Do Antiarrhythmic Drugs Help In Cardiac Arrest?

Do Antiarrhythmic Drugs Help In Cardiac Arrest?

When considering 14 RCTs on use of antiarrhythmic drugs for shockable cardiac arrest, there was no benefit for survival to discharge or survival with good neurological outcome. Lidocaine improved ROSC vs placebo.

Prehospital Airway Management

Prehospital Airway Management

In light of the important prehospital airway management articles that came out this week, I thought it might be helpful to go into more depth on the topic of prehospital airway management.

How Many Intubations Does It Take For Proficiency?

How Many Intubations Does It Take For Proficiency?

It is estimated that to place an endotracheal tube (ETT) successfully in 30-60 seconds, using direct laryngoscopy, would take 3-5 years of experience and 137-243 endotracheal intubations (ETI). Increased experience did not reduce the time chest compressions were paused. The key take home is that ETI during CPR is really hard. Be prepared.

EMS ETT or LT for OHCA? Answers in PART

EMS ETT or LT for OHCA? Answers in PART

For adults with out-of-hospital cardiac arrest, initial laryngeal tube insertion by emergency medical service providers was associated with improved 72-hour survival, return of spontaneous circulation, hospital survival, favorable neurologic outcome, and airway success compared to initial endotracheal tube insertion.

PAMPer - Prehospital Plasma for Hemorrhagic Shock Saves Lives

PAMPer - Prehospital Plasma for Hemorrhagic Shock Saves Lives

Prehospital administration of 2 units of thawed plasma in adult trauma patients at risk for hemorrhagic shock reduced mortality compared to standard care, NNT = 10.

PARAMEDIC2 - Epinephrine in Arrest RCT

PARAMEDIC2 - Epinephrine in Arrest RCT

Epinephrine for out-of-hospital cardiac arrest improved overall 30-day survival (3.2%, epi vs 2.4%, placebo) but did not improve survival to discharge with a good neurological outcome.  In fact, more patients who received epinephrine and survived had severe neurological impairment than in the placebo group.

Midazolam Beat Haloperidol for Agitation

Midazolam Beat Haloperidol for Agitation

Midazolam 5mg IM beat haloperidol 5 mg, ziprasidone 20 mg, olanzapine 10 mg, and haloperidol 10 mg (all also given IM), with 71% sedated at 15 minutes.  Olazapine came in second.

Time to Epi for Non-Shockable Rhythm Matters

Time to Epi for Non-Shockable Rhythm Matters

Earlier epinephrine administration for non-shockable rhythm was associated with better overall survival to discharge and neurologically-intact survival.  Reducing EMS time to the scene, time to IV (or IO) access, and time to drug may improve survival in this group of patients.

Fast PEA | Slow PEA - Survival Difference

Fast PEA | Slow PEA - Survival Difference

There is a difference between PEA rhythms.  Slow rates of electrical activity had the usual dismal prognosis.  But those with electrical rates >60 had survival and favorable neurological outcome comparable to VF/VT, 22% and 15% respectively.

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