Here is an interesting statistic – the “Number Needed to Treat” for aspirin in acute STEMI is actually about 42, for thrombolysis in STEMI it is about 43, similar for primary angioplasty.
We do a lot of things which are thought of as imperative where there is good evidence everyday.
So, what do we do with the patient who comes in in pulseless VT and we have a win with the defib? What about the overdose who has an arrest and then comes back after a bit of CPR and other interventions?
Well the evidence is that we should be doing therapeutic hypothermia. Ever done this? Nope, neither have I. Yet I have seen plenty of successful resuscitations ( mostly not ). What is the NNT (number needed to treat ) to prevent serious neurological disability or death …..
6…. yes thats right SIX! On a purely statistical basis this intervention is more likley to result in a better outcome that thrombolysis. If you compare it to thrombolysing for CVA – there is no comparison – hypothermia wins hands down. In fact there are few interventions in modern medicine with such a low NNT!
Want to hear more. Check out the NYC Hypothermia site where you can find links to the original evidence and to the protocols used there- this is likley to become the new norm post resuscitation.
For us in the country – we need to know this because it is a valuable intervention that needs to be started as soon as the patient gets ROSC (return of spontaneous circulation) in a resus situation. If you delay you might be losing valuable neurons and giving the patient (whom you have just done a great resus ) a poorer final outcome, so it seems to make sense to me that we should do this!
Getting patients cooled in the tropics might be a bit tricky, but it is worth a crack? Of course, we would need to be able to maintain hypothermia in transit – is this an impossible logistical challenge?
The Neonatologists are doing this right now for birth asphyxia. Have you seen it or had any cases which you might have done so??
Let me know, Casey