Does ACLS work?

I'll have a fair amount to say about my experience of the Guidelines 2005 process later., but for now I'll just note that the only reference I saw to the Stiell et al. study (mentioned below) in the evidence-evaluation worksheets posted on the web was in the worksheet on BVM ventilation. My comment on the validity of this reference can be seen here (comment number 3). As far as I know, the Stiell study received no further attention in the Guidelines 2005 evidence evaluation process. This may be a prime example of not being able to see the forest for the trees. Many very specific worksheet topics were addressed, with the frequent conclusion that insufficient evidence exists to change the existing recommendations. This begs the question of the value of the existing recommendations, which by and large are based on extremely flimsy evidence--or none at all. The Stiell study raises the very real possibility that none of this ACLS stuff makes any difference whatsoever in improving survival.

First post

After neglecting my informational web site (In-Hospital Defibrillation) for way too long, I hope to make it a useful resource again--with my daughter's help. Norah has agreed to give her technical assistance, at least sporadically, to keep the site functioning. Thanks, Norah.

I have decided for the near future to channel my interest in resuscitation issues into writing this blog. I've had a couple of manuscripts turned down by journals recently, and of course with publishing on the web rejection is not a problem--what is a problem is the possibility that nobody much will ever read what you write. But then, I have never received much direct feedback on my journal writings (most of them available at In-Hospital Defibrillation), so for all I know from direct experience, nobody much has read them either. I can at least use the hit counter to see how many people glance at this. Other attributes of the web log medium are of course that it provides the potential for more back-and-forth discussion (though not quite as much as the discussion list format-and I hope to get the discussion list on defib.net working again soon), and it allows far greater latitude for opinions, digressions, rants, etc. [Please note--defib.net and In-Hospital Defibrillation are now defunct (2011)]

At least for now, I'm calling this blog “No Heroics. ” I've liked the irony of the medical slang term “heroics” ever since I first heard it; it seems to get at a lot of what is wrong with resuscitation efforts. So often they seem to be choreographed responses to reassure caregivers that they are bringing a great armentarium of treatment modalities to bear in a valiant effort to defeat sudden death--more to sustain caregivers' morale and image of themselves as capable and effective in a crisis (not to mention the “legal exposure”--aka “CYA”--aspect) than to provide effective treatment.

That's a pretty harsh view I suppose, and I'm not sure I know anyone in health care that would not try their damnedest to provide effective lifesaving treatment-but the reality I see is that most experienced healthcare providers think that there is a huge element of “just going through the motions” in the whole BLS/ACLS package. And if you take the trouble to look at the literature, this is certainly borne out. One of the most important articles of the past decade in this area, in my opinion, is: Stiell IG, Wells GA, et al., Advanced cardiac life support in out-of-hospital cardiac arrest, N Engl J Med 2004; 351:647-656 Abstract. That study showed pretty convincingly that ACLS interventions as a whole have no beneficial effect on survival.