Do Antiarrhythmic Drugs Help In Cardiac Arrest?

Do Antiarrhythmic Drugs Help In Cardiac Arrest?

When considering 14 RCTs on use of antiarrhythmic drugs for shockable cardiac arrest, there was no benefit for survival to discharge or survival with good neurological outcome. Lidocaine improved ROSC vs placebo.

Prehospital Airway Management

Prehospital Airway Management

In light of the important prehospital airway management articles that came out this week, I thought it might be helpful to go into more depth on the topic of prehospital airway management.

How Many Intubations Does It Take For Proficiency?

How Many Intubations Does It Take For Proficiency?

It is estimated that to place an endotracheal tube (ETT) successfully in 30-60 seconds, using direct laryngoscopy, would take 3-5 years of experience and 137-243 endotracheal intubations (ETI). Increased experience did not reduce the time chest compressions were paused. The key take home is that ETI during CPR is really hard. Be prepared.

EMS ETT or LT for OHCA? Answers in PART

EMS ETT or LT for OHCA? Answers in PART

For adults with out-of-hospital cardiac arrest, initial laryngeal tube insertion by emergency medical service providers was associated with improved 72-hour survival, return of spontaneous circulation, hospital survival, favorable neurologic outcome, and airway success compared to initial endotracheal tube insertion.

PAMPer - Prehospital Plasma for Hemorrhagic Shock Saves Lives

PAMPer - Prehospital Plasma for Hemorrhagic Shock Saves Lives

Prehospital administration of 2 units of thawed plasma in adult trauma patients at risk for hemorrhagic shock reduced mortality compared to standard care, NNT = 10.

PARAMEDIC2 - Epinephrine in Arrest RCT

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.

Bougie vs Stylet - The BEAM Trial

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.

IOTA - Oxygen, Less Is More

IOTA - Oxygen, Less Is More

For adults with varied acute illnesses, use of supplemental oxygen in patients with room air SpO2 of 94% or greater was associated with increased short and longterm mortality.

Are 3 Ports Better Than One? Triple Lumen Flow Rates

Are 3 Ports Better Than One? Triple Lumen Flow Rates

There were no statistically significant differences in pressure-bag flow rates for 1L of NS through all three ports of a standard triple-lumen catheter (TLC) compared to a 16 gauge peripheral venous catheter (PVC) or a 6Fr sheath introducer.  On gravity-flow, it was not statistically different from a 16 gauge PVC.  But 14ga PVC and 8.5Fr sheath rates were superior in both instances.

Time to Epi for Non-Shockable Rhythm Matters

Time to Epi for Non-Shockable Rhythm Matters

Earlier epinephrine administration for non-shockable rhythm was associated with better overall survival to discharge and neurologically-intact survival.  Reducing EMS time to the scene, time to IV (or IO) access, and time to drug may improve survival in this group of patients.

LR - When NOT to Use It

LR - When NOT to Use It

With all the talk of using balanced, lower chloride solutions for volume in the ED and ICU, we thought it might be a good idea to discuss the potential downsides of LR.

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