Health care practitioners are becoming increasingly aware of the ethical dimensions of their work. In response, moves are being made to gather empirical data that serves to inform the decision-making process. Through a brief examination of one piece of empirical work, the author suggests that although such data is undoubtedly of value as a body of evidence to be used within an ethical debate, it can never replace the debate itself. The value of evidence-based practice is well established. The persuasiveness of empirical evidence may be less welcome, however, when presented in isolation of the wider context. Conclusions drawn from such data must be scrutinized from a broad perspective in order to ensure that proposals drawn from them fit soundly with our moral reasoning.
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http://dx.doi.org/10.1054/aaen.1999.0090 | DOI Listing |
CJEM
November 2024
Department of Emergency Medicine, Dalhousie University, Halifax Infirmary, Halifax, NS, Canada.
Introduction: Patients requiring emergent endotracheal intubation are at higher risk of post-intubation hypotension due to altered physiology in critical illness. Post-intubation hypotension increases mortality and hospital length of stay, however, the impact of vasopressors on its incidence and outcomes is not known. This scoping review identified studies reporting hemodynamic data in patients undergoing emergent intubation to provide a literature overview on post-intubation hypotension in cohorts that did and did not receive vasopressors.
View Article and Find Full Text PDFCirculation
January 2024
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania (R.W.M., K.K.C., K.G., V.M.N., H.A.W., R.A.B., R.M.S.).
Background: Supported by laboratory and clinical investigations of adult cardiopulmonary arrest, resuscitation guidelines recommend monitoring end-tidal carbon dioxide (ETCO) as an indicator of cardiopulmonary resuscitation (CPR) quality, but they note that "specific values to guide therapy have not been established in children."
Methods: This prospective observational cohort study was a National Heart, Lung, and Blood Institute-funded ancillary study of children in the ICU-RESUS trial (Intensive Care Unit-Resuscitation Project; NCT02837497). Hospitalized children (≤18 years of age and ≥37 weeks postgestational age) who received chest compressions of any duration for cardiopulmonary arrest, had an endotracheal or tracheostomy tube at the start of CPR, and evaluable intra-arrest ETCO data were included.
Resuscitation
September 2023
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
Background: Previous studies have identified pulmonary hypertension (PH) as a relatively common diagnosis in children with in-hospital cardiac arrest (IHCA), and preclinical laboratory studies have found poor outcomes and low systemic blood pressures during CPR for PH-associated cardiac arrest. The objective of this study was to determine the prevalence of PH among children with IHCA and the association between PH diagnosis and intra-arrest physiology and survival outcomes.
Methods: This was a prospectively designed secondary analysis of patients enrolled in the ICU-RESUS clinical trial (NCT02837497).
Pediatr Crit Care Med
November 2022
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA.
Objectives: The COVID-19 pandemic resulted in adaptations to pediatric resuscitation systems of care. The objective of this study was to determine the temporal association between the pandemic and pediatric in-hospital cardiac arrest (IHCA) process of care metrics, cardiopulmonary resuscitation (cardiopulmonary resuscitation) quality, and patient outcomes.
Design: Multicenter retrospective analysis of a dataset comprising observations of IHCA outcomes pre pandemic (March 1, 2019 to February 29, 2020) versus pandemic (March 1, 2020 to February 28, 2021).
Acad Med
May 2022
T.M. Chan is associate dean, Continuing Professional Development, Faculty of Health Sciences, associate professor, Divisions of Education & Innovation and Emergency Medicine, Department of Medicine, and clinician-scientist, MERIT, McMaster University, Hamilton, Ontario, Canada. She is also program director, Clinician Educator Area of Focused Competency Diploma Program, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0001-6104-462X .
Problem: Physical distancing restrictions during the COVID-19 pandemic led to the transition from in-person to online teaching for many medical educators. This report describes the Virtual Resus Room (VRR)-a free, novel, open-access resource for running collaborative online simulations.
Approach: The lead author created the VRR in May 2020 to give learners the opportunity to rehearse their crisis resource management skills by working as a team to complete virtual tasks.
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