When Dan Shire’s heart stopped beating in 2016, it led to a race against time to save his life.
Shire’s wife heard him struggling to breathe in the middle of the night. Then she ran to the phone to call 911, started CPR, and waited minute-by-painful-minute for first responders to show up.
Once paramedics arrived at the couple’s Pickering, Ont., home, they used a defibrillator on Shire four times, then tried a potent medication in an attempt to restart his heart.
That drug, epinephrine — also called adrenaline — is given intravenously every three to five minutes, up to an average of six milligrams. It stimulates blood flow by squeezing the blood vessels, which can, in some cases, help get someone’s heart beating again.
But researchers worry there’s a dangerous ripple effect: When you save someone’s heart, you can hurt their brain. Studies suggest higher doses of epinephrine might actually cause neurological damage.
In Shire’s case, he survived his episode of cardiac arrest and now leads a largely normal life. But the 67-year-old does have cognitive impacts such as short-term memory issues and some difficulty with complex tasks like driving. He’s not sure how much of that is from his heart stopping — cutting off oxygen to his brain for the better part of 16 minutes — or the dose of epinephrine he was given.
When Dan Shire’s heart stopped beating in 2016, it led to a race against time to save his life. Paramedics gave him epinephrine. He survived, but with some cognitive impacts. (Turgut Yeter/CBC)
To give cardiac arrest patients the best chance at not only survival, but also a high quality of life, Canadian researchers have launched a massive, years-long trial to find the “sweet spot” for epinephrine usage.
“There could be a tendency that [first responders] are erring on the side of giving you as aggressive a treatment as possible to save your life in that moment,” said Shire.
“A month later, you might find yourself in the position where you had too much epinephrine, and now have problems with cognitive outcomes.”
Trial will include multiple provinces
Dubbed EpiDose, the randomized controlled trial involves paramedic teams in B.C., Ontario, and eventually more provinces. Each time those teams encounter a patient with cardiac arrest, they’ll randomly provide either a higher or lower dose of epinephrine.
Then researchers will track the results, not just to see which lives are saved, but to find out about their brain function afterwards.
It’s the latest in a set of ongoing studies on epinephrine from a research team co-led by Dr. Steve Lin, the interim chief of emergency medicine at St. Michael’s Hospital, a part of Unity Health Toronto.
The team is hoping to include data on nearly 4,000 randomly-selected patients — a process that could take five to six years.
Study aims to find best adrenaline dose for cardiac arrest patients
The drug epinephrine — or adrenaline — can increase a person’s chances of survival and full recovery after a cardiac arrest, but the optimal dose isn’t really known. A new study is equipping some paramedics in Ontario and B.C. with different doses of the drug to help determine the answer.
Lin said the researchers are proposing a new “ceiling” for the standard dose, if the results suggest that a lower dose of two milligrams in total works just as well or better than the current standard of six milligrams. His team will then be contacting survivors to see how their bout of cardiac arrest impacted their life, including their later neurological function.
That’s another reason why the trial will take years: Survivors will be few and far between. When it comes to cardiac arrest, most people don’t make it, with only an estimated 10 per cent of patients surviving if their heart stops outside of a hospital.
“Cardiac arrest is the most deadly condition, right?” noted Lin. “It’s when your heart actually stops beating. And if left untreated, patients will certainly die.”
Optimizing the dose
Epinephrine can save lives, he stressed, particularly when it’s used following first-response measures like cardiopulmonary resuscitation (CPR) and a defibrillator, which applies an electric charge to help a stopped heart start beating. But Lin is hopeful that a smaller epinephrine dose might optimize outcomes, allowing the medication to help restart the heart without damaging later brain function.
One randomized trial looking at epinephrine use for out-of-hospital cardiac arrest, published in 2018 in the New England Journal of Medicine, found the overall rate of survival 30 days later was slightly better in the group given epinephrine — up to an average of close to five milligrams — compared to those given a placebo.
But there were also noticeable differences in the groups’ brain function. Close to a third of those given epinephrine ended up with severe neurological disability, compared to less than 18 per cent in the placebo group.
“There is some evidence that there might be very high doses given that can harm the brain, because you squeeze the blood vessel so much that it starts to decrease blood flow to the brain itself,” Lin said.
“I think we can actually do better.”
How to do basic CPR when someone’s heart stops
When someone goes into cardiac arrest, cardiopulmonary resuscitation, or CPR, is one of the best ways to give them a shot at survival. Chris Schmied from St. John’s Ambulance walks health reporter Lauren Pelley through the basic steps.
‘These are really tough calls’
Sitting in the back of an ambulance in Oakville, Ont., longtime Halton Region paramedic Olena Campeau holds up one of the study kits: A white box labeled EpiDose, with no further information on what’s inside. It’s only when paramedics open the kit that they’ll learn which treatment arm a patient is assigned to, Campeau explained.
Halton Region was among the first paramedic teams to sign onto the trial, alongside services in Peel, Toronto, Ottawa and British Columbia Emergency Health Services.
Longtime Halton Region paramedic Olena Campeau is part of one of the first responder teams who are participating in the EpiDose study. Conducting this kind of research is crucial, she says, but it comes with challenges. (Turgut Yeter/CBC)
Conducting this kind of research is crucial, but it comes with challenges, she added. Cardiac arrest calls are fast-paced — since every moment counts when it comes to survival rates — and can happen anywhere.
“I attended to a cardiac arrest on a patient at an outdoor climbing wall,” Campeau said. “These are really tough calls for paramedics.”
The patients themselves are also unconscious, which adds another layer of complexity to the EpiDose research since people can’t actually give verbal or written consent to participate.
There’s also no time for paramedics to get a sign-off from someone’s family members, Lin noted, and that’s assuming anyone who knows the patient is even present.
Typically, advance consent from participants is a hallmark of medical studies like this. But since cardiac arrest is so deadly — and concrete research on the ideal epinephrine dose is so lacking — Lin said the team’s research is allowed under strict research ethics guidelines.
Surviving patients, or a deceased patient’s family, will be alerted after the fact, and patient information collected during the trial will also be de-identified and replaced by a unique study number to keep patients’ identities private.
The study was approved by the Sunnybrook Research Ethics Board, which means it meets federal guidelines for ethical research involving humans.
Kits for the EpiDose trial contain either a larger or smaller dose of epinephrine, but paramedics don’t know until they open the kit which dose the patient will get. That way, the patients are randomly assigned to get more or less of the potent drug. (Lauren Pelley/CBC)
Study could ‘change treatment’ approach globally
Emergency physician Dr. Benjamin Abella, director of the Center for Resuscitation Science at the University of Pennsylvania, said while adrenaline has been a cornerstone of cardiac arrest treatment for many years, it’s never been put to a proper clinical trial.
Animal models, and more recent human data, do suggest the drug improves initial survival rates, he noted — as in simply bringing back someone’s pulse. “But it leads to way more neurological injuries. That has to be really considered in how we approach patients with cardiac arrest.”
If someone near you goes into cardiac arrest, your quick actions could help save their life. Dr. Roopinder Sandhu, professor in cardiac sciences at the University of Calgary, shares what you need to know about basic life support and how to prevent cardiac arrest. For transcripts of The Dose, please visit: lnk.to/dose-transcripts. Transcripts of each episode will be made available by the next workday.
Abella, who isn’t involved in the EpiDose trial, welcomed deeper research into how well epinephrine works, given that hundreds of thousands of people across North America experience cardiac arrest in any given year.
“Dosing and timing of epinephrine are both really open questions, and we don’t have the answers,” he said. “I’m old enough to remember a time when dosing for epinephrine was much higher during cardiac arrest in the guidelines than what we do currently. And so that was changed — and it may need to change yet again.”
Lin and Campeau are both optimistic that the EpiDose trial could eventually reshape how paramedics tackle situations where someone’s heart has stopped beating, and even inform global clinical guidelines for how to best use epinephrine.
“We know that this is a crucial study,” Campeau said. “It can change treatment for cardiac patients across Canada, and possibly worldwide.”
Skinstitut Holiday Gift Kits take the stress out of gifting
Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.
In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.
“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.
There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.
Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.
Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.
In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.
Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?
It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.
Here’s how you can prepare your digital life for your survivors:
Apple
The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.
For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.
You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.
Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.
Google
Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.
When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.
You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.
There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.
Facebook and Instagram
Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.
When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.
The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.
You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.
TikTok
The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.
Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.
X
It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.
Passwords
Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?
Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.
But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.
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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.
The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.
New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.
The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.
Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.
Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.
“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.
“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”
McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.
But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.
The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.
He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.
“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.
“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.
McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”
McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.
He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.
“Early identification of reading difficulty can truly change the trajectory of a child’s life.”
This report by The Canadian Press was first published Oct. 23, 2024.
