Recent discussions
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James Menegazzi
Based on the extant literature, I believe that this recommendation is sound and defensible.
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James Menegazzi
This review has misinterpreted the results of the Niederberger, et al. of which I am the senior author. The potential benefit is for patients with initial ECG rhythms of PEA and asystole. Since we have nothing else to offer these patients other than repeated doses of adrenaline, bicarb administration makes sense. To rule out its potential benefit for patients with these ECG rhythms is misleading.
James J. Menegazzi
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Sebastian Schnaubelt
Dear TF,
This is a very important topic, thank you for addressing it!
We regularly see problems in bra removal due to uncertainty whether to do it or not, and pads being partly placed on parts of the bra instead of fully on bare skin.
There is currently no evidence (concerning bras) assessing whether not vs. fully placing the pads on bare skin results in changed outcomes (all outcomes ranging from energies to patient outcomes), and I would not see the study on pigs as transferrable to real-life conditions in humans.
Therefore, in doubt, I would suggest to (instead of practically recommending against removing it) recommend either removing the bra or push it to the side / up / down or else, so that it is ensured that pads are placed on bare skin only. Also, there is the other issue of chest compression being potentially hindered by bra parts lying on the pressure point.
I fear that if left as it is now, the recommendation will lead to guidelines either not mentioning the topic or just saying it is not necessary to remove a bra (and then being interpreted as “just leave it it doesn't matter”).
Thank you for considering this!
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David Fredman
Locked AED cabinets is an effective way to reduce the efficiency of AEDs, be it in public locations or anywhere. In Sweden, and likely other countries as well, insurances are offered that will replace an AED if it´s stolen or vandalized, and in some instances even replace electrodes and batteries if the AED instead is used.
I´d encourage more insurance companies in more countries to move in this direction, to increase the likelihood of AED use and the chance to survival.
I believe fear of theft can be mitigated through insurances and thus more AEDs could be available in public. But I would also encourage researchers and other entities (national resuscitation councils etc.) to dig a bit deeper in to the sources around theft. Currently in Sweden the media boosts stories on stolen AEDs more than stories on successful rescuing with an available public AED. Another angle on the story could be if theft of AEDs are a big problem on societal level or is it a big problem on an individual level. The individual level issue could be mitigated through insurances, and if the theft issue is big on a national level I´d encourage AED vendors and producers to work with police and second-hand sales platforms to block sales of electrodes and batteries to AEDs that were reported stolen. If we work together to stop that “second hand” market, the theft of AEDs would likely decrease. And I´m looking at the big fishes here, the serial number of an AED could be used for so much more than it is today, and theft prevention is one thing. We need to work together to make sure that AEDs can reach their full potential in public locations, and locking them in is not the way to go.
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Janet Bray
Thank you for your comments, which will be considered by the BLS Task Force. Animal studies are excluded and ETCO2 was not a prespecified outcome included in the review protocol. We plan to publish the systematic review, and this evidence will likely be highlighted there. Janet Bray (BLS Task Force Chair)
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Janet Bray
The review followed proper systematic review processes. The CoSTR presents a summary of the methods and results, the full SR is being prepared for publication.
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Janet Bray
Thank you all for your comments, which will be considered by the BLS Task Force. Janet Bray (BLS Task Force Chair)
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Janet Bray
Thank you all for your comments, which will be considered by the BLS Task Force. Janet Bray (BLS Task Force Chair)
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Janet Bray
Thank you for your comment. Janet Bray (BLS Task Force Chair)
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Ryan Brown
Methodologically sound ScR. Important work with important results. The research backs up my gestalt on access to AEDs.