Management of ventricular fibrillation by doctors in cardiac arrest teams

BMJ 1995;310:1265 (13 May)

Letters

Management of ventricular fibrillation by doctors in cardiac arrest teams

Guidelines do not discount change according to clinical circumstance

EDITOR,--The audit of the management of cardiac arrest by TM Cook and J Handel agrees with many others in showing thatdoctors do not consistently apply guidelines on resuscitation.¹The interpretation of this as unacceptable seems to misunderstandthe nature of guidelines generally and those of the EuropeanResuscitation Council in particular.

Guidelines suggest a course of action but do not discount changeaccording to clinical circumstance; the European ResuscitationCouncil's handbook, Guidelines for Resuscitation (1994), statesthat "guidelines are not set in tablets of stone."² One of thehidden rules of medical audit is that the standard being comparedwith actual practice has been validated. The guidelines of 1992represent a valuable and important consensus view, but thereis no claim that they would make any difference to outcome.This is not scientific nihilism: the universal and rigid application. . . [Full text of this article]