R&R In The FASTLANE 033

Welcome to the 33rd edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.

This edition contains 10 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the : Overview; Archives and Contributors

This Edition’s R&R Hall of Famer

Lin S, Callaway CW, Shah PS, Wagner JD et al. Adrenaline for out-of-hospital cardiac resuscitation: A systematic review and meta-analysis of randomised controlled trials. Resuscitation 2014; 85(6):732-740. PubMed ID: 24642404

• This week’s Hall of Famer is hot off the press, in fact, it’s only available on-line in the ePub format. The medical field as put a great deal of time and effort researching interventions on cardiac arrest. This article is a meta-analysis and systematic review looking at the utility of epinephrine (adrenaline) in out-of-hospital cardiac arrest (OHCA). Although the findings aren’t surprising – no benefit to adrenaline/epinephrine in survival to discharge or neurologic outcomes in OHCA – we continue to administer the drug in the face of mounting evidence against its supposed utility.
• Recommended by: Anand Swaminathan
• Read More: Epinephrine in Cardiac Arrest (From emdocs.net)

Yeatts DJ, Dutton RP, Hu PF, Chang YW, Brown CH, Chen H, Grissom TE, Kufera JA, Scalea TM. Effect of video laryngoscopy on trauma patient survival: a randomized controlled trial. J Trauma Acute Care Surg 2013; 75(2):212-9 PubMed ID: 23823612

• VL (with a Glidescope) leads to the same outcome as DL in trauma patients. VL takes longer to accomplish and may be associated with higher mortality in patients with severe head injuries, however this relationship will require more study to confirm.
• Recommended by: Ken Milne
• Read More: Video Killed Direct Laryngoscopy (From Ken Milne)

Meyer G et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism.NEJM 2014; 370(15): 1402-11.PubMed ID: 24716681

• Trial of tenectaplase + heparin vs. placebo + heparin in patients with submassive pulmonary embolism. Treatment with tenectaplase led to a significant decrease in the combined primary endpoint of death and hemodynamic decompensation but with a significant increase in extracanial bleeding and stroke. These findings challenge the broad us of thrombolytics for submassive PE.
• Recommended by: Salim Rezaie
• Read More: PEITHO Trial: Fibrinolysis for Intermediate-Risk Pulmonary Embolism (From Salim Rezaie)

Asfar P et al. High versus low blood-pressure target in patients with septic shock. NEJM 2014; 70(17):1583-93. PubMed ID: 24635770

• There has long been the idea that patients with chronic hypertension should be titrated to a higher MAP when they are in septic shock. This study attempted to shows that targeting a higher MAP of 80-85 mm Hg instead of 65-70 mm Hg would have a benefit in patients with chronic hypertension. The study was unable to show this a mortality benefit. However, not all patients achieved the stated goals and they were unable to completely tailor treatment to premorbid blood pressure.
• Recommended by: Anand Swaminathan

Saboo AR, Dutta S, Sodhi KS. Digital palpation of endotracheal tube tip as a method of confirming endotracheal tube position in neonates: an open-label, three-armed randomized controlled trial. Paediatr Anaesth. 2013 Oct;23(10):934-9. PubMed ID: 23521151

• Malposition of the tracheal tube after intubation of neonates is a significant issue. The suprasternal notch roughly corresponds to vertebral level T2, which is close to the mid-tracheal point. Suprasternal palpation of endotracheal tube tip was superior to a weight-based algorithm for ensuring proper endotracheal tube depth in neonates.
• Recommended by: Cliff Reid
• Read More: Palpating Neonatal Tracheal Tubes (From Cliff Reid)

Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA. 2014; 311(13):1308-16. PubMed ID: 24638143

• From 2000 – 2012, mortality from severe sepsis fell from 35% to 18.4% and mortality from septic shock fell from 40.3% to 22% (presumably) thanks to early diagnosis, early and appropriate antibiotics and aggressive supportive therapy. Or is something else going on? Retrospective studies are always prone to confounders.
• Recommended by: Anand Swaminathan, Chris Nickson

Farley H et al. Patient Satisfaction Surveys and Quality of Care: An Information Paper. Ann Emerg Med. 2014 PubMed PMID: 24656761.

• Let’s stop the confabulation of patient satisfaction with quality of care! In many institutions, physician reimbursement and employment is tied to patient satisfaction. This is a great review of the current literature on patient satisfaction measures and a call to ensure that this stops being equated with quality.
• Recommended by: Jeremy Fried

Safavi KC, Li S, Dharmarajan K, et al. Hospital Variation in the Use of Noninvasive Cardiac Imaging and Its Association With Downstream Testing, Interventions, and Outcomes. JAMA Intern Med. 2014. PubMed ID: 24515551

• Hospitals with increased utilization of non-invasive cardiac imaging had increased rates of invasive angiography with no decrease in readmission rates for myocardial infarction. This is further evidence that non-invasive cardiac imaging does not decrease patient centered outcomes and increases overall testing. The use of non-invasive cardiac imaging in the Emergency Department remains controversial.
• Recommended by: Rory Spiegel

Parvizi D et al. The potential impact of wrong TBSA estimations on fluid resuscitation in patients suffering from burns: Things to keep in mind. Burns 2014 Mar;40(2):241-5. PubMed ID: 24050977

• Accurate estimation of burn size is challenge. Over-resuscitation of patients with burns is more of a problem than under-resuscitation. Fluid creep and over- resuscitation can have deleterious effects such as compartment syndrome. Perhaps it is time that we use technology to guide us
• Recommended by: Sa’ad Lahri

Beitler, JR et al. Prone positioning reduces mortality from acute respiratory distress syndrome in the low tidal volume era: a meta-analysis. Int Care Med 2014; 40:332-41. PubMed ID: 24435203

• Prone positioning has been employed for decades in patients with ARDS despite the absence of robust evidence. In this meta-analysis, prone positioning was associated with a decreased risk of death when lower tidal volumes were employed but not with higher tidal volumes. Although prone positioning is technically difficult and takes training to do safely and properly, it should be considered in patients in whom oxygenation proves difficult in spite ARDSnet settings.
• Recommended by: Anand Swaminathan