Rock Star Review of Critical Care Literature – 2018

January 23, 2020

Written by Clay Smith

Spoon Feed
This is a great reference list of critical care articles with EM relevance from the year 2018.

Why does this matter?
This is a group of authors we respect, and these are the critical care articles they thought were most important from the year 2018. JournalFeed covered ten of these in real time back in 2018. What were their picks?

The Lucky 13 CC from 2018

1. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med. 2018; 379:711–21. Authors’ take: “30-day survival occurred in 3.2% of patients who received epinephrine compared to 2.4% of patients who received placebo. In survivors, severe neurologic impairment occurred in 31% of patients who received epinephrine compared to 17.8% of patients who received placebo.”
   JF Summary

2. Effect of bag-mask ventilation vs endotracheal intubation during cardiopulmonary resuscitation on neurological outcome after out-of-hospital cardiopulmonary arrest. A randomized clinical trial. JAMA. 2018; 319:779–87. Authors’ take: “28-day survival with favorable neurologic outcome occurred in 4.3% of patients in the BMV group and in 4.2% of patients in the ETI group. There was no difference in the secondary outcomes of survival to hospital admission and 28-day survival between the two groups.”
   JF Summary

3. Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: The AIRWAYS-2 randomized clinical trial. JAMA. 2018; 320:779–91. Authors’ take: “The primary outcome of neurologic outcome at hospital discharge or 30-days after OHCA occurred in 6.4% of patients randomized to an SGA and 6.8% of patients randomized to ETI. Initial successful insertion rates were greater in the SGA group without any increase in complications.”
   JF Summary

4. Association between elevated mean arterial blood pressure and neurologic outcome after resuscitation from cardiac arrest: results from a multicenter prospective cohort study. Crit Care Med. 2018;47(1):93–100. Authors’ take: “Patients in the higher MAP group (MAP greater than 90 mmHg) had a higher incidence of good neurologic outcome when compared patients with a MAP between 70 and 90 mmHg. A MAP greater than 90 mmHg was found to be an independent predictor of good neurologic function at hospital discharge. The benefit of a higher MAP was greater in patients with a history of hypertension compared with those with no history of hypertension.”

5. Association between early hyperoxia exposure after resuscitation from cardiac arrest and neurological disability: a prospective multi-center protocol-directed cohort study. Circulation 2018;137(20):2114–2124. Authors’ take: “Patients exposed to hyperoxia had a higher incidence of poor neurologic outcome at hospital discharge compared to patients not exposed to hyperoxia. Hyperoxia was found to be an independent predictor of poor neurologic outcome at hospital discharge.”
   JF Summary

6. Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med. 2018;378(9):797–808. Authors’ take: “No significant difference in the primary outcome of 90-day all-cause mortality in patients who received hydrocortisone compared to those who received placebo. Time to shock resolution, time to ICU discharge, and the duration of the initial episode of mechanical ventilation were all shorter in patients who received hydrocortisone.”
   JF Summary

7. Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med. 2018;378: 809–18. Authors’ take: “The primary outcome of 90-day all-cause mortality occurred 43% of the hydrocortisone-fludrocortisone group compared with 49.1% in the placebo group. Those in the hydrocortisone-fludrocortisone group had a statistically significant difference in all-cause mortality at ICU discharge. Patients in the hydrocortisone-fludrocortisone group had a shorter time to cessation of mechanical ventilation and cessation of vasopressor therapy.”
   JF Summary

8. Effect of use of a bougie vs endotracheal tube and stylet on first-attempt intubation success among patients with difficult airways undergoing emergency intubation: A randomized clinical trial. JAMA 2018; 319:2179–2189. Authors’ take: “The primary outcome of first attempt success in those with at least one characteristic of a difficult airway occurred in 96% of patients randomized to the bougie and 82% of patients randomized to the ETT plus stylet.”
   JF Summary

9. Cardiac arrest and mortality related to intubation procedure in critically ill adult patients: A multicenter cohort study. Crit Care Med. 2018; 46:532. Authors’ take: “Patients who suffered an intubation-related cardiac arrest had a higher 28-day mortality rate compared with patients who did not have an intubation-related cardiac arrest. A systolic blood pressure <90 mm Hg prior to intubation, hypoxemia prior to intubation, the absence of preoxygenation, obesity, and age >75 years were associated with intubation– related cardiac arrest.”
   JF Summary

10. Effect of a low vs intermediate tidal volume strategy on ventilator-free days in intensive care unit patients without ARDS. The PReVENT Trial. JAMA 2018; 320 (18):1872–1880. Authors’ take: “There was no significant difference in the primary outcome of ventilator free days and alive at day 28 between the low tidal volume ventilation group and the intermediate tidal volume ventilation group.”
    JF Summary

11. Practice patterns and outcomes associated with early sedation depth in mechanically ventilated patients: A systematic review and
    meta-analysis. Crit Care Med 2018; 46 (3):471–479. Authors’ take: “A statistically significant decrease in mortality was found for patients who received an early, lighter level of sedation compared with patients who received early, deep sedation. Lighter sedation was also associated with significantly fewer days of mechanical ventilation and shorter ICU lengths of stay.”

12. Balanced crystalloids versus saline in critically ill adults. N Engl J Med 2018;378(9): 829–39. Authors’ take: “The primary outcome of MAKE at 30 days occurred in 14.3% of the balanced crystalloid group compared with 15.4% of the 0.9% sodium chloride group.”
    JF Summary

13. Sodium bicarbonate therapy for patients with severe metabolic acidemia in the intensive care unit (BICAR-ICU): a multicenter, open-label, randomized controlled, phase 3 trial. Lancet. 2018; 392:31–40. Authors’ take: “There was no significant difference in the primary outcome of all-cause 28-day mortality and failure of at least one organ system at seven days after randomization between patients in the intervention group and those in the control group.”

Source
Winters ME, Hu K, Martinez JP, Mallemat H, Brady WJ. The critical care literature 2018. Am J Emerg Med. 2019 Nov 28. pii: S0735-6757(19)30772-7. doi: 10.1016/j.ajem.2019.11.032. [Epub ahead of print]

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