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Elliot Phelps
Dr. Skutar
ENGL2089
September 8, 2015
Scholarly Article Critique
The scholarly article I have selected to evaluate comes from the journal Circulation. The
article describes a study to determine if therapeutic hypothermia by paramedics will create better
out comes for patients in cardiac arrest. The first thing I am evaluating is the qualifications of
authors of the article. There are eight authors listed on this article and they represent 23 different
investigators for the research project. Five of the authors are MDs and another author has a PhD.
They appear to have the proper credentials to write this article. The author with a PhD is listed as
a statistician which makes me think that the results that are reported were evaluated by her before
they were published. Some of the investigators work at hospitals while others work at
universities, and I feel that people in those positions have a lot of credibility. In addition, the
Australian National Health and Medical Research Council and the National Heart Foundation of
Australia both provided grants to fund this study, indicating credibility. Finally, because the
American Heart Association publishes the journal Circulation, I feel that organization wouldn’t
publish something that wasn’t valid research. All of this evidence makes me feel that the authors
have solid credentials for writing this article, and I feel confident that the results are valid.
The article starts with a great hook within the first sentence: “Cardiovascular disease is a
leading cause of premature death in developed countries, and many of these deaths occur before
hospital arrival because of ventricular fibrillation” (737). I think this is a good hook because, as
a paramedic, I do everything I can to make sure that people don’t die and I try to get them to the
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hospital as fast as I can so that they can receive the lifesaving treatment they need. If a
paramedic, emergency room nurse, or doctor sees this article, this first sentence will be a good
hook to get them to read the rest of the article. The authors include a reference for this first
sentence. They reference a medical journal, which makes me believe that the statement is true
and valid. The next two sentences in the introduction paragraph also keep the reader’s attention
and illustrate the problem that will be researched in the article. Like the first sentence, the
second sentence references a published article. Here the authors say that “Despite early
fibrillation and advanced cardiac life support provided by emergency medical services, fewer
than half of all patients in out-of-hospital cardiac arrest are resuscitated successfully” (737). It
makes me disappointed to see that only half of all cardiac arrest patients are successfully
resuscitated and it makes me want to read the article to learn about new ways that we could raise
the amount of successful resuscitations. There’s one more sentence in this introduction: “Among
those who have a return of spontaneous circulation and are transported to a hospital, many have
sustained severe anoxic neurological injury during the cardiac arrest, and this injury is a leading
cause of subsequent death in the hospital” (737). This sentence makes me even more
disappointed to see that many patients that have return of spontaneous circulation and have a
successful resuscitation will die anyway due to damages caused by lack of oxygen. While this
introduction section of the scholarly article has only three sentences, they are very powerful
sentences. After reading the introduction, I am feeling very optimistic about what the authors
will report as a new treatment option in this article. They have very clearly identified the
problem that they are considering in the research. These three sentences have created a very
strong introduction paragraph.
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Next the authors talk about the current recommended treatment for patients who are in
cardiac arrest. They provide a number of references to other published articles which gives me
confidence that this really is standard procedure. Then they provide their research question:
“Whether earlier cooling by paramedics improves patient outcomes compared with later cooling
after admission to hospital” (738). They have clearly stated the purpose of their study in this
statement and I am interested to find out the results of this study. Next, the authors describe the
sample used in the experiment. The sample comes from Melbourne, Australia, and the authors
describe the total population of the area, the number of certified paramedics, and the amount of
hospitals that will be receiving the patients for this study. All of this information is important in a
scholarly article so that the reader of the article can judge the quality of the research. The authors
provide very specific details about how the therapeutic treatment would be delivered in and out
of hospital. To qualify for this study, the patients have to meet a criteria of initial cardiac rhythm
of ventricular fibrillation, systolic blood pressure of higher than 90 mmHg, return of spontaneous
circulation, cardiac arrest time of greater than 10 minutes, fifteen years of age or older, and have
intravenous access. All patients who did not meet this criteria we eliminated from the study and
not given the therapeutic hypothermia treatment. It is very important for the authors to describe
the sample subjects and who is and is not part of the sample. Scholarly research articles must
describe the sample so that other researches can evaluate or recreate the research.
One part of this study that I found very interesting was how the paramedics treated the
patients that fit the criteria. For each patient that met the criteria for therapeutic hypothermia, the
paramedics were to choose from randomized envelopes that gave different treatments for the
patient. It is important in a study to have controlled and randomized samples. It is also important
for the authors to mention this in the study so that the reader knew that there was no bias. The
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authors’ careful description of the study procedures made me feel more confident that there was
little bias in this research. One thing that the authors did that was especially helpful in
understanding the processes used this study was to provide a flow chat. The flow chart gave a
visual overview of the study and showed the number of patients that met the criteria and the
number of patients that were disqualified. The flow chart ended by showing how many patients
were placed in the pre-hospital cooling treatment and in the hospital cooling treatment. The flow
chart made it easy for me to understand how they started with over six thousand patients in
cardiac arrest and ended up with just over one hundred in each treatment group. It was an
effective way for the writers to show this information.
Next the authors describe their statistical analysis. The authors had a separate section to
describe the statistical analysis that was done. They reported their analysis method and
referenced the software that they used. It is very important for a scholarly article to describe
exactly what was done with the data, and the authors of the article did that very well.
Unfortunately, after analyzing the first two hundred patients in the study, they found no
statistical difference between the two groups of patients that were treated with therapeutic
hypothermia in and out of hospital settings and the researchers decided to end the study. The
authors included a table which made it easy to see that there were no significant differences
between the paramedic cooling group and the hospital cooling group on their baseline
characteristics, such as their age, gender, witnessed arrest, time of paramedic arrival, medications
given, and other treatments. This gives the reader confidence that the two treatment groups are
similar and that any difference between their survival rates will be due to whether they receive
paramedic cooling or hospital cooling. The second table showed that there were no significant
differences between the vital signs of the patients that received paramedic cooling and hospital
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cooling. Both of these tables make it easy for the reader to understand the results of this study.
The authors used these tables effectively to summarize their findings for the reader.
The final section in the article is the Discussion section. In this section the authors go
over all of the information gathered throughout the study, talk about the results, and give some
ideas about why there were no differences between the two treatments. The authors state that
“our larger study showed that although paramedic cooling resulted in a modest decrease in core
temperature, there was no difference in outcomes at hospital discharge. The reasons for this
finding are speculative” (739). The authors speculate that there were no differences between the
groups because the paramedics were unable to finish the therapeutic hypothermia treatment
before reaching the hospital due to short transport time. It is good that the authors mention that
this is just speculation because they have no evidence to support that hypothesis. The next part of
the discussion section includes limitations to the research. The authors include three limitations
that might have affected the results. This makes me feel that they have been very honest in their
reporting of their research because they include these limitations. Their next paragraph talks
about the strengths of the research and gives the reader an idea of how their research had
validity. They conclude the article by summarizing the main findings. This is a good way to end
a scholarly article because the reader is recapped on the results and findings of the study.
At the end of the article is a Clinical Perspective. This paragraph describes the study and
findings in a brief, one paragraph summary. The Clinical Perspective provides out-of-hospital
EMS workers a brief synopsis saying that therapeutic hypothermia is recommended, but in their
study they were unable to prove if the treatment was more effective in or out of the hospital
setting. The authors end this paragraph by stating that “further research into cooling during
cardiopulmonary resuscitation should be undertaken” (742). This synopsis is an effective way for
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paramedic and emergency room doctors to remember the content of the article and understand
how it applies to their daily work without having to read the entire article.
The article ends with a reminder that readers of the article can receive continuing medical
education credit, which is required by all emergency medical workers, by taking a quiz online
about the article and therapeutic hypothermia treatment. Because medical workers are given the
opportunity to receive continuing medical education credit by reading the article, it makes me
feel that this is an important piece of research and has validity. The credit given from the quiz
about the article will entice more readers.
In conclusion, the authors did an excellent job writing this scholarly article. They started
with an interesting, important hook, described their methods in a very understandable and
complete manner, provided details about their statistical analysis, were honest about the
limitations of the study, speculated about reasons why they didn’t find their expected results, and
gave suggestions for future research. They also used charts and tables to make it easier for the
readers to understand the study and results. I would recommend this article to other people
within the medical profession. I can’t think of any ways to improve this scholarly article.
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Works Cited
Bernard, Stephen A., Karen Smith, Peter Cameron, Kevin Masci, David M. Taylor,
James Cooper, Anne-Maree Kelly, and William Silvester. “Induction of Therapeutic
Hypothermia by Paramedics after Resuscitation from Out-of-Hospital Ventricular Fibrillation
Cardiac Arrest.” Circulation (2010): 737-742. Print.