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.
Brain Injury in DKA | Fluid Rate or Type RCT by PECARN
Neither the fluid rate (fast or slow) or type (NS vs 1/2NS) altered the risk of brain injury with decline in GCS <14 in children with DKA.
Bougie vs Stylet – The BEAM Trial
First attempt success was higher in the bougie group vs stylet group (98% vs 87% in all comers, 96% vs 82% in patients with at least one difficult airway characteristic). The median duration of the first-attempt as well as incidence of hypoxemia was similar between bougie and stylet groups.
NPO Status – No Correlation With Sedation Outcomes
In this cohort of thousands of pediatric ED sedation patients who didn't meet the American Society of Anesthesiologists (ASA) fasting guideline, none had aspiration nor was there any correlation of fasting time with any adverse events or vomiting. It is time to change hospital NPO policies for the ED.
The 10/20 Rule | Seizure vs Syncope
Syncope and seizure may be differentiated in two key ways. Ten or fewer jerks favor syncope; 20 or more jerks favor seizure. Loss of tone favors syncope.
BVM or ETT in Arrest – New RCT
Bag mask ventilation and endotracheal intubation were equal for airway management in patients with cardiac arrest in terms of good neurological outcome at 28-days.
SMART Trial – Balanced Crystalloids vs NS in Critically Ill Adults
In patients admitted to the ICU, use of balanced fluids resulted in a lower rate of major acute kidney events (MAKE) at 30 days compared to normal saline (14.3% vs 15.4%). This is a NNT of 94 to avoid one MAKE.
SALT-ED Trial – Balanced Crystalloid vs NS
In non-critically ill patients that received IV fluids in the ED, there was a lower incidence of major adverse kidney events in the balanced crystalloid group compared to saline (4.7% vs 5.6%) with a NNT of 111. There was no difference in terms of hospital-free days between the groups.
DEFUSE 3 – A New DAWN in Extending the Stroke Window?
Patients beyond the 6-hour invasive stroke treatment window benefitted from endovascular treatment of proximal MCA or ICA occlusion up to 16 hours from onset if there was a large ischemic penumbra on perfusion imaging that had not yet infarcted.
Paradigm Shift – Cuffed ETT for Children
Cuffed endotracheal tubes (ETT) had better ventilation characteristics and fewer complications during routine surgery than uncuffed.