Painkillers may increase risk of cardiac arrest

Health Care Comments Off

Pain is one of the most common presenting complaints of patients. And, painkillers are the most widely used drugs, whether taken OTC or prescribed. But, they have side-effects and their adverse effects on GIT, kidney, heart and liver have been well-documented.

Now a new research published in the March 2017 issue of European Heart Journal – Cardiovascular Pharmacotherapy has shown an association of non-steroidal anti-inflammatory drugs (NSAIDs), especialy diclofenac and ibuprofen, to increased risk of out-of-hospital cardiac arrest.

All patients who had an out-of-hospital cardiac arrest in Denmark between 2001 and 2010 were identified from the nationwide Danish Cardiac Arrest Registry. Data was collected on all redeemed prescriptions for NSAIDs from Danish pharmacies since 1995. These included the non-selective NSAIDs (diclofenac, naproxen, ibuprofen), and COX-2 selective inhibitors (rofecoxib, celecoxib). A total of 28,947 patients had an out-of-hospital cardiac arrest in Denmark during the 10-year period. Of these, 3,376 were treated with an NSAID up to 30 days before the event. Ibuprofen and diclofenac were the most commonly used NSAIDs, making up 51% and 22% of total NSAID use, respectively.

Use of any NSAID was associated with a 31% increased risk of cardiac arrest. Diclofenac and ibuprofen were associated with a 50% and 31% increased risk, respectively. Naproxen, celecoxib and rofecoxib were not associated with the occurrence of cardiac arrest, probably due to a low number of events.

It is a common perception amongst the public that OTC drugs are safe because they are available over the counter. However, this study further highlights the fact that though available without a doctor’s prescription, OTC drug does not mean that it can be taken without a doctor’s advice. If not taken as directed, painkillers can cause side effects, at times potentially dangerous.

(Source: ESC Press release, March 15, 2017)

Dr KK Aggarwal
National President IMA and HCFI

Do CPR for 30 mins before transporting cardiac arrest victims to hospital

Health Care Comments Off

Quite often we read about people collapsing due to a cardiac arrest. Former President APJ Abdul Kalam collapsed while he was addressing students in Shillong. He was immediately rushed to the hospital but could not be revived. More recently, Mr E Ahamed, Member of Parliament collapsed in the Parliament after he suffered cardiac arrest and passed away.

Such instances bring CPR or cardiopulmonary resuscitation back into the spotlight. The first instinct is to immediately rush a person to the hospital when you see somebody collapse suddenly. But at times, a first responder CPR may help revive the person until medical help arrives or a defibrillator is available.

Recently, a story was reported at WPRI News in February (Feb 16, 2017) about a major change in prehospital protocol policy in Rhode Island, USA for First Responders for the management of victims of cardiac arrest, which said: “Starting March 1, as dictated by the Rhode Island Department of Health, emergency response personnel will be required to conduct 30 minutes of cardiopulmonary resuscitation, or CPR, on cardiac arrest victims before transporting them to the hospital.”

The American Heart Association (AHA) has published updated Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in October 2015 in the journal Circulation, with some updates while continuing to emphasize on the characteristics of high-quality CPR: compressing the chest at an adequate rate and depth, allowing complete chest recoil after each compression (avoid leaning on the chest between compressions), minimizing interruptions in compressions, and avoiding excessive ventilation.

• The recommended chest compression rate have been updated to 100-120/ min from the earlier at least 100/min.
• The recommendation for chest compression depth for adults is at least 2 inches (5 cm) but not greater than 2.4 inches (6 cm). The earlier recommendation was at least 2 inches (5 cm).
• Chest compression should be started first before rescue breaths (C-A-B rather than A-B-C). The single rescuer should begin CPR with 30 chest compressions followed by 2 breaths.

The premise of a successful cardiopulmonary resuscitation (CPR) is earlier the better and longer the better.

When you come across a victim of cardiac arrest, three simple rules must be followed: Call the ambulance, check if the person is breathing or has a pulse and if not, then start chest compressions and continue for at least 30 minutes till medical help arrives.

Don’t stop CPR too soon …

Dr KK Aggarwal
National President IMA and HCFI

Do CPR and also give IV amiodarone in cardiac arrest

Health Care Comments Off
Anti-arrhythmic injections when given by paramedics to patients with out-of-hospital cardiac arrest who had failed electrical shock treatment, improves likelihood of patients surviving transport to the hospital. The study is published online in the New England Journal of Medicine.
The trial shows that amiodarone and lidocaine offer hope for bringing patients back to life and into the hospital after cardiac arrest. There was a significant improvement in survival to hospital discharge with either drug when the cardiac arrest was bystander-witnessed.
A bystander-witnessed cardiac arrest is one that is witnessed by another person.
Sudden cardiac arrest is a condition in which the heart suddenly or unexpectedly stops beating, cutting off blood flow to the brain and other vital organs.

« Previous Entries