Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest

Josef Dankiewicz, Tobias Cronberg, Gisela Lilja et el published a trial of normothermia vs hypothermia in out of hospital cardiac arrest in NEJM. BACKGROUND Targeted temperature management (TTM, therapeutic hypothermia) after cardiac arrest first came to use in clinical setting since the publication of two landmark articles in 2002(1,2). Earlier it was noted that persons … Read more

ECMO in refractory out of hospital VFib cardiac arrest

Yannopoulos D, Bartos J, Raveendran G, Walser E, et al published a trial in the Lancet   about therapy in patients with out of hospital  refractory ventricular fibrillation cardiac arrest.  WHAT Phase 2, single-center, open-label, pragmatic, randomized clinical trial.   WHERE University of Minnesota Medical Center (MN, USA) PATIENTS Adult patients (aged 18-75) with out of hospital … Read more

Update in cardiac resuscitation : New CPR Guidelines

Ashish Panchel, Jason Bartos, Jose Cabanas et el published uptdated guidelines for cardiac resuscitation in Circulation. Salient features are summarized in this picture. Now a days the guidelines are updated on a continuous basis but these are the salient changes summarized in a table form. Most updated treatment recommendations for cardiac arrest resuscitation   FOR … Read more

Balanced crystalloids are gaining ground in sepsis?

Brown RM, Wang L, Coston TD , Krishnan NI et el published a secondary analysis of patients from SMART (Isotonic Solutions and Major Adverse Renal Events Trial) admitted with sepsis to ICU. Original  smart trial  was published in 2017,  which is discussed here .  A total of 15,802 patients  were enrolled in the trial.  It was a pragmatic, cluster-level … Read more

2019 Focused update on Advanced cardiac life support

American Heart Association published focused update on Advanced Cardiac Life Support in conjunction with 2019 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendation from International liaison committee on resuscitation(ILCOR). This focus update  provide new recommendations for use of advanced airways, vasopressors and extracorporeal CPR( ECPR).  Rest of the guidelines remain … Read more

Targeted Temperature Management in Cardiac Arrest with Nonshockable Rhythm

J.B. Lascarrou, H. Merdji, A. Le Gouge et el published the results of HYPERION (Hypothermia after Cardiac Arrest in Nonshockable Rhythm) trial in NEJM. WHAT Open-label, randomized, controlled trial comparing moderate therapeutic hypothermia (33°C during the first 24 hours) with targeted normothermia (37°C) in adult patients with coma(GCS <8) after resuscitation from cardiac arrest with … Read more

Intraosseous Access is associated with lower survival in out of hospital cardiac arrest

Takahisa Kawano,  Brian Grunau,  Frank X. Scheuermeyer  et el published a study comparing  intraosseous versus intravenous vascular access on survival as well as neurological outcome in out of hospital cardiac arrest in Annals of emergency medicine. BACKGROUND Intraosseous access (IO) was first pioneered by Drinkler and colleagues in 1922 but it became popular as a substitute to … Read more

Plasma as pre hospital resuscitation in trauma patients

J.L. Sperry, F.X. Guyette, J.B. Brown, M.H. Yazer et el published a trial of plasma vs standard fluid resuscitation in trauma patients who were at risk of hemorrhagic shock while being transported by air medical services. BACKGROUND In hospital treatment of trauma involves “damage control resuscitation” which aims to prevent coagulopathy by minimization of the use of crystalloid-based … Read more