Ketamine for the Win? Induction Agents Compared
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A Bayesian meta-analysis found an 83.2% probability that ketamine lowers mortality compared to etomidate in critically ill patients undergoing intubation.
Source
Ketamine versus etomidate as an induction agent for tracheal intubation in critically ill adults: a Bayesian meta-analysis. Crit Care. 2024 Feb 17.
Comparing Intubation of Critically Ill Children between APRNs and Physicians
Dr. Amal Mattu and friends have a new video course you don't want to miss. Take a look!
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Review of tracheal intubations (TIs) performed in pediatric ICUs found advanced practice registered nurses (APRNs) had a lower first attempt success compared to doctors and respiratory therapists.
Epinephrine or Airway First in OHCA?
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In adults presenting to EMS after OHCA, those receiving epinephrine prior to advanced airway management (AAM = supraglottic airway, SGA, or endotracheal tube) experienced better outcomes and prehospital ROSC than those receiving AAM before epinephrine. This was true for both shockable and non-shockable initial rhythms.
Source
Sequence of Epinephrine and Advanced Airway Placement After Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2024 Feb 5;7(2):e2356863. doi: 10.1001/jamanetworkopen.2023.56863.
Guidelines for Prehospital Airway Management
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A panel of experts appraising a systematic review on prehospital airway management created 22 recommendations relating to ventilation (BVM vs SGA vs ETI), video laryngoscopy (VL), and drug-assisted airway management.
Source
Evidence-Based Guideline for Prehospital Airway Management. Prehosp Emerg Care. 2023. Dec 22. Doi: 10.1080/10903127.2023.2281363. Online ahead of print.
Don’t Push! Excessive Neonatal Mask Pressure and Apnea-Bradycardia
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When providing respiratory support to preterm infants with a facemask, avoid excessive force on the face that is associated with apnea and bradycardia.
Source
Exerted force on the face mask in preterm infants at birth is associated with apnoea and bradycardia. Resuscitation. 2024;194:110086.
GCS of 8… But Should You Intubate?
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In patients with suspected acute poisoning who are comatose, a more restrictive intubation approach where intubation is withheld unless an accompanying emergent indication is present, may lead to fewer ICU admissions, decreased ICU length of stay, and decreased requirement for mechanical ventilation, with fewer adverse events.
Source
Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning: A Randomized Clinical Trial. JAMA. 2023 Dec 19;330(23):2267-2274. doi: 10.1001/jama.2023.24391.
Good Bagging in CPR Saves Lives?
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For the majority of out-of-hospital cardiac arrest (OHCA) patients undergoing standard (30:2 compressions:breaths) cardiopulmonary resuscitation (CPR) prior to definitive airway placement, bag-valve mask (BVM) ventilations did not achieve adequate lung volumes most of the time. Receiving adequate BVM ventilations >50% of the time was associated with significantly higher rates of return of spontaneous circulation (ROSC) and survival.
Source
Bag-Valve-Mask Ventilation and Survival from Out-of-Hospital Cardiac Arrest: A Multicenter Study. Circulation. 2023 Nov 12. doi: 10.1161/CIRCULATIONAHA.123.065561. Epub ahead of print.
Ketamine vs Etomidate RCT- Which Causes Higher SOFA Score?
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This single center RCT found no difference in maximum Sequential Organ Failure Assessment (SOFA) score between critically ill adult ED patients receiving ketamine vs etomidate for rapid sequence intubation (RSI).
Source
The Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum Sequential Organ Failure Assessment Score: A Randomized Clinical Trial. The Journal of Emergency Medicine, Volume 65, Issue 5, 2023, Pages e371-e382, ISSN 0736-4679, https://doi.org/10.1016/j.jemermed.2023.06.009.
Early or Delayed Intubation in Critically Ill Patients?
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Advanced statistics emulating clinical trial protocols from an ICU database did not identify consistent differences in 30-day mortality when ICU patients were intubated early (within 8 hours of admission) or late (after 48 hours).
Source
Emulating Target Trials Comparing Early and Delayed Intubation Strategies. Chest. 2023 Oct;164(4):885-891. doi: 10.1016/j.chest.2023.04.048. Epub 2023 May 5.
Hot Topics in RSI – Guidelines from The Society of Critical Care Medicine
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Positioning, preoxygenation, medication selection, and other questions surrounding emergent rapid sequence intubation (RSI) are addressed by an expert panel.