NEJM study in 2016 showed no survival benefits or favorable neurological outcome regarding use of Amiodarone vs Lidocaine vs placebo in OHCA. In a recent publication by Acad Emerg Med, a post hoc analysis of original study was done and the authors found time to Amiodarone in OHCA could be associated with better survival to […]
Continue ReadingThere are bunch of rumors that come to play regarding what other medications we can use in cardiac arrest patient, Calcium, Sodium Bicarb, tPA,… A study published in JAMA tried to answer part of this question: “Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest, […]
Continue ReadingThe choice of vasopressor is always a topic of controversy regarding post cardiac arrest patients. Intensive Care Medicine recently published an article with focus on “Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock”. This study was in Paris metropolitan region. They included 766 patients and they found using Epi in OHCA post cardiac […]
Continue ReadingVery interesting study in patients who got ROSC and had an ECG. Patients with an ECG before 7 minutes after ROSC had more false positive ECG findings in favor of STEMI vs 8-33 minutes and more than 33 minutes. Link to study
Continue ReadingI may not activate cath lab during night shift for ROSC, status post cardiac arrest with no sign of STEMI! Lemkes et al. found in a multi-center cardiac arrest study among patients with immediate vs delayed coronary angiography that there is no survival benefit at 90 days. Link to PubMed
Continue ReadingWe know interruptions during cardiac arrest will have a worse outcome but intubation during a cardiac arrest for several reasons decreased survival rate among these patients. JAMA study measured good functional outcome among patients were intubated during the first 15 minutes and who were not intubated within the first 15 minutes! JAMA Full text
Continue ReadingIt has been a very difficult time for Epi since last 5 years! 2011: Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial 2012: Prehospital Epinephrine Use and Survival Among Patients With Out-of-Hospital Cardiac Arrest 2014: Is Epinephrine During Cardiac Arrest Associated With Worse Outcomes in Resuscitated Patients? and now […]
Continue ReadingAmiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest, which one is your choice? The 2015 update of ACLS is still recommending Amio in Vfib, VTach Cardiac arrest after Shock and Epi, But new study in NEJM proved that among 3026 patients who randomized to Amiodarone (974), Lidocaine (993), or Placebo (1059), there were no statistically […]
Continue ReadingIn a meta-analysis published in Resuscitation, 10 observational study reviewed and showed among patients with out of hospital cardiac arrest, patients who intubated via ETT had significantly better
Continue ReadingOXYGEN! Please put patient on NC 2 -4. This is one of our critical action in mock oral board questions, but is it really a critical action, how much oxygen do we need for a pt w/o hypoxemia?
Continue ReadingWe discussed 2 studies in our class specific session on impact of EPi on out of hospital cardiac arrest. J Am Coll Cardiol published another study this month and challenged again use of Epi in OHCA. 1,556 patients from 2000 to 2012, using EPi with different doses, and the conclusion is pre-hospital use of epinephrine […]
Continue ReadingMedical Principles and Practice published an article that uses a structured teaching tools to summarized 5 Hs and 5 Ts in PEA cardiac arrest, Lets start with 5 Hs(Hyper and Hypo K, Hypoxia, Hydrogen, Hypovolemia and Hypothermia) and 5 Ts( Tension PTX, Tamponade, Trauma, Toxins, Thrombosis), a very routine practice in ACLS guideline,
Continue ReadingWow. This is the third one, after 2 articles that showed Epi in prehospital really does not decrease mortality , now this retrospective study presenteddata that none of patients with asystole and no
Continue ReadingIn October 2011, I reviewed an interesting article in Resuscitation, September 2011 regarding use of Epinephrine in per-hospital setting, ,now we have another study published in JAMA, March 2012.
Continue ReadingThis is a very interesting study regarding usage of epinephrine in out of hospital setting. This is probably the first control trial in human post cardiac arrest. The study is about
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