefighter back in the day and in my experience getting people to an ER/hospital inside of 1 hour regardless of the injury or illness seemed to be a huge determining factor in increasing survivability.

    The so called "golden hour"

    If you can get them to the ER still breathing within an hour the ER can do wonders today.
     
  18. Fiery Red XIII

    Fiery Red XIII Adorkable CLM

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    You should see the different devices we use for CPR and intubations, 1 week we use em, the next week no, then for 2 weeks, only certain rigs have em, then back to week 1.


    Red
     
  19. HarleyGuy

    HarleyGuy

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    I was watching TV one night and this doctor was on there and the subject turned to heart attacks.

    His first recommendation of course was to immediately call 911, then take an aspirin and squeez the tip of your left pinky?

    Sounded a little silly to me but at that point, what do you have to lose.

    Any thoughts about buying a defibillator (sp?)for the home?...
    Seems I heard you can buy one reasonably these days.
     
  20. RCP

    RCP

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    I haven't seen the geezer squeezer used in quite awhile:supergrin: