Giving epinephrine to out-of-hospital cardiac arrest victims appears to help jumpstart hearts in the short-term but may leave them worse off later on. According to a large observational study that drew from a Japanese cardiac arrest registry, patients who received epinephrine were less likely to be alive and to have good functional outcomes one month later.
Researchers from Kyushu University in Japan looked at outcomes for 417,000 people who suffered out-of-hospital cardiac arrest. They found that about 18.5 percent of those who were given IV epinephrine returned to spontaneous circulation before arrival at the hospital, compared with 5.7 percent who didn’t receive it. However, looking at the total sample, only about 5.1 percent of patients who received epinephrine survived to one month, compared with 7 percent for those not given the drug—a 54 percent difference. Patients given epinephrine were also significantly more likely to suffer severe neurological disability, according to the study, which is in the March 21 issue of the Journal of the American Medical Association.
In an accompanying editorial, Clifton Callaway, M.D., Ph.D., of the University of Pittsburgh, writes that epinephrine has been a “cornerstone” of resuscitation since the 1960s, yet the new study “suggests epinephrine use may be associated with lower survival and worse neurological outcomes.” Callaway calls for large, placebo-controlled trials to get a more definitive answer on whether epinephrine helps or harms. “Physicians and other practitioners involved in cardiac resuscitation must consider carefully whether continued use of epinephrine is justified,” he writes.
While epinephrine boosts coronary perfusion pressure to help the heart get going again, it decreases blood flow to all other organs, possibly leading to brain and heart problems shortly thereafter, Callaway says.
Prehospital Steroids Don’t Decrease Risk of Lung Injury
Prehospital administration of corticosteroids doesn’t reduce lung injury in critically ill patients, recent research finds. Researchers from the Mayo Clinic in Jacksonville, Fla., analyzed data on nearly 5,600 hospitalized patients with at least one risk factor for acute lung injury, such as a history of lung disease. A total of 460 were given steroids before arriving at the hospital; 7 percent developed an acute lung injury regardless of whether they received prehospital steroids.
Researchers also found that patients who received prehospital steroids were less likely to receive mechanical ventilation. But that seemingly positive finding was negated by another: Patients who received prehospital steroids also had a higher chance of dying in the hospital.
Studies dating back to the 1980s have yielded mixed results regarding the use of steroids and acute lung injury and the issue remains controversial, according to the authors, who presented the study at a Society for Critical Care Medicine meeting in February. In this study, for example, patients who were given steroids tended to be older, sicker and taking more medications; they also were more likely to have a history of cancer and chest irradiation, which could influence outcomes.
ED Visits Related to Illegal Drugs Vary by City
At 571 per 100,000 population, Boston has the highest rate of emergency department visits involving illegal drugs among 11 major U.S. metropolitan areas, according to a report from the U.S. Substance Abuse and Mental Health Services Administration. Boston was followed by New York City (555 per 100,000), Chicago (507 per 100,000) and Detroit (462 per 100,000). The national average was 317 per 100,000.
Among illicit drugs, heroin led to the most ED visits. Boston was the highest, with 251 per 100,000 population; the national average was 67 per 100,000. Other metropolitan areas studied include Denver; Miami-Dade County, Fla.; Fort Lauderdale, Fla.; Minneapolis-St. Paul; Phoenix-Scottsdale; San Francisco; and Seattle-Tacoma.
Gun Injuries Among Children Higher Than Thought
Nearly 186,000 U.S. children under age 19 were seen in emergency departments for gun injuries from 1999 to 2007, about 30 percent higher than prior research has documented, according to a study presented at a recent American Academy of Pediatrics meeting.
Researchers analyzed data from the National Hospital Ambulatory Medical Care Survey and found that approximately 20,600 firearm injuries occurred in children each year during the study period. Of those, 4.5 percent, or 8,368, were fatal. About 63 percent of the injuries were intentional; 37 percent were unintentional. Boys, African-Americans and kids aged 11 and older were at higher risk.
Autonomy, Support Key to Workers’ Happiness
Feelings of autonomy and organizational support are among the keys to workers’ happiness and productivity, research shows.
Researchers in France had more than 1,110 workers from small, medium and large companies fill out questionnaires asking them about their perceptions of their supervisors’ management style and support from their organization. Workers who felt their supervisors were coercive and overly controlling, as well as those who saw their organizations as unsupportive of their needs, reported lower levels of well-being, while those who felt autonomous and supported were happier.
“To satisfy employees’ needs, supervisors should provide subordinates with options rather than use threats and deadlines, a strategy which could improve their workforce’s well-being,” wrote the researchers, whose study was published online Dec. 22, 2011, in the Journal of Business and Psychology. According to background information in the article, workplace well-being can account for more than 25 percent of variations in individual performance.
