The Critical Care Reviews Newsletter “brings you the best critical care research and open access articles from across the medical literature over the past seven days.” “The big news this week is the publication of the landmark PARAMEDIC2 trial, comparing adrenaline with placebo in out-of-hospital cardiac arrest”. Also included are other randomised controlled trials including “Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area”, systematic reviews such as “Neurologic Outcomes after Extracorporeal Membrane Oxygenation Assisted CPR for Resuscitation of Out-of-Hospital Cardiac Arrest Patients” and guidelines including “European Association for the Study of the Liver Clinical Practice Guidelines for the management of patients with decompensated cirrhosis.” The full text of the newsletter can be accessed via this link.
The Critical Care Reviews Newsletter provides the best critical care research and open access articles from across the medical literature. The highlights of this issue are “the TRUE-AHF trial, examining ularitide in acute heart failure, an individual patient level meta-analysis evaluating tidal volumes used in three large ARDS randomized control trials and an observational study investigating early predictors of poor outcome after out-of-hospital cardiac arrest.”
To access the full text of these articles from the journal’s homepage requires a personal subscription to the journal. Individual articles can be ordered via the Rotherham NHS Foundation Trust Library and Knowledge Service. Registered members of the library can make article requests online via this link.
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Background: Despite advances in treatment, mortality in acute myocardial infarction complicated by cardiogenic shock remains high. Short-term mechanical circulatory support devices acutely improve hemodynamic conditions. The Impella CP is a new percutaneous circulatory support device that provides more hemodynamic support than the intra-aortic balloon pump (IABP).
Objectives: The aim of this study was to determine whether the Impella CP can decrease 30-day mortality when compared with IABP in patients with severe shock complicating acute myocardial infarction.
Methods: In a randomized, prospective, open-label, multi-center trial, we assigned 48 patients with severe cardiogenic shock complicating acute myocardial infarction to Impella CP (n=24) or IABP (n=24). Severe cardiogenic shock was defined as systolic blood pressure lower than 90 mmHg or the need for inotropic or vasoactive medication and the requirement for mechanical ventilation. The primary endpoint was 30-day all-cause mortality.
Results: At 30 days, mortality in patients treated with either IABP or Impella CP was similar (50% and 46%, respectively, hazard ratio (HR) with Impella CP, 0.96 (95% confidence interval (CI) 0.42 to 2.18; p=0.92). At 6 months, mortality rates for both Impella CP and IABP were 50% (HR 1.04 (95% CI; 0.47-2.32, p=0.923).
Conclusions: In this explorative randomized controlled trial involving mechanically ventilated cardiogenic shock patients after acute myocardial infarction, routine treatment with Impella CP was not associated with reduced 30-day mortality compared with IABP.
Abella, B. Current Opinion in Critical Care. June 2016. Volume 22 (3). pp. 218–224
Purpose of review: Cardiopulmonary resuscitation (CPR) represents the cornerstone of cardiac arrest resuscitation care. Prompt delivery of high-quality CPR can dramatically improve survival outcomes; however, the definitions of optimal CPR have evolved over several decades. The present review will discuss the metrics of CPR delivery, and the evidence supporting the importance of CPR quality to improve clinical outcomes.
Recent findings: The introduction of new technologies to quantify metrics of CPR delivery has yielded important insights into CPR quality. Investigations using CPR recording devices have allowed the assessment of specific CPR performance parameters and their relative importance regarding return of spontaneous circulation and survival to hospital discharge. Additional work has suggested new opportunities to measure physiologic markers during CPR and potentially tailor CPR delivery to patient requirements.
Summary: Through recent laboratory and clinical investigations, a more evidence-based definition of high-quality CPR continues to emerge. Exciting opportunities now exist to study quantitative metrics of CPR and potentially guide resuscitation care in a goal-directed fashion. Concepts of high-quality CPR have also informed new approaches to training and quality improvement efforts for cardiac arrest care.
Aminophylline is a drug that might help resuscitate patients in cardiac arrest when electrical activity is very slow or absent. Aminophylline may restore blood flow to the heart, improve electrical activity and make other drugs used in resuscitation more effective. We found five studies that included 1254 patients who had this type of cardiac arrest in the prehospital setting. Four of the five studies (1186 patients) were well-designed studies with low risk of bias. Although no adverse events were reported, aminophylline showed no advantage when it was added to the standard resuscitation practice of paramedics when compared with placebo in these patients. It is not known whether giving aminophylline sooner would be helpful.
This Cochrane systematic review was undertaken by staff at Dalhouise University, Halifax Canada and published on line on 23rd November 2015. More information including the full text can be found via this link.
Jean-Luc Diehl The French Intensive Care Society organized on 5th and 6th June 2014 its 4th “Paris International Conference in Intensive Care”, whose principle is to bring together the best international experts on a hot topic in critical care medicine. The 2014 theme was “Breakthrough in cardiac arrest”, with many high-quality updates on epidemiology, public health data, pre-hospital and in-ICU cares. The present review includes short summaries of the major presentations, classified into six main chapters:
Epidemiology of CA
Post-resuscitation management: targeted temperature management
Post-resuscitation management: optimizing organ perfusion and metabolic parameters