Ketamine for the Win? Induction Agents Compared
Dr. Amal Mattu and friends have a new video course you don't want to miss. Take a look!
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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.
New Meta-analysis – ECPR vs CPR in Cardiac Arrest
Dr. Amal Mattu and friends have a new video course you don't want to miss. Take a look!
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This updated meta-analysis re-demonstrated a benefit for extracorporeal cardiopulmonary resuscitation (ECPR) in reducing overall in-hospital cardiac arrest (IHCA) mortality and improving neurological outcomes after cardiac arrest but also demonstrated a new significant reduction in out of hospital cardiac arrest (OHCA) mortality with ECPR.
Source
Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: an updated meta-analysis and trial sequential analysis. Crit Care. 2024 Feb 21;28(1):57. doi: 10.1186/s13054-024-04830-5.
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.
ECMO (aka ECPR) for Refractory OHCA
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This "brass tacks" summary of a recent systematic review found no improvement in favorable neurologic outcomes or reduction of in-hospital mortality for extracorporeal cardiopulmonary resuscitation (ECPR) when compared to standard advanced cardiac life support (ACLS) for refractory out-of-hospital cardiac arrest (OHCA).
Source
Extracorporeal Cardiopulmonary Resuscitation in Refractory Out-of-Hospital Cardiac Arrest. Acad Emerg Med. 2023 Dec 05;31(2):190-192. doi: 10.1111/acem.14844.
Why Are More PE Patients Dying?
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Mortality in patients with high-risk pulmonary embolism (PE) in the United States increased over the last decade. Surprised? Here’s why this might be true, and what we should do about it.
Mortality of High-Risk PE Is, Well…High
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A prospective study by the PERT Consortium found an in-hospital mortality rate of 20% in patients with high-risk PE. 41.9% of patients with high-risk PE were treated with advanced therapies (systemic thrombolytics, catheter-directed thrombolysis or embolectomy, surgical embolectomy, ECMO).
Source
Contemporary Management and Outcomes of Patients With High-Risk Pulmonary Embolism. J Am Coll Cardiol. 2024;83(1):35-43. doi:10.1016/j.jacc.2023.10.026
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.
Oxy-PICU RCT – Oxygenation Targets in Ventilated Children
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A conservative (SpO2 88-92%) oxygenation target resulted in a small but significant greater probability of better outcome compared to a liberal (SpO2 >94%) target in children admitted to the PICU on invasive mechanical ventilation.
Source
Conservative versus liberal oxygenation targets in critically ill children (Oxy-PICU): a UK multicentre, open, parallel-group, randomised clinical trial. Lancet. 2023 Dec 1:S0140-6736(23)01968-2. doi: 10.1016/S0140-6736(23)01968-2. Epub ahead of print.
High-Dose Nitroglycerin for SCAPE – But How High?
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High-dose nitroglycerin improves outcomes in patients with sympathetic crashing acute pulmonary edema (SCAPE) without significant side effects when compared to low-dose nitroglycerin.
Post-Cardiac Arrest Critical Care | Spoon Feed Version
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Today we are covering a new, joint scientific statement from the American Heart Association and Neurocritical Care Society regarding care of patients who suffered cardiac arrest and subsequently had ROSC.
Source
Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement From the American Heart Association and Neurocritical Care Society. Circulation. 2023 Nov 28. doi: 10.1161/CIR.0000000000001163. Online ahead of print.