Emergency Drug Kits at the Danish Hospital Pharmacies: A Study of the Management and Challenges
Authors
Christensen, Maria ; Knudsen, Stine Abildgaard
Term
4. term
Publication year
2018
Submitted on
2018-06-14
Pages
59
Abstract
This thesis examines how Danish hospital pharmacies manage emergency drug kits and the challenges involved. It comprises two theory chapters and a main article: (1) a synthesis of evidence on vasopressors and antiarrhythmics in cardiac arrest based on one randomized trial, two systematic reviews, six meta-analyses, and current AHA and ERC guidelines (publications from 2009–2018), and (2) an overview of hospital pharmacy functions in Denmark and procurement through Amgros. The literature review indicates that standard-dose adrenaline during CPR increases return of spontaneous circulation (ROSC) and admission compared with placebo, while higher doses may further raise ROSC at the cost of worse neurological outcomes; vasopressin is not clearly superior overall, though some subgroups (e.g., asystole) may benefit. For antiarrhythmics, amiodarone remains recommended for shock-resistant VF/pVT, yet the overall evidence is mixed: both amiodarone and lidocaine appear to improve survival to hospital admission versus placebo without consistent gains in survival to discharge or neurological outcomes, and some analyses suggest possible advantages for lidocaine on long-term survival. These uncertainties complicate standardizing kit contents and underscore the need for large, well-controlled trials. The main article focuses on the practical management of emergency drug kits within hospital pharmacies and associated organizational and logistical challenges; however, methods and specific findings from that study are not included in this excerpt.
Dette speciale undersøger, hvordan danske sygehusapoteker håndterer akutlægemiddelkasser (emergency drug kits) og hvilke udfordringer, der knytter sig hertil. Arbejdet består af to teoretiske kapitler og en hovedartikel: (1) en gennemgang af evidensen for brugen af vasopressorer og antiarytmika ved hjertestop baseret på ét randomiseret studie, to systematiske reviews, seks metaanalyser og de aktuelle AHA- og ERC-retningslinjer (publikationer fra 2009–2018), og (2) en beskrivelse af sygehusapotekernes opgaver i Danmark og indkøb gennem Amgros. Litteraturoversigten viser, at adrenalin i standarddoser under HLR øger sandsynligheden for return of spontaneous circulation (ROSC) og indlæggelse sammenlignet med placebo, mens høje doser kan øge ROSC men samtidig være forbundet med dårligere neurologiske udfald; vasopressin er samlet set ikke klart overlegen, om end enkelte subgrupper (fx asystoli) kan have fordel. For antiarytmika anbefales amiodaron fortsat ved stødresistent VF/pVT, men den samlede evidens er blandet: amiodaron og lidokain synes at forbedre overlevelse til indlæggelse versus placebo, uden konsistente gevinster i overlevelse til udskrivelse eller neurologi, og enkelte analyser peger på mulig fordel for lidokain på lang sigt. Disse usikkerheder udfordrer standardisering af kit-indhold og understreger behovet for store, velkontrollerede studier. Hovedartiklen retter fokus mod den praktiske forvaltning af akutlægemiddelkasser på sygehusapoteker og tilhørende organisatoriske og logistiske udfordringer; metoder og specifikke resultater herfra fremgår dog ikke af nærværende uddrag.
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Other projects by the authors
Christensen, Maria:
- Emergency Drug Kits at the Danish Hospital Pharmacies: A Study of the Management and Challenges (2018)
Knudsen, Stine Abildgaard: