Neurocritical care

Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest

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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

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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

Targeted Temperature Management in Cardiac Arrest with Nonshockable Rhythm

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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

FDA approved First Factor Xa Inhibitor Antidote

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An estimated 4 million people are taking factor Xa inhibitors, such as rivaroxaban (Xarelto, Bayer/Janssen Pharmaceuticals) and apixaban (Eliquis, Bristol-Myers Squibb). In the USA, Apixaban generated 4.9 billion dollars for the company last year. Until now, there was no approved reversal agent for these factor Xa inhibitors. In the United States alone, there were approximately … Read more

Delayed thrombectomy in acute stroke effective

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R.G. Nogueira, A.P. Jadhav, D.C. Haussen et el published in NEJM on Nov 18,2017 trial results of delayed(6-24 hours) thrombectomy in acute stroke patients who had a mismatch between the severity of the clinical deficit and the infarct volume, conducted at 26 centers in the United States, Canada, Europe, and Australia. BACKGROUND National Institute of Neurologic Disorders and Stroke … Read more

Head position in acute ischemic stroke

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C.S. Anderson, H. Arima and P. Lavados et el published in NEJM a new cluster randomized trial about head position in acute ischemic stroke showing no difference between head elevation and flat position for first 24 hours (HeadPost Trial). BACKGROUND Earlier animal and non randomized small human studies showed that flat position may increase the … Read more

Guidelines for VTE prophylaxis in Neurocritical Care

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Nyquist, Paul, Jichici, Draga et el recently published evidence based guidelines for prevention of venous thromboembolism in neurocritical care. Risk of venous thromboembolism is present in all hospitalized patients and specially higher in neurocritical patients due to immobility. Combination therapy with chemoprophylaxis (Unfractioned heparin, Low molecular heparin) and mechanical prophylaxis (Intermittent pneumatic compression devices) is superior … Read more