The International Liaison Committee on Resuscitation (ILCOR) appointed a task force in 2013 to prepare recommendations regarding first-aid care by trained or untrained rescuers. The recommendations were released with the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The goal was to provide an evidence base for the initial care provided by laypersons, EMS, and physicians outside of the office or hospital setting.
ACEP Now has partnered with three emergency medicine residency training programs (Wake Forest School of Medicine, Winston-Salem, North Carolina; Mayo School of Graduate Medical Education/Mayo Clinic, Rochester, Minnesota; and Warren Alpert Medical School of Brown University, Providence, Rhode Island) to review 15 of these recommendations following the PICO (Population, Intervention, Comparator, and Outcomes) analytic format utilized by the recommendation authors.
- Howard Mell, MD, MPH, CPE, FACEP, assistant professor, Wake Forest Baptist Medical Center, Department of Emergency Medicine
- Jessica L. Smith, MD, FACEP, associate professor (clinical), Warren Alpert Medical School of Brown University, and program director, Emergency Medicine Residency
- Jason Stopyra, MD, FACEP, assistant professor, Wake Forest Baptist Medical Center, Department of Emergency Medicine
- Matthew Sztajnkrycer, MD, PHD, FACEP, associate professor, Mayo Clinic, Department of Emergency Medicine
Reference: Singletary EM, Charlton NP, Epstein JL, et al. Part 15: first aid: 2015 American Heart Association and American Red Cross guidelines update for first aid. Circulation. 2015;132(suppl 2):S574–S589.
BRONCHODILATORS FOR ASTHMA WITH SHORTNESS OF BREATH (FA-534)
Recommendation Author: Bradley M. Chapman, MD
Dr. Chapman is a member of the emergency medicine residency training class of 2018 at the Wake Forest School of Medicine.
Question: Among adults and children in the prehospital setting who suffer from asthma and are experiencing difficulty in breathing (P), does bronchodilator administration (I) compared with no bronchodilator administration (C) change time to resolution of symptoms, time to resumption of usual activity, complications, harm to patient, therapeutic endpoints, and need for advanced medical care (O)?
Results: Eight double-blind randomized controlled trials (RCTs), two observational studies, and one meta-analysis were identified that addressed the PICO but were all deemed very-low-quality evidence.
Outcomes: Regarding the critical outcome of time to resolution of symptoms, two RCTs showed benefit in reduction of time to subjective improvement in dyspnea in participants treated with fast-acting bronchodilators. Regarding complications, two RCTs and one observational study demonstrated little or no difference between participants treated with bronchodilators and those treated with placebo. Regarding the therapeutic endpoints of oxygenation and ventilation, two RCTs showed benefit in an improvement in forced expiratory volume over one second when comparing inhalers to placebo.