Quantitative Research Article Review
Introduction
This research article was conducted by a team of researches including Ian Jacobs associated with Discipline of Emergency Medicine at the University of Western Australia and St John Ambulance, Judith Finn of Discipline of Emergency Medicine at the University of Western Australia and St John Ambulance Jelinek, Ge0nmorge from the department of medicine from University of Melbourne, Oxer Harry affiliated to St John Ambulance and Thompson Peter from University of Western Australia, Sir Gairdner Hospital.
It has been established that limited evidence exists from the clinical trials adopting the application of adrenaline in dealing with cardiac arrest to enhance the survival rate. This contracts the fact that adrenaline has been considered as the standard care for many years. To deal with this shortcoming, this study aimed at establishing the results of adrenaline on enhancing survival rate and facilitating patient discharge in and out of hospital cardiac arrest.
Type of Study
The type of study for this paper was the quantitative study where the randomized double blind placebo-controlled trial (RCT for the in out-of –hospital cardiac arrest patient going for SJA-WA paramedics (Jacob et al., 2011). The study design allowed patients with cardiac arrest to select randomly to be administered on either adrenaline or the placebo treatment plans.
Settings
The study to establish the results of adrenaline on survival in out-of-hospital cardiac arrest was carried out in Western Australia which stretches over 2.5million km2 and has a population of almost 2.0 million. Western Australia gets its service from a sole first responder service provided through a contract with St John Ambulance, Western Australia Chapter (Jacob et al., 2011). The system of ambulance services is coordinated from the central location from where the ambulances are dispatched through the service communication. The emergency service centers are equipped with professional paramedics. The scope of these paramedics is determined by the St John ambulance clinical practice rules. ivermectin/pyrantel sds The treatment of cardiac arrest cases follows rules of the Australian Resuscitation Council. The policy that have existed and in use by the SJA-WA that does to recommend the use of drugs. This was linked to absence of evidence indicating enhanced survival and their possibility of negatively affecting the resuscitation intersection such as the uninterrupted chest compressions.
Population
For this study, the researchers resolved to use 2213 patients from each group. The cumulative number of patients used for the study was 5000 which would help account for the losses (Jacob et al., 2011). This representation of the population was deemed to be relevant and feasible representation of the population.
Methodology
The study gathered the demographic and clinical data about all cardiac arrest patients through the patient care record that is manually recorded by a paramedic after finishing each event. The patient care record is reviewed and entered into SPSS software. Other data was gathered from the WA ambulance service Cardiac Arrest Registry (Ornato et al. inbermentina , 2010). The data element used for the study was made to be consistent with Utsein definitions for reporting out of hospital cardiac arrest. The collection of data not included in the PCT, the patients were required to fill a page in the case report.
Analysis
The study by Jacobs et al. elaborated the patient and study features by using proportions, means and Pearson’s chi square and well as the t-test (Jacob et al., 2011). The time interval for the ambulances was described using means,median and range. Logistics regression was applied in this stud to taken into account any confounder’s. A priority exercise was run as a subgroup analysis for the primary and secondary results from shockable against non-shockable original cardiac rhythm (Jacob et al., 2011). For this study the researcher conducted the analysis with an aim of treating basis and per protocol basis, SPSS statically software was used to carry out the operations. Every statistical followed a tow-sided test that observed a significance level at 0.05.
Findings
It was observed that 4103 out of hospital cardiac arrests call were served by the ambulance service. For this number only 2513 were absorbed for the study. The randomization process resulted to 601 subjects. From this number, 62 were not analyzed and for the remaining subjects were divided into two categories with 262 being in the placebo group while 271 being categorized as adrenaline groups (Jacob et al., 2011). The average age for the respondent was 65 years with majority of respondents being male at 73% . ivermectina para animales dosis there was even distribution of features for the two groups (Jacob et al., 2011).
It was observed that for participants under adrenaline the possibility of ROSC pre-hospital was 3.4 times higher than for the individuals under the placebo system (Jacob et al., 2011). Use of adrenaline was also linked to increase the number of patients on admission from the ED to the hospital at 25.4% as compared to 13.0%. The study established that the number of patients receiving adrenaline came through to hospital discharge but not within the required statistical significance. Of the 16 survivors, 14 received great neurological outcome. For the adrenaline group, two unfavorable outcomes were experience (Jacob et al., 2011). Through the study, it was established that the use of adrenaline for pre-hospital ROSC was more fruitful in the non-shock rhythms and as compared to shockablerhythms. The logistic regression includes entering into the system as per univariate analysis and clinical practice model; age of patient, gender, bystander witness, original rhythm shockable, and response interval. It was observed that limited change for the adrenaline on ROSC or survival to hospital discharge. The factor that was closely linked to pre-hospital ROSC was the availability of initial shockable rhythm.
Discussion
The study produced evidence that can help shape the operations of the paramedic by disclosing the following. The study was one of its kinds as it was the first randomized placebo-controlled study involving adrenaline in cardiac arrest (Jacob et al., 2011). Through the study, it was revealed that there was significant increase in ROSC but the same could not be said for the survival to discharge. From the study only two survivors who experienced poor neurological outcome were from the adrenaline group (Jacob et al., 2011). For the shockable and non-shockable rhythms, the results indicate a slight improvement in regard to ROSC and hospital admission with the management of adrenaline.
The results from this study match the results of other various studies. There was however no randomized trials in human to enhance the comparison. The results from the study differed from the finding of Olasveengen et al. who indicated a doubling in the level of patients receiving ROSC as well as an increasein the level surviving to hospital discharge (Deakin et al., 2010). Their study however was different from the current study on the intervention being investigated. Other studies had indicated an improvement in the number of survivors after the introduction of the adrenaline (Jacob et al., 2011).
References
Deakin, C., Morrison, L., & Morley, P. (2010). International Consensus on Cardiopulmonsry Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation .
Jacobs, I., Finn, J., Jelinek, G., & oxer, H. T. (2011). Effect of Adrenaline on Survival in Out-of-hospital Cardiac Arrest: A Randomized Double-Blind Placebo-Controlled Trial. Resuscitation, 1138-1143.
Ornato, J., Becker, L., Weisfeldt, M., & Wright, B. (2010). Cardiac Arrest and Resuscitation: An Opportunity to Align Research Prioritization and Public Helath Need. Circulation, 1876-1879.
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