Lactulose and Probiotics Are Effective in Preventing Recurrent Hepatic Encephalopathy.

Both treatments were significantly more effective than placebo.

Hepatic encephalopathy (HE) is a common complication of hepatic cirrhosis. Lactulose has been effective in treating patients with acute or recurrent HE, but data supporting its use are lacking. Probiotics might also be beneficial for these patients, by altering gut flora to reduce ammonia production, although few studies have evaluated probiotics in this setting.

Now, investigators have conducted an open-label, randomized, controlled trial to evaluate the efficacy of lactulose and probiotics in 235 consecutive cirrhotic patients at a single hospital in India who had recovered from HE and had not received any HE medication. Patients were randomized to lactulose (30 mL 3 times daily), probiotics (1 capsule containing 112.5 billion viable lyophilized bacteria 3 times daily), or placebo. The primary endpoint was development of overt HE, according to West Haven criteria.

During 12-month follow-up, recurrent HE developed in more patients receiving placebo (37) than lactulose (18; P=0.001) or probiotics (22; P=0.02). Rates of hospitalization and death from causes other than HE were similar among the three groups.

Comment: Although unblinded, this study was large and well executed. It demonstrated that lactulose and probiotics are similarly effective in secondary prophylaxis of HE. Whether all probiotics would be as effective is unclear, but we now potentially have other therapeutic options for preventing recurrent HE in addition to rifaximin plus lactulose (JW Gastroenterol Mar 24 2010).

Source: Journal Watch Gastroenterology .


Transplant jaw made by 3D printer claimed as first.

A 3D printer-created lower jaw has been fitted to an 83-year-old woman’s face in what doctors say is the first operation of its kind.

The transplant was carried out in June in the Netherlands, but is only now being publicised.

The implant was made out of titanium powder – heated and fused together by a laser, one layer at a time.

Technicians say the operation’s success paves the way for the use of more 3D-printed patient-specific parts.

The surgery follows research carried out at the Biomedical Research Institute at Hasselt University in Belgium, and the implant was built by LayerWise – a specialised metal-parts manufacturer based in the same country.

The patient involved had developed a chronic bone infection. Doctors believed reconstructive surgery would have been risky because of her age and so opted for the new technology.

The implant is a complex part – involving articulated joints, cavities to promote muscle attachment and grooves to direct the regrowth of nerves and veins.

However, once designed, it only took a few hours to print.


“Once we received the 3D digital design, the part was split up automatically into 2D layers and then we sent those cross sections to the printing machine,” Ruben Wauthle, LayerWise’s medical applications engineer, told the BBC.

“It used a laser beam to melt successive thin layers of titanium powder together to build the part.

“This was repeated with each cross section melted to the previous layer. It took 33 layers to build 1mm of height, so you can imagine there were many thousand layers necessary to build this jawbone.”

Once completed, the part was given a bioceramic coating. The team said the operation to attach it to the woman’s face took four hours, a fifth of the time required for traditional reconstructive surgery.

“Shortly after waking up from the anaesthetics the patient spoke a few words, and the day after the patient was able to swallow again,” said Dr Jules Poukens from Hasselt University, who led the surgical team.


“The new treatment is a world premiere because it concerns the first patient-specific implant in replacement of the entire lower jaw.”

The woman was able to go home after four days.

Her new jaw weighs 107g, just over a third heavier than before, but the doctors said that she should find it easy to get used to the extra weight.

Follow-up surgery is scheduled later this month when the team will remove healing implants inserted into holes built into the implant’s surface.

A specially made dental bridge will then be attached to the part, following which false teeth will be screwed into the holes to provide a set of dentures.

The team said that it expected similar techniques to become more common over the coming years.

“The advantages are that the surgery time decreases because the implants perfectly fit the patients and hospitalisation time also lowers – all reducing medical costs,” said Mr Wauthle.

A high-temperature plasma spray was used to cover the jaw part with a bioceramic coating

“You can build parts that you can’t create using any other technique. For example you can print porous titanium structures which allow bone in-growth and allow a better fixation of the implant, giving it a longer lifetime.”

The research follows a separate project at Washington State University last year in which engineers demonstrated how 3D-printer-created ceramic scaffolds could be used to promote the growth of new bone tissue.

They said experiments on animals suggested the technique could be used in humans within the next couple of decades.

LayerWise believes the two projects only hint at the scope of the potential medical uses for 3D printing.

Mr Wauthle said that the ultimate goal was to print body organs ready for transplant, but cautioned that such advances might be beyond their lifetimes.

“There are still big biological and chemical issues to be solved,” he said.

“At the moment we use metal powder for printing. To print organic tissue and bone you would need organic material as your ‘ink’. Technically it could be possible – but there is still a long way to go before we’re there.”

Source: BBC heath.




Believe it or not, coffee enemas are very beneficial.

A conversation about enemas can stimulate everything from laughter to horror. There are many old wives tales about enemas and how they can “cure” everything from the common cold to cancer. So let’s took a look at the facts and science behind the use of enemas.

Ancient civilizations included enemas in their cleansing rituals. The pharaohs of Egypt had their ‘guardians of the anus,” a doctor who specialized in administering the enemas and keeping their bowels clean. In the 1700s, enemas were a common practice in France and were considered indispensable for vibrant health.

At the turn of the 20th century, scientists in Germany noticed that caffeine opened the bile ducts and stimulated the production of bile in the liver of laboratory animals. Coffee enemas were even included in the Merck Manual, which is the medical doctor’s “bible,” until 1972.

Coffee enemas have gained modern popularity because of natural cancer protocols such as the Gerson Therapy, which incorporates daily enemas as part of their healing regime.

What exactly is an enema? An enema involves the insertion of a small tube into the rectum and then introducing fluids like coffee or herbal teas into the large intestine. This is best accomplished while lying on the left side with knees slightly bent. The amount of fluid can vary from one to four quarts, depending on what the need may be. Retaining the enema for 15-20 minutes provides the best results.

The benefits of the coffee enema are primarily due to the detoxification of the liver and not necessarily the emptying of the lower bowel. With the barrage of chemicals we are exposed to every day, as well as the internal toxins that are produced from daily metabolism, the liver can become overloaded and burdened with an excessive amount of toxicity.

As the coffee sits in the bowel, the fluid is absorbed through the intestinal wall into the blood stream, specifically through the portal vein of the liver. This carries the stimulating effects of the caffeine and other phytochemicals into the back door of the liver, so to speak, and stimulates the liver and gall bladder. Since fresh blood flows through the liver every three minutes, the detoxification of the liver is quite significant during those 15-20 minutes.

Aside from the detoxification of the liver, the coffee enemas provide certain phytochemicals, specifically kahweol and cafestol. These nutrients activate glutathione, which is a primary antioxidant in the cell. Detoxification on a cellular level is key to healing and creating vibrant health.

In laboratory studies, Kahweol has shown anti-inflammatory properties, stopped formation of new vascularity or blood flow in the early formation of tumors.

Both kahweol and cafestol have displayed anti-cancer properties in laboratory studies.

Enemas can also be performed with various teas, such as green tea or red clover tea, although coffee is said to produce better results.

If you are on a specific healing journey or you simply want to detox, make coffee enemas a regular part of your wellness protocol.

National Toxicology Program Cafestol (CASRN 469-83-0) and Kahweol (CASRN 6894-43-5) – Review of Toxicological Literature. (PDF)

About the author:
Dr. Veronique Desaulniers, better known as Dr. V, has maintained successful practices in the Wellness Industry since 1979.
Specializing in Bio-Energetics, Meridian Stress Analysis, Homeopathy, Thermography and Chiropractic, Dr. V brings a unique approach to Health and Wellness.
After personally overcoming Breast Cancer without the use of chemo, radiation or surgery, Dr. V currently helps to empower women about healing and preventing Breast Cancer, naturally.
For more information about Dr. V’s personal Cancer Coaching visit
Learn more:

Wrong Call: The Trouble Diagnosing Diabetes.

With cases of diabetes growing each year, many adults are getting caught in a potentially dangerous situation: they are diagnosed with Type 2 diabetes when they actually have Type 1 diabetes, a substantially different condition.

Alissa Kaplan Michaels, who has Type 1 diabetes, struggled for 3½ years before her disease was diagnosed correctly.

Both types of diabetes make it difficult for patients to control blood-sugar levels, which can lead to complications that include blindness, kidney failure and death. But Type 1 and Type 2 require different forms of treatment.

Alissa Kaplan Michaels, who has Type 1 diabetes, lived for 3½ years with the wrong diagnosis. The New York public-relations consultant says she complained to her doctor in 2008 of blurry vision and was told she had Type 2 diabetes after a blood test showed high sugar levels. She changed her diet and exercised more, but her blood-sugar levels kept rising. She started taking several oral diabetes medications. She stopped eating bread and pasta. She changed doctors—three times. And she still felt terrible.

Don’t Confuse These

Despite the similar sounding names, Type 1 and Type 2 diabetes are substantially different conditions. Type 1 is an autoimmune disorder that attacks the body’s ability to make insulin. In Type 2, brought on by inactivity and obesity, the body can’t make efficient use of insulin to control blood sugar.

Type 1 Diabetes

  • The condition begins mainly in childhood and adolescence, but increasingly in adults.
  • People with Type 1 are often thin or normal weight.
  • Patients are prone to ketoacidosis, a dangerous buildup of acids in the blood.
  • Regular insulin injections are required treatment.

Source: National Institutes of Health

Type 2 Diabetes

  • Onset is primarily in people over 40 years old, but increasingly in younger patients.
  • People with Type 2 are often obese.
  • There is no ketoacidosis.
  • Treatment involves healthy diet and exercise, diabetes medications, and sometimes insulin injections.

Last fall, a covering doctor at her endocrinologist’s practice started asking about her health history, childhood weight patterns, her recent struggles with her blood sugar and family history of Type 2 diabetes, of which there was none. That day, Ms. Kaplan Michaels got a new diagnosis. She didn’t have Type 2 diabetes, she had Type 1.

Ms. Kaplan Michaels, 44 years old, immediately dropped the oral medications that had upset her stomach. Instead, she increased her daily insulin injections. She also resumed eating carbohydrates. Within weeks, her energy was back. “At first I was relieved and then I was very angry,” she says. “Nobody should have to go to four doctors to get a diagnosis for something that isn’t that difficult to diagnose.”

Type 1 diabetes is an autoimmune disorder that attacks the body’s ability to make insulin, which allows the body to properly process glucose. The disorder, once called juvenile diabetes, begins mainly in children and adolescents, but is increasingly occurring in adults. Type 1 diabetics need daily insulin injections to survive. If patients manage their blood-sugar levels well, they can live for decades without encountering the dangerous complications associated with the disease.

Type 2 diabetes, by contrast, is brought on by inactivity and obesity, mainly in adults, and is characterized by the body’s inability to make efficient use of insulin. Type 2 diabetes, which is beginning to occur in teenagers, can be kept at bay in some cases with lifestyle changes and is widely treated with oral medications to improve insulin absorption. Type 2 diabetics also can require insulin injections.

“Most of my [adult Type 1 patients] have been misdiagnosed as having Type 2,” says Robin Goland, co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York. “Once the right diagnosis is made the patient feels much, much better, but they are distrustful of doctors and who could blame them?”

Ms. Kaplan Michaels, pictured with her son, Leo, was able to resume an active life after her Type 1 diabetes was correctly diagnosed and she began proper treatment.

Estimates of the number of people with Type 1 diabetes in the U.S. range from 1.3 million to 2.6 million people, accounting for 5% to 10% of the total diabetic population. Incidence of Type 1 has been rising in the U.S. and in parts of Europe by about 2.5% to 4% a year for reasons scientists can’t explain, according to several large-scale studies published in peer-reviewed medical journals. Scientists say Type 1 diabetes is caused by a combination of genetic and environmental factors but they don’t know what the trigger is.

An incorrect diagnosis usually occurs in the offices of primary-care doctors, many of whom haven’t received adequate education in medical school about rising rates of Type 1 in adults and how to diagnose it. “It is not on their radar because they see so much diabetes and it is by far mostly Type 2,” said Irl B. Hirsch, professor of medicine at the University of Washington Medical Center in Seattle.

After elevated blood sugars are detected, diagnosing which diabetes a person has usually is done by looking at the patient, assessing family history, weight and age, doctors say. “It’s not a good way to make a diagnosis. You’d like to measure something that represents the disease process,” says Jerry Palmer, director of endocrinology at VA Puget Sound Health Care System. To properly diagnose Type 1, doctors need to test for antibodies that indicate the presence of the autoimmune disorder. But few order such tests.

Cherie Serota, 48, was told by her primary-care doctor in early 2009 that she was on the brink of having Type 2 diabetes. Weighing just 120 pounds, Ms. Serota, of Brookville, N.Y., didn’t fit the profile of a typical Type 2 patient. She revved up her exercise regime and watched her diet. One night after Chinese takeout sent her blood-sugar levels high, she called her doctor who told her this was normal and not to eat Chinese food anymore. Eventually she stopped eating carbohydrates. “That really did me in,” says the mother of three. “I had no energy.”

Six months later, feeling drained and now down to 113 pounds, the former fashion executive sought out an endocrinologist at New York University who told her she had Type 1. When she told her primary-care doctor, he was so surprised she made him call the specialist, she says.

“I understand why I was misdiagnosed; it is a very small amount of people who are diagnosed as an adult,” Ms. Serota says.

In some adults with Type 1, the loss of insulin-producing cells, located in the pancreas, is much slower than for children, making the onset of the disease more gradual. Some researchers consider the slow onset a distinct form of Type 1 called latent autoimmune diabetes in adults, or Lada. Because the disease progresses more slowly, it can be more easily confused with Type 2, researchers say.

Benjamin Jones, a 63-year-old retired probation officer, likely had the slow-onset form of the disease. For six years, Mr. Jones treated what had been diagnosed as Type 2 diabetes. He changed his diet and took three oral medications daily. An avid exerciser, Mr. Jones says for several years he was able to keep his blood-sugar levels in check in part by Rollerblading, swimming, playing tennis and basketball, and cycling. Still, rarely did his blood-sugar level dip below 120, which is high for a non-diabetic person.

After a bad reaction to a flu shot earlier this year, Mr. Jones says his sugar levels surged to 500. He says he asked to be put on insulin, but his primary-care doctor refused, fearing that Mr. Jones could risk hypoglycemia, a condition in which blood sugars go too low. That was when Mr. Jones sought out a specialist at the Joslin Diabetes Center in Boston. He was immediately put on insulin, given an antibody test and told he had Type 1.

“When your sugar is high you don’t feel right. You feel on edge,” Mr. Jones says. “I feel like a new person, like I should feel.”

Source: WSJ.




“Do You Want a Child Who is XL — or a Child Who Will Excel?”

Generation XL: Raising Healthy, Intelligent Kids in a
High-Tech, Junk-Food World

Generation XL

There is no doubt about it-the health of our children has become a national emergency.

Hospital costs for obesity-related ailments in children have more than TRIPLED over the last twenty years, with 30 percent of boys, and a staggering 40 percent of girls, at risk of developing type 2 diabetes-an obesity-related condition-sometime during their lives.

Childhood, a pivotal time for creating a healthy foundation for future well-being and longevity, has been profoundly degraded by inactivity through TV, video games and computers, with chemically enhanced diets more fit for cyborgs than growing youngsters.

We have super-sized fast foods, with more additives and preservatives than raw food material. Plus, sugar-laden beverages (the main staple of most people today) have lead to an epidemic of children who are out of shape, over-weight and feel horrible both physically and emotionally.

Formerly abnormal childhood afflictions have become the norm as more and more children are riddled with pain, learning disorders, ADD/ADHD, obesity, fatigue and depression.

Meanwhile, concerned parents turn to their doctors for “cures,” but end up with nothing more than … more chemicals! And — more problems.

Are there any answers? Can you, as a parent, ensure a future of vibrant health, physical fitness and a harmonious mind for your child?

Can you make sure that YOUR child does not end up a sad statistic? YES, YOU CAN!

Let Us Show You the Fad-Free Way to Creating a Healthy Lifestyle for Your Child!

Generation XL: Raising Healthy, Intelligent Kids in a High-Tech, Junk-Food World is an easy, step-by-step 246-page hardcover book guide that will show you how you can end the vicious cycle of poor health and over-medication.

Imagine your child happy, harmonious, fit, full of energy and free from debilitating ailments.

Our all-natural, common sense strategies for creating a lifetime of vibrant health have already changed the lives of thousands of patients in our private practices, and now we are sharing this vital knowledge with you!


Now, if you think this is just another diet book, think again. It’s not.

There are already too many of those out there, most of which have little or no impact on long-term health. In an easy-to-follow style, this book will take you by the hand and gently teach you how to reach life-long wellness by taking small, steady steps in the right direction.

The results are positive, lasting changes to health and well-being.

Packed with the most cutting edge information available today, it will show you what no regular diet or fitness book can: how to change what truly matters-your family culture-into one that supports good health, optimal weight, increased immune system and decreased illness, maximized brain function and a balanced emotional state.

Here’s just a small sample of what you’ll find in Generation XL:

  • Diseases related to obesity now kill more people than smoking and nearly every other kind of medical condition. Discover the three major causes of childhood obesity and poor physical health, and how you can reverse the process-page xvi.
  • Find out the real science behind how the body gains and loses fat, and get the “skinny” on fat vs. muscle-pages 33-36, 129
  • Discover the principles that are essential for producing safe, steady weight loss and a strong body-page 5.
  • Find out the main dietary and lifestyle changes-the “Big 4”-you can use to improve your family’s health most dramatically-pages 55-56.
  • Learn the difference between “good” vs. “bad” fats, and why good fats are an essential part of your child’s diet for proper brain and nerve function-pages 49-53.
  • Peer pressure is a fact of life, but there are proven ways YOU can have superior influence on your kids. We’ll share specific methods for fostering inner well-being in your children so that they can feel good about themselves-pages 11-20.

Generation XL

  • Little-known secrets to dramatically increase your child’s learning ability. Help your child develop the mental skills to succeed and thrive through the brain-body connection-pages 126-128.
  • What you need to know about the three steps to weight gain and why your child’s diet may cause him to STAY fat. We’ll show you how to reverse this evil cycle and what you need to do to get the weight off (and keep it off for life)-pages 34-36.
  • Discover the four factors used to gauge a person’s level of health, and how to measure a child’s ideal weight (forget about Body Mass Index used for adults-kids are different!)-pages 64-70.
  • AND, the seven tricks that make your changes STICK-not just for a week or two, but for a lifetime! -pages 111-116.
  • Plus, 22 of the best tips to help your child fall asleep faster and get a better night’s rest-pages 119-122
  • Plus, many more kid-proof gems to help you.

These guidelines really are key to making positive, lasting changes, so we urge you to take advantage of this special offer today to ensure a brighter future for your child.

Source: Dr. Mercola

“Free-Range Certified 100% Organic Chicken: An Exceptionally Clean, Healthy and Delicious Source of Essential Protein!”

Free-Range Certified 100% Organic Chicken: An Exceptionally Clean, Healthy and Delicious Source of Essential Protein!”

Eating clean and healthy protein is absolutely crucial if you want to prevent disease and premature aging, increase your daily energy and live longer. But unlike the unhealthy chicken you’ll find in grocery stores and restaurants, which you should restrict in your diet (as you will read below), this free-range certified organic chicken is one of the cleanest and healthiest sources of protein that you will find anywhere.

As many of you know, I only recommend foods that meet the highest of requirements in terms of their health value to you. Well, it has taken my team many months of research and evaluation to find and finally offer you an organic chicken product that comes with my absolute highest recommendation because it meets all of these qualifications for a perfect meat:

  • USDA Certified organic, meaning 100% organically raised from “egg to plate”.
  • No antibiotics ever used.
  • No hormones ever used.
  • No pesticides or herbicides ever used in the soil or the feed.
  • No artificial ingredients whatsoever.
  • Entirely free-ranged so these chickens are not “stressed;” meanwhile, mass-produced chickens are raised in severely cramped quarters which translate to not only reduced health value, but less taste.
  • The juiciest, most delicious tasting chicken you’ve ever tried.
  • An exceptional source of protein, as you can see in the chart below.
  • Come from farms that promote sustainable farming and sound environmental practices.

Why Does “Free-Range” and “Antibiotic-Free” Matter So Much with Chicken?

The mass-produced chicken you find in grocery stores, are typically inhumanely raised in extremely cramped quarters where they can barely move. This creates stress in the chickens that can lead to disease and the need for antibiotics. Stressed growing conditions can also cause “stunted” meat devoid of taste and total health value, hence creating the need for chemicals to artificially moisten the meat.

Organic, free-range chickens, on the other hand, have plenty of room to roam and eat their entirely natural diets. Thriving in a stress-free environment, this makes all the difference in the world in terms of their health and taste value to you.

Another crucial reason this free-range organic chicken is an exceptional source of protein in your diet is because it is free of antibiotics. Over half of the antibiotics fed to mass-produced farm animals including chickens, are identical to the ones administered to humans. As has been well publicized in the media, overuse of such antibiotics can lead to strains of bacteria resistance to the antibiotic, opening doors wider to the potential for human disease.

(*See The World Health Organization report, “WHO Global Strategy for Containment of Antimicrobial Resistance,” for more information on this. This report states that farmers’ use of antibiotics in livestock enables microbes to build up defenses against the drugs, leap up in the food chain and attack human immune systems, and they’re one of many major health organizations that call for an end to such antibiotics in poultry and livestock.)



     From Fat: 10

Total Fat


Saturated Fat






Total Carbs




Organic Chicken Thighs
Nutrition Information


     From Fat: 110

Total Fat


Saturated Fat






Total Carbs




Organic Whole Chicken
Nutrition Information
(Serving Size 4OZ. (112G))


     From Fat: 130

Total Fat


Saturated Fat






Total Carbs





Introducing…Unsurpassed Certified Organic Free-Range Chicken

We work with a select network of organic farmers who strongly believe in raising chickens as nature intended. Freely roaming with access to fresh air and sunshine, along with vegetarian organic feed are the basic essentials.

Beyond that, we support self-sufficient and sustainable agriculture, family farms, and organic practices that produce healthy, environmentally friendly food.

We have searched the country to locate poultry and meats that are not only organic, but also tender, juicy, and delicious.

Our organic chicken is raised by farmers who do things the old fashioned way – meaning they take care of the land and humanely raise animals without antibiotics, synthetic hormones, or synthetic pesticides.

The chicken’s feed is grown on the farm without synthetic fertilizers and pesticides as well, contributing even further to sustainable farming practices.

Farms that practice sustainable agriculture are good for the environment. By reducing their use of chemical pesticides and fertilizers and using less fuel to truck in pesticides, fertilizers and feed, they decrease chemical run-off and the dependence on foreign oil.

Overall, these farms create a smaller carbon footprint and help replenish and preserve the land for future generations.

When you eat free-range chicken from us, you know we’re providing the healthiest, safest, and tastiest chicken available anywhere.

A Healthful Source of Protein… And a Great Value Too

“Take Your Food to the Salt” and Transform Any Dish From Ho-Hum to Spectacular

Don’t just salt your food with Himalayan Crystal Salt, take it to the slab!

Featured on several top cooking shows, using a Himalayan Salt Kitchen Slab has become the newest sensation for extraordinary food preparation and presentation.

Simply preheat your crystal salt slab over a grill or stove and toss on your favorite sliced meats, seafood, vegetables or eggs. The Himalayan Salt sears your food to perfection, with a just a light touch of heavenly salty mineral sweetness.

The Himalayan Salt Kitchen Slab is perfect for cold foods, too. Just chill your slab in the refrigerator and then load with sushi, hors d’oeuvres, cheeses and slices of fruit. You’ll love the delicate saltiness imparted to your food and the beautiful translucent pink salt serving platter will become an instant conversation starter.

For a special treat, arrange thin strips of raw grass-fed beef on your chilled slab and watch as the salt cures the edges.

Chill slab in the freezer overnight and serve ice cream on top for a beautiful presentation and delicate salty-sweet goodness.

Find out more about the Himalayan Salt Kitchen Slab here.

Besides being a truly ideal source of clean and healthy protein with all the essential amino acids your body needs to prevent disease, avoid premature aging, increase energy and strength and live longer, this free-ranged certified organic chicken is:

  • Totally delicious … in fact, you’ve probably never tasted a better chicken because it is raised entirely on its natural diet, in its natural environment.
  • Just as versatile and easy to prepare as any other chicken, but naturally more moist and juicy.
  • A great value. Yes, it costs more than store-bought chickens that are mass produced and of negligible health value, but it costs less than many so-called “healthy” chickens and significantly less than many other forms of healthy meats.
  • ·         Source: Dr. Mercola

No Return of Pulses in the Field Portends Dismal Survival.

This study’s findings support use of prehospital termination-of-resuscitation protocols.

Prehospital cardiac arrest patients who do not achieve return of spontaneous circulation (ROSC) continue to be transported to the hospital despite the existence of prehospital termination-of-resuscitation protocols (JW Emerg Med Oct 17 2008). To determine survival rates in such patients, researchers analyzed data from two urban emergency medical service systems for patients who experienced cardiac arrest presumed to be of medical etiology from 2008 to 2010.

Among 2483 patients in whom resuscitation was attempted, survival to hospital discharge was 6.6%. ROSC in the field occurred in 36% of patients. Survival rates were 17.2% in patients with ROSC in the field versus 0.7% in those without ROSC. None of the 11 patients who survived without ROSC in the field had an initial rhythm of asystole.

Comment: If termination-of-resuscitation protocols that are based on ROSC had been followed in this study, the transport rate would have been halved. Although the authors’ recommendation for no transport of patients without field ROSC or shockable rhythm would save critical resources and reduce risks to prehospital providers and the public from collisions, nonmedical indications such as family wishes sometimes mandate transport of nonviable patients. When such patients are transported, these data are useful for receiving-hospital emergency physicians to determine whether to continue resuscitative efforts on arrival.

Source: Journal Watch Emergency Medicine