Handling apparent asystole and the AHA's approach to the exchange of ideas--Part II

My later involvement in this issue and the AHA's response (or non-response) is briefly summarized in a 2008 article:

Stewart JA. The prohibition on shocking apparent asystole: a history and critique of the argument. Am J Emerg Med. 2008 ;26(5):618-22.

However, the main purpose of that article was to critique the AHA's shifting rationales for prohibiting shocks for apparent asystole and to suggest an unstated reason for the prohibition. I'll go more deeply here into my views about the personal/political aspects of the AHA's position.

In 1999, the AHA issued an invitation to the general healthcare community to submit "evidence-based worksheets" for consideration at the conferences that were to determine the 2000 AHA Guidelines for Emergency Cardiac Care. The invitation was long and detailed, saying in part:

A major reason the we are seeking contributions and proposals is to allow everyone interested in CPR and ECC to "have their say" on a guideline proposal. We know that you have good ideas and thoughtful proposals. This worksheet allows you to make your voice heard.

I wrote about the invitation on a listserve I subscribed to at the time that was run by Merginet and dealt with ECC topics. I knew that the AHA physician I had so angered (albeit unintentionally) several years earlier also subscribed (In 1996 I had received a letter from him saying that he had spread the word about me among his colleagues and that consequently my ideas would be given no credence), which I think was the reason that a couple of days later the invitation disappeared from the AHA ECC web site.

A few weeks later, essentially the same invitation appeared in Currents in Emergency Cardiac Care. I had already been working on my two worksheets, a very time-consuming process, and I thought the deadline in this latest invitation was unrealistic (about a month as I remember) if they really wanted to encourage submissions. I said so on the Merginet listserve, and shortly thereafter the deadline was extended by two weeks.

I submitted two worksheets (with co-authors) by the deadline, one on the topic of shocking apparent asystole and another on the AHA's promotion of AEDs for trained caregivers. I did not receive even an automated e-mail acknowledgment of receipt (I had to call), which I thought peculiar given the elaborate and lengthy invitation:

The worksheet is not simply a medium for suggestions--we have other methods for receiving suggestions. You proposal or "great idea" can only be considered if accompanied by a reasonable attempt to complete the Evidence Worksheet. Preparing the worksheet requires an investment of time.

A bit later an invitation appeared for a few members of the general public to apply to attend the first Guidelines 2000 Conference where changes to the Guidelines would be discussed. Applicants were required to submit a form describing their accomplishments in the field of cardiac resuscitation and reasons for wanting to attend. I thought I had a good shot, having been the principal author of two worksheets, and I applied. I was turned down. When I inquired about the reasoning, I was told that all the applicants were deemed equally worthy, so they had simply selected those who had sent in the applications first. A second invitation was issued for the second conference and I applied again, sending my application on the same day the invitation appeared. Again, I was turned down.

I made several subsequent inquiries about the worksheets: How many were submitted, on what topics, and most importantly, why was public acknowledgment of the submissions never given, even though it had been clearly promised in the original invitation? (To quote again from the invitation: "The names of all persons who submit a worksheet will be acknowledged in a credits section of the journal in which the Guidelines 2000 are published.") The replies I received were obfuscations and evasions: a "handful" of worksheets had been received, and apparently no one had kept copies. I suspect that my two worksheets were the only ones submitted, and since I was out of favor with the ECC experts, they had been buried.

Beyond my personal sense of outrage about these events, I think this history shows that for the AHA ECC Committee, personalities and politics can trump ideas, even when many lives may be at stake. More about these matters later.

Copies of the worksheets I and my co-authors submitted are available on request.