Cardiac Catheterization Laboratory Management of the Comatose Adult Patient With an Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association

Circulation – 19 Dec 2023

Out-of-hospital cardiac arrest is a leading cause of death, accounting for ≈50% of all cardiovascular deaths. The prognosis of such individuals is poor, with <10% surviving to hospital discharge. Survival with a favorable neurologic outcome is highest among individuals who present with a witnessed shockable rhythm, received bystander cardiopulmonary resuscitation, achieve return of spontaneous circulation within 15 minutes of arrest, and have evidence of ST-segment elevation on initial ECG after return of spontaneous circulation. The cardiac catheterization laboratory plays an important role in the coordinated Chain of Survival for patients with out-of-hospital cardiac arrest. The catheterization laboratory can be used to provide diagnostic, therapeutic, and resuscitative support after sudden cardiac arrest from many different cardiac causes, but it has a unique importance in the treatment of cardiac arrest resulting from underlying coronary artery disease. Over the past few years, numerous trials have clarified the role of the cardiac catheterization laboratory in the management of resuscitated patients or those with ongoing cardiac arrest. This scientific statement provides an update on the contemporary approach to managing resuscitated patients or those with ongoing cardiac arrest.

Further information – Cardiac Catheterization Laboratory Management of the Comatose Adult Patient With an Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association

Intensive Care Society – Your Society – Our Strategy 2023-2027

Intensive Care Society 2023

This strategy was created and designed collaboratively to implement an ambitious vision to grow the Intensive Care Society. We want the strategy to enable us to deliver quality services and products that meet the changing needs of today’s and tomorrow’s members and our wider beneficiaries. We also want to ensure the strategy enables
us to fulfil our charitable object and is underpinned by an efficient, effective and economical infrastructure.

Read the Report – Intensive Care Society – Your Society – Our Strategy 2023-2027

Airway management in neonates and infants: – European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines

European Journal of Anaesthesiology 41(1):p 3-23, January 2024. 

This practice guideline aims to provide an evidence-based approach to airway management in neonates and infants. It was developed by a core group of experts in paediatric airway management, with the intention to serve anaesthetists working in a variety of paediatric settings, from highly specialised to district centres. As expertise and resources differ across centres, these practice guidelines are not a standard of care, however, they should serve as a basis for developing local institutionally approved operating procedures and best practice guidelines.

Further information – Airway management in neonates and infants

American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation

Journal of Burn Care & Research, 2023

In 2020, the American Burn Association (ABA) began a process to create new Clinical Practice Guidelines (CPGs). The ad hoc CPG committee developed a standardized, evidence-based process for CPG production, which is now in use by several Investigator Panels. An overarching goal will be to harmonize the new CPGs with the ABA Quality Registry and burn center verification standards. The authors of this guideline represent the Investigator Panel for the topic of acute burn shock resuscitation, and construction of this CPG was conducted between March 2022 and March 2023.

Further information – American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation

AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review

Gastroenterology 2023;

Cirrhosis is a major cause of morbidity and mortality in the United States and worldwide. It consists of compensated, decompensated, and further decompensated stages; median survival is more than 15 years, 2 years, and 9 months for each stage, respectively. With each stage, there is progressive worsening of portal hypertension and the vasodilatory–hyperdynamic circulatory state, resulting in a progressive decrease in effective arterial blood volume and renal perfusion. Vasoconstrictors reduce portal pressure via splanchnic vasoconstriction and are used in the management of variceal hemorrhage. Intravenous (IV) albumin increases effective arterial blood volume and is used in the prevention of acute kidney injury (AKI) and death after large-volume paracentesis and in patients with spontaneous bacterial peritonitis (SBP). The combination of vasoconstrictors and albumin is used in the reversal of hepatorenal syndrome (HRS-AKI), the most lethal complication of cirrhosis. Because a potent vasoconstrictor, terlipressin, was recently approved by the US Food and Drug Administration, and because recent trials have explored use of IV albumin in other settings, it was considered that a best practice update would be relevant regarding the use of vasoactive drugs and IV albumin in the following 3 specific scenarios: variceal hemorrhage, ascites and SBP, and HRS.

Further information – AGA Clinical Practice Update on the Use of Vasoactive Drugs and Intravenous Albumin in Cirrhosis: Expert Review

Airway management in neonates and infants – European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines

European Journal of Anaesthesiology – 29th Nov 2023

Airway management is required during general anaesthesia and is essential for life-threatening conditions such as cardiopulmonary resuscitation. Evidence from recent trials indicates a high incidence of critical events during airway management, especially in neonates or infants. It is important to define the optimal techniques and strategies for airway management in these groups. In this joint European Society of Anaesthesiology and Intensive Care (ESAIC) and British Journal of Anaesthesia (BJA) guideline on airway management in neonates and infants, we present aggregated and evidence-based recommendations to assist clinicians in providing safe and effective medical care.

Further information – Airway management in neonates and infants

Delivery of a novel intervention to facilitate liberation from mechanical ventilation in paediatric intensive care: A process evaluation

PLOS One – Nov 27 2023

Prolonged mechanical ventilation increases the risk of mortality and morbidity. Optimising sedation and early testing for possible liberation from invasive mechanical ventilation (IMV) has been shown to reduce time on the ventilator. Alongside a multicentre trial of sedation and ventilation weaning, we conducted a mixed method process evaluation to understand how the intervention content and delivery was linked to trial outcomes.

Read the article – Delivery of a novel intervention to facilitate liberation from mechanical ventilation in paediatric intensive care: A process evaluation

An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline

American Journal of Respiratory and Critical Care Medicine – November 2023

This document updates previously published Clinical Practice Guidelines for the management of patients with acute respiratory distress syndrome (ARDS), incorporating new evidence addressing the use of corticosteroids, venovenous extracorporeal membrane oxygenation, neuromuscular blocking agents, and positive end-expiratory pressure (PEEP). Methods: We summarized evidence addressing four “PICO questions” (patient, intervention, comparison, and outcome). A multidisciplinary panel with expertise in ARDS used the Grading of Recommendations, Assessment, Development, and Evaluation framework to develop clinical recommendations. Results: We suggest the use of: 1) corticosteroids for patients with ARDS (conditional recommendation, moderate certainty of evidence), 2) venovenous extracorporeal membrane oxygenation in selected patients with severe ARDS (conditional recommendation, low certainty of evidence), 3) neuromuscular blockers in patients with early severe ARDS (conditional recommendation, low certainty of evidence), and 4) higher PEEP without lung recruitment maneuvers as opposed to lower PEEP in patients with moderate to severe ARDS (conditional recommendation, low to moderate certainty), and 5) we recommend against using prolonged lung recruitment maneuvers in patients with moderate to severe ARDS (strong recommendation, moderate certainty). Conclusions: We provide updated evidence-based recommendations for the management of ARDS. Individual patient and illness characteristics should be factored into clinical decision making and implementation of these recommendations while additional evidence is generated from much-needed clinical trials.

An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline