Critical Care

CRITICAL – Indications for ECPR

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Registry study data finds the criteria to start extracorporeal cardiopulmonary resuscitation (ECPR) of age <75, time from emergency call to hospital arrival within 45 minutes and initial shockable rhythm to be predictive of good neurological outcomes and survival at one month.

Source
Clinical outcomes among out-of-hospital cardiac arrest patients treated by extracorporeal cardiopulmonary resuscitation: The CRITICAL study in Osaka. Resuscitation. 2022 Jun 14:S0300-9572(22)00568-8. doi: 10.1016/j.resuscitation.2022.06.007. Epub ahead of print.

Pre-AeRATE RCT – HFNC 60L vs NC 15L for Apneic Oxygenation

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There was no benefit to using high-flow nasal cannula at 60L/min vs regular NC at 15L/min for pre- and apneic oxygenation during emergency department intubations.

Source
Pre- and apnoeic high-flow oxygenation for rapid sequence intubation in the emergency department (the Pre-AeRATE trial): A multicentre randomised controlled trial. Ann Acad Med Singap. 2022 Mar;51(3):149-160. doi: 10.47102/annals-acadmedsg.2021407.

Does pSOFA in the PED Predict Mortality?

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The pSOFA score was not a good screening tool for predicting in-hospital mortality when used in a pediatric emergency department (PED) setting.

Source
Validation of the Pediatric Sequential Organ Failure Assessment Score and Evaluation of Third International Consensus Definitions for Sepsis and Septic Shock Definitions in the Pediatric Emergency Department. JAMA Pediatr. 2022 May 16. doi: 10.1001/jamapediatrics.2022.1301. Online ahead of print.

Does Video Laryngoscope Shape Affect Ramped Intubation Success?

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There was no significant difference in first-attempt success rate for ramped and upright position intubations in the Emergency Department when comparing hyperangulated and standard geometry video laryngoscopes.

Source
Impact of video laryngoscope shape on first-attempt success during non-supine emergency department intubations. Am J Emerg Med. 2022 Apr 27;57:47-53. doi: 10.1016/j.ajem.2022.04.024. Online ahead of print.

Does Ramped Position Increase First-Pass Success During Intubation?

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This systematic review and meta-analysis does not show any statistical difference in first-pass success rate or adverse intubation-related events between patients intubated in a inclined versus supine position.

Source
Effect of inclined positioning on first-pass success during endotracheal intubation: a systematic review and meta-analysis. Emerg Med J. 2022;0:1-7. Doi:10.1136/emermed-2021-212968

Do Balanced Fluids Help Critically Ill Children?

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There is some evidence that bolus treatment in critically ill pediatric patients (28 days old to 18 years old) with balanced fluids (such as LR) versus unbalanced fluids (such as NS) results in improved serum bicarbonate and blood pH values. However, it’s not clear if this is clinically beneficial.

Source
Balanced Versus Unbalanced Fluid in Critically Ill Children: Systematic Review and Meta-Analysis. Pediatr Crit Care Med. 2022 Mar 1;23(3):181-191. doi: 10.1097/PCC.0000000000002890.

Can’t Intubate, Can’t Oxygenate | Teaching Invasive Airway With Impalpable Neck Anatomy

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Scalpel-finger-cannula was faster and had higher first-attempt success rate than scalpel-finger-bougie for front-of-neck access in simulated obese, bleeding manikin models.

Source
Success and Time to Oxygen Delivery for Scalpel-Finger-Cannula and Scalpel-Finger-Bougie Front-of-Neck Access: A Randomized Crossover Study With a Simulated “Can’t Intubate, Can’t Oxygenate” Scenario in a Manikin Model With Impalpable Neck Anatomy. Anesth Analg. 2022 Mar 3. doi: 10.1213/ANE.0000000000005969. Online ahead of print.

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