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• W2045803759 abstract "In medicine, we learn from our own and from other colleagues clinical experience. We try to not repeat mistakes, and most of all, try to make our efforts more efficient and successful by researching whether new options make sense, or not. Throughout history, appreciation of research efforts has been very varied. For example, due to official bans, physicians performing autopsies at stages in the past were risking their own lives. To day, there is a general consensus that the absence of autopsies precludes effective quality control in medicine. The physician who passed a right atrial catheter on himself was not praised for a new invention that is invaluable for critical care medicine today, but was removed from his post the next day. While the self-constructed roadblocks are relatively obvious in the two previous examples, the issue is more obscure today. The efforts of the European Community government may simply put a block on any research involving patients who are unable to give informed consent [1] This is a similar development to the unfortunate situation in the United States, where clinical research into resuscitation has been drasically reduced in recent years, or is subject to efforts to satisfy institutional review boards that can only be regarded as ridiculous. This is a dilemma, since the new CPR guidelines of both the American Heart Association [2] and the European Resuscitation Council [3] explicitly state that they are evidence-based; indicating that only new, convincingly positive clinical data is allowed to change clinical resuscitation guidelines. Moreover, if clinical resuscitation research is blocked by law or regulatory efforts that we are unable to comply with, it is most unlikely that we will be able to improve resuscitation practice. We will be placed in a very difficult situation similar to the paediatric cardiac arrest researchers. Because of current government restrictions to study interventions in minors presenting with cardiac arrest, few studies are being conducted in paediatric cardiovascular emergency care Accordingly, parts of the paediatric resuscitation guidelines have had to be extrapolated from adult, or even laboratory studies [2,3]. This is a situation that we definitely must prevent in the future for both adult and paediatric patients. While it is obvious that every effort has to be made that clinical projects studying resuscitation make sense and will protect patients from redundant or even dangerous interventions, we have to prevent politicians taking over research. Otherwise, lawyers will have an even bigger impact in our professional lives and those of our pateints. The dose of adrenaline/epinephrine for adult cardiac arrest patients is based on a canine study employing dogs of /15 kg body weight that was performed almost 100 years ago. Subsequent dose-response studies have revealed that the dose of adrenaline during CPR is extremely difficult [4]. While we are unable to prove at this point in time whether vasopressin may be a superior drug to adrenaline during CPR in humans, we are in the last stage of conducting a randomised clinical trial. This shows that developing and testing a promising alternative such as vasopressin is possible, even with extremely limited funds [5]. Induced moderate hypothermia after return of spontaneous circulation has improved survival and neurological outcome after resuscitation, one of the finest examples of life-saving resuscitation [6]. There is no doubt that these developments were not sudden overnight breakthroughs, but the result of painstaking piecemeal research showing that significant progress in resuscitation is possible. When asked about their new life after the incident patients recovering from severe trauma or cardiac arrest did not care what precise therapy they receivedthey and their families simply wished to go home to their loved ones alive. We need to make it clear, that if a law blocking research in patients who are unable to give informed consent is introduced into Europe, progress will slow dramatically, or even stop. Fewer patients will leave our hospitals alive and more will be severely disabled or even dead. Are the legislators interested in this fact? We should make it plain that a new century * Tel. 0043 512 504-2400; fax. 0043 512 504-5744. E-mail address: volker.wenzel@uibk.ac.at (V. Wenzel). Resuscitation 53 (2002) 243 /244" @default.
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• W2045803759 date "2002-06-01" @default.
• W2045803759 modified "2023-09-25" @default.
• W2045803759 title "Optimising Progress in Resuscitation not Optimising Roadblocks" @default.
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• W2045803759 doi "https://doi.org/10.1016/s0300-9572(02)00104-1" @default.
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