The New England journal of medicine
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Editorial Comparative Study
Rate-setting in hospitals -- the beginning or the end?
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We performed electrophysiologic studies in 31 survivors of out-of-hospital cardiac arrest not associated with acute myocardial infarction. At the time of resuscitation, eight patients had sustained ventricular tachycardia and 23 patients had ventricular fibrillation. Programmed right ventricular stimulation later revealed electrically inducible ventricular arrhythmias in 25 of the 31 patients (81 per cent). ⋯ None of the 19 patients in whom the inducible arrhythmias was suppressed before discharge has died suddenly or had a symptomatic arrhythmia after a mean follow-up of 15 months (range, five to 26 months). Of the six patients in whom inducible arrhythmias could not be suppressed, three died suddenly (one in the hospital) within six months. We conclude that ventricular arrhythmias can be initiated and reproduced by programmed ventricular stimulation in a majority of patients who have been resuscitated after out-of-hospital cardiac arrest and that complete suppression of these arrhythmias with anti-arrhythmic therapy is highly predictive of survival for at least one year.
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The use of inflammable anesthetics in the United States has been debated widely over the past several years. Those in favor of continued use of these agents argue for educational use, professional freedom, pharmacologic safety, and the need to retain an option. Those in favor of a ban on such agents cite the lack of demonstrated pharmacologic advantage, diminishing physician expertise, risk of fire, and cost. ⋯ As their use declines further, the cost per patient increases because most of the costs are fixed. We advocate a ban on inflammable anesthetics. Without definitive action on the part of policy makers, the use of these agents is likely to continue at a very low, and hence a relatively expensive, rate.