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EBM vs. EBM: combining evidence-based and experienced-based medicine in resuscitation research
Paul E Pepe1, Tom P Aufderheide
1aDepartments of Emergency Medicine and Internal Medicine, School of Public Health and Office of Health System Affairs, the University of Texas Southwestern Medical Center, Dallas, Texas bDepartment of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Purpose Of Review:
To discuss the clear rationale for evidence-based medicine (EvBM) in the challenging realms of resuscitation research, yet also provide case examples in which even the well designed, multicentered randomized clinical trial may have had unrecognized limitations, and thus misleading results. This is where experienced-based medicine (ExBM) helps to resolve the issue.
Recent Findings:
Recent publications have brought to task the conclusions drawn from various clinical trials of resuscitative interventions. These articles have indicated that some major clinical trials that later determined the universal guidelines for resuscitative protocols may have been affected by unrecognized confounding variables, effect modifiers and other problems such as delayed timing. Many interventions, deemed to be ineffective because of these study factors, may actually have lifesaving effects that would have been confirmed had the proper circumstances been in place. With the right mindset, the clinician-researcher can often identify and address those situations.
Summary:
When clinical trials indicate ineffectiveness of an intervention that worked very well in other circumstances, both preclinical and clinical, clinician-investigators should continue to re-search the issues and not always take conclusions at face value.