By John Lichfield in Paris, The Independent
Thursday, 12 June 2008

France may have to reconsider its medical definition of death after a heart-attack victim came alive in the operating theatre as doctors were about to remove his organs for transplant.

The patient, whose identity has not been revealed, recovered after a long period in intensive care and is now able to walk and talk.

The 45-year-old man owes his life to the fact that surgeons authorised to remove organs for transplant operations were not immediately available. Under experimental rules adopted in France last year, to make more organ transplants possible, the man had already reached the point where he could be officially regarded as dead. Similar rules – allowing the removal of organs when a patient’s heart has stopped and fails to respond to prolonged massage – already apply in several other European countries, including Britain.

Professor Alain Tenaillon, the organ transplant specialist at the French government’s agency of bio-medicine, told Le Monde: “All the specialist literature suggests that anyone whose heart has stopped and has been massaged correctly for more than 30 minutes, is probably brain dead. But we have to accept that there are exceptions…. There are no absolute rules in this area.”

BMJ 2008;336:166-167 (26 January).Editorials by Giuseppe Biondi-Zoccai, assistant professor in cardiology et al.

Aspirin resistance in cardiovascular disease carries a worse prognosis, but may be indicative of pre-existing higher risk.

Aspirin has clear benefits in cardiovascular disease. It reduces total mortality, cardiovascular mortality, and cardiovascular morbidity in people with cardiovascular disease or those at high risk of the disease; it is also cheap, relatively safe, and easy to use.

To date, most research has focused on whether aspirin resistance really exists. We don’t know whether aspirin resistance is a true abnormal response or whether it reflects normal variability in drug activity. Management of patients with aspirin resistance should include a comprehensive appraisal of thrombotic and bleeding risks, the likelihood of non-adherence to treatment, and access to other antiplatelet agents.

BY: Mike Clancy, ER consultant, BMJ 2007;335:623-624 (29 September)

Acute chest pain is responsible for one in four emergency medical admissions in the United Kingdom observation and investigation is not easy, especially when the consequences of misdiagnosis include infarction, arrhythmia, and death.

The strategy of evaluating such patients in a chest pain unit based within or near the emergency department is used in 30% of emergency departments in the United States.

In theory, a chest pain unit should improve outcomes—but does it?

The ESCAPE trial by Goodacre and colleagues tried to answer this question.

The introduction of a chest pain unit had no significant effect on the proportion of people attending the emergency department with chest pain, the proportion of people with chest pain who were admitted, or the number of people admitted over the next 30 days.

Setting up a chest pain unit led to more patients being tested, but no reduction in the proportion of patients admitted.

The trial showed no benefits of chest pain units.

If you want to find out more about the effectiveness of chest pain units, just CLICK HERE.

Patients with cardiac chest pain should call emergency services 

BY: Will T Roberts, research fellow, Adam D Timmis, professor of clinical cardiology BMJ  2007;335:669 (29 September). 

In acute myocardial infarction, the risk of ventricular fibrillation is highest in the first 12 hours after onset of symptoms.

Key points

In acute myocardial infarction the most important means of saving life is to get the patient to a defibrillator and to start reperfusion therapy as soon as possible after the onset of symptoms