April 2024

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In a very specific subgroup of weights, using an ETT that is 0.5 mm smaller than the NRP recommended size was associated with reduced adverse events during tracheal intubation of neonates. 

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Endotracheal tube size adjustments within 7 day of neonatal intubation. Pediatrics. 2024 Mar 12:e2023062925. Online Ahead of Print.

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The HOT-COVID RCT found that hypoxemic COVID-19 patients in the ICU benefitted from a lower oxygenation target (PaO₂ 60 mm Hg) by having more days without life support than those who had a higher oxygenation target (PaO₂ goal 90 mm Hg).

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Lower vs Higher Oxygenation Target and Days Alive Without Life Support in COVID-19: The HOT-COVID Randomized Clinical Trial. JAMA. Published online March 19, 2024. doi:10.1001/jama.2024.2934

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In patients with ACS and concern for STEMI/NSTEMI requiring urgent intervention, randomization to the contrast volume reduction (CVR) group reduced the rate of acute kidney injury (AKI) and sustained kidney damage.

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Kidney Injury After Minimal Radiographic Contrast Administration in Patients With Acute Coronary Syndromes. J Am Coll Cardiol. 2024;83(11):1059-1069. doi:10.1016/j.jacc.2024.01.016

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Bayesian analysis is becoming more common in clinical research and offers advantages over traditional frequentist methods when used appropriately. This primer can help understand Bayesian analysis better.

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Introduction to Bayesian Analyses for Clinical Research. Anesth Analg. 2024;138(3):530-541. doi:10.1213/ANE.0000000000006696

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This was an exploratory analysis of the recently published SELECT2 trial, which randomized 352 adults with acute ischemic stroke due to carotid or M1 MCA occlusion to endovascular thrombectomy (EVT) or medical management. The current analysis showed that EVT was superior in functional outcomes across a variety of ischemic severities and penumbra profiles on imaging.

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Endovascular Thrombectomy for Large Ischemic Stroke Across Ischemic Injury and Penumbra Profiles. JAMA. 2024;331(9):750-763. 

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In patients with anterior circulation large-vessel occlusion (LVO) stroke presenting to thrombectomy capable stroke centers, the benefit of intravascular thrombolysis in the setting of endovascular thrombectomy appears to be time-dependent.

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Time to Treatment With Intravenous Thrombolysis Before Thrombectomy and Functional Outcomes in Acute Ischemic Stroke: A Meta-Analysis. JAMA. 2024 Mar 5;331(9):764-777. doi: 10.1001/jama.2024.0589. PMID: 38324409; PMCID: PMC10851137.

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In a controlled hypoxemia study, pulse oximetry was falsely elevated in subjects with darker skin pigmentation and low perfusion.

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Low Perfusion and Missed Diagnosis of Hypoxemia by Pulse Oximetry in Darkly Pigmented Skin: A Prospective Study. Anesth Analg. 2024 Mar 1;138(3):552-561. doi: 10.1213/ANE.0000000000006755. Epub 2023 Dec 18. PMID: 38109495.

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High-dose epinephrine (>3mg) was associated with unfavorable neurologic outcome when compared to low-dose epinephrine (≤3mg) after extracorporeal cardiopulmonary resuscitation.

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Cumulative epinephrine dose during cardiac arrest and neurologic outcome after extracorporeal cardiopulmonary resuscitation. Am J Emerg Med. 2024 Mar 15;80:61-66. doi: 10.1016/j.ajem.2024.03.013. Epub ahead of print. PMID: 38507848.

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Targeted ETCO2 ≥20 mm Hg during pediatric resuscitation was associated with higher rate of survival in patients with in-hospital cardiac arrest.

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In subgroup analysis, there may be more successful ROSC in patients with upper extremity IO access compared to lower extremity access in OHCA, but these results should be adopted with caution.

Source
Retrospective Comparison of Upper and Lower Extremity Intraosseous Access During Out-of-Hospital Cardiac Arrest Resuscitation. Prehosp Emerg Care. 2024 Mar 26:1-8. doi: 10.1080/10903127.2024.2321285. Epub ahead of print. PMID: 38416867.