Paramedics must avoid too much injury care

NEW YORK (Reuters Health) - Intensive life support efforts outside the hospital are helpful when someone's heart has stopped beating, but they offer no benefit, and may even be harmful, for injured patients.

Greek researchers who studied the issue say their findings suggest that when paramedics "stay and play" with trauma patients at the scene of the incident instead of "scooping and running," they may be delaying necessary surgery or other treatment that should take place at a hospital.

"The longer patients have stayed in the field, the worse their chances for survival," said John W. Blenko, associate professor of anesthesiology at the University of Maryland School of Medicine and head of the Resuscitation Committee at the R. Adams Cowley Shock Trauma Center, in an interview with Reuters Health. "What these patients really need is surgical intervention."

Basic life support consists mainly of cardiopulmonary resuscitation, or CPR -- the practice of compressing a patient's chest to drive blood through the body when the heart has stopped beating -- and the use of a defibrillator to shock the organ back to life.

The researchers reported in the journal Resuscitation that basic life support helped both groups of patients -- those whose heart had stopped beating, and those who'd been injured, for example, in a car accident.

Advanced life support adds layers of more sophisticated treatment. These include the use of breathing devices that can better supply a patient's lungs with oxygen, medicines to constrict blood vessels and stabilize the rhythm of the heart, electronic monitoring and possibly a pacemaker, said Blenko, who was not involved in the new research.

In the latest study, researchers from the University of Athens found that the evidence strongly supports the use of advanced life support when someone's heart has stopped beating outside the hospital - at a shopping mall or swimming pool, for example. Compared to basic life support, the use of the advanced technique increased the odds of being discharged alive from the hospital by 50%, the researchers said.

And when physicians are in the ambulance to help provide advanced life support - as often is the case in Europe - a heart patient's chances of being discharged alive are doubled compared to more rudimentary resuscitation efforts.

But advanced resuscitation didn't seem to boost the chances of survival for injured patients and may even reduce it a bit, according to the Greek group.

George Bakalos, a physician and epidemiologist at the University of Athens School of Medicine, who helped conduct the study, said prolonged times spent at the scene of the injury likely explains the lack of benefit from advanced life support.

"The presence of a physician in the rescue team may reduce further the probability of survival," he told Reuters Health, as doctors are prone to spend even more time than paramedics tending to the patient. However, he noted, "there were certain limitations in this group - such as the type of trauma and its severity - that should be taken into consideration before any conclusions are extrapolated."

Bakalos and his colleagues called for more research into which form of life support is most useful for patients with different kinds of injuries, and of whether advanced or basic resuscitation efforts outside the hospital work better depending on the location of the incident.

SOURCE: http://bit.ly/j0cJtg Resuscitation, online April 17, 2011.