R&R In The FASTLANE 098

Welcome to the 98th 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 6 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

Niemann CU, et al. Therapeutic hypothermia in deceased organ donors and kidney-graft function. NEJM 2015; 373: 405-414. PMID: 26222557

• This trial had to be terminated early because an interim analysis showed efficacy of the intervention. A resurrection for therapeutic hypothermia perhaps? This prospective randomised controlled trial showed that targeted temperature control in donors had a statistically and clinically significant protective effect on renal-graft outcomes in recipients. Organ donors were randomly assigned either to be maintained at normothermia (a body temperature of 36.5 to 37.5°C, the current clinical standard) or to undergo modest cooling (34 to 35°C). A difficult trial to perform because of ethical and logistic reasons. Will we be changing our practise?
• Recommended by: Nudrat Rashid
• Read More: Editorial Jochmans I, Watson C. Taking the Heat Out of Organ Donation. NEJM 2015; 373: 477-478. PMID: 26222564

Frontera JA et al. Reversal of Coagulopathy Using Prothrombin Complex Concentrates is Associated with Improved Outcome Compared to Fresh Frozen Plasma in Warfarin-Associated Intracranial Hemorrhage. Neurocrit Care. 2014; 21(3): 397-406. PMID: 24671832

•  This is one of recent several papers about PCC vs. FFP for ICH. This study compared appropriate doses for PCC (bebulin) vs. FFP (10ml/kg) vs. FFP+PCC. All patients received Vit K. There were no differences between PCC and FFP related to time to correct INR or vascular complications. Interestingly there was a significantly lower rate of death and re-bleed on the PCC group. The expected difference on speed of correction was not seen by the outcomes were significantly better with PCC, is it time to adopt it as standard of care?
• Recommended by: Daniel Cabrera

Beam DM et al. Immediate Discharge and Home Treatment With Rivaroxaban of Low-risk Venous Thromboembolism Diagnosed in Two U.S. Emergency Departments: A One-year Preplanned Analysis. Acad Emerg Med 2015. PMID: 26113241

• This study provides us with more evidence that in a appropriately selected low risk patient population with VTE, and close follow up, outpatient anticoagulation with Rivaroxaban is feasible with very low rate of recurrence of VTE and risk of bleeding while on therapy.
• Recommended by: Salim R. Rezaie

Wei YB et al. Genitourinary toxicity of ketamine. Hong Kong Med J 2013; 19(4):341-8. PMID: 23832948.

• Something to look out for – those who abuse ketamine for long enough often end up with bladder issues. Ulcerative cystitis is common. Stopping the ketamine works for some but for a lot of people there’s some permanent dysfunction. Keep it in mind. It turns out there are somethings you can’t fix with ketamine.
• Recommended by: Andy Neill

Seol SH et al. Young Man With Pain in Finger.  Ann Emerg Med 2015; 65(3): e3-4. PMID: 25702188

• A novel use of the slit lamp to assist in procedures requiring significant magnification other than ophthalmic. The authors describe removing small splinters from a patient’s finger that they were otherwise unable to visualize. Another arrow to put in our quiver as do our best to manage patients in unanticipated ways.
• Recommended by: Jeremy Fried

Blom MT et al. Defibrillators Improved Survival After Out-of-Hospital Cardiac Arrest and Use of Automated External. Circulation 2014; 130(21):1868-75. PMID: 25399395

• This is a population-based cohort study that describes the increased use of AEDs and improvement in outcomes of OHCA during the study period (2006-2012). The findings are intuitive but nice to see some evidence behind what we have done. Surprisingly, the rate of AED use tripled (21.4% to 59.3%) but there was a much smaller increase in favorable neurologic outcomes (16.2% to 19.7%)
• Recommended by: Anand Swaminathan