INCEPTION RCT – Early ECMO for Refractory Arrest
Spoon Feed
This multicenter randomized controlled trial (the INCEPTION trial), comparing ECPR vs conventional CPR for refractory cardiac arrest, showed no improvement in neurologically intact survival at 30 days.
Source
Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest. N Engl J Med. 2023 Jan 26;388(4):299-309. doi: 10.1056/NEJMoa2204511.
Epi for OHCA – ROSC, Survival…But Are We Saving the Brain?
Spoon Feed
In this systematic review and meta-analysis, researchers found the epinephrine in standard doses, high doses, and with vasopressin lead to an improvement in ROSC and survival to hospital admission in out of hospital cardiac arrest (OHCA) but did not improve survival to discharge or functional neurologic outcome.
Source
Epinephrine in Out-of-Hospital Cardiac Arrest: A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms. Chest. 2023 Jan 31:S0012-3692(23)00165-4. doi: 10.1016/j.chest.2023.01.033. Epub ahead of print.
CPR Fatigue Is REAL – How Do Fit Rescuers Perform?
Spoon Feed
In this study of firefighters performing CPR with feedback devices, researchers found that compression depth decreased over the course of a two-minute chest compression cycle while compression rate stayed within goal.
Source
Temporal analysis of continuous chest compression rate and depth performed by firefighters during out of hospital cardiac arrest. Resuscitation. 2023 Feb 16;185:109738. doi: 10.1016/j.resuscitation.2023.109738. Epub ahead of print.
Lunacy? Does a Full Moon Mean More 911 Calls?
Spoon Feed
A full moon has no association with EMS activation patterns in the United States.
Source
Full moons are not associated with increases in emergency medical services (EMS) activations (911 calls) in the United States. Am J Emerg Med. 2022 Nov;61:227-228. doi: 10.1016/j.ajem.2022.07.044. Epub 2022 Jul 20.
EXACT Trial – Oxygen Saturation Targets after Cardiac Arrest
Spoon Feed
Targeting a lower oxygen saturation (90-94%), compared to standard care (98-100%), in patients who were resuscitated after out-of-hospital cardiac arrest (OHCA) until admission to the intensive care unit did not significantly improve survival to hospital discharge.
Source
Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 2022 Nov 8;328(18):1818-1826. doi: 10.1001/jama.2022.17701.
Does Calcium Work for PEA in Suspected Hyperkalemia?
Spoon Feed
Empiric calcium administration in PEA arrest not only failed to improve ROSC, but also had no impact when ECG features of hyperkalemia and acute myocardial ischemia were present.
Source
Effect of Calcium in Patients with Pulseless Electrical Activity and Electrocardiographic Characteristics Potentially Associated with Hyperkalemia and Ischemia-Sub-study of the Calcium for Out-of-hospital Cardiac Arrest (COCA) trial. Resuscitation. 2022 Nov 17;S0300-9572(22)00712-2. doi: 10.1016/j.resuscitation.2022.11.006. Online ahead of print.
Refractory Ventricular Fibrillation – What’s the Best Defibrillation Strategy?
Spoon Feed
For the treatment of refractory ventricular fibrillation (VF) in out-of-hospital cardiac arrest, survival to hospital discharge was more common among patients who received double sequential external defibrillation (DSED) and vector-change (VC) defibrillation than those who received standard defibrillation.
Source
Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 6. doi: 10.1056/NEJMoa2207304. Online ahead of print.
Should Medics Clear C-Spine in the Field?
Spoon Feed
In this large, single-center prospective cohort implementation study, paramedics were able to apply a modified Canadian C-spine rule to assess low risk trauma patients and transport a large proportion of them to a higher level of care without spinal precautions.
The TBI SBP Sweet Spot – Is 130-180 mmHg the New Normotension?
Spoon Feed
In-hospital mortality of TBI patients decreased linearly as the lowest observed out-of-hospital systolic blood pressure increased, with the lowest mortality between 130 and 180 mmHg.
Source
Optimal Out-of-Hospital Blood Pressure in Major Traumatic Brain Injury: A Challenge to the Current Understanding of Hypotension. Ann Emerg Med. 2022 Jul;80(1):46-59. doi: 10.1016/j.annemergmed.2022.01.045. Epub 2022 Mar 24.
Does Prehospital Intranasal Glucagon for Hypoglycemia Work?
Spoon Feed
In this small study of hypoglycemic patients who received prehospital intranasal glucagon, 32% had substantial improvement, 30% had slight improvement, and 38% had no improvement. There was no clear patient characteristic that predicted response.
Source
Prehospital Intranasal Glucagon for Hypoglycemia. Prehosp Emerg Care. 2022 Mar 2;1-4. doi: 10.1080/10903127.2022.2045406. Online ahead of print.