Welcome to the 108th 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
ran DT, et al. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev 2015. PMID: 26512948
- Cochrane review update on roc vs sux for intubation conditions. Not surprisingly, they reach the same (I think misguided) conclusion: sux is better… which they only find if you look at lower dose roc (0.6 mg/kg). No difference at appropriate doses (1.2 mg/kg) but admittedly much less data. Even when they find the same intubating conditions at appropriate doses, they again conclude that sux is better because it wears off, which is, at the very least, up for debate.
- Recommended by Seth Trueger
Atir S et al. When Knowledge Knows No Bounds: Self-Perceived Expertise Predicts Claims of Impossible Knowledge. Psychol Sci 2015. PMID: 26174782
- This article has little to do with clinical EM or critical care but gives us insight into how we think. The last author on this piece is psychologist David Dunning (he of the Ig Nobel Prize winning Dunning-Kruger Effect). This article reveals not only that we overestimate our abilities but that when our perceived expertise in an area is high, we overestimate our abilities even more. What do we do with this information? Continually question our abilities and our confidence so as not to be sucked in to this trap. This is an enlightening read for those interested in social sciences and how we think..
- Recommended by Anand Swaminathan
Nichol G,et al. Trial of Continuous or Interrupted Chest Compressions during CPR. NEJM 2015. PMID: 26550795
- What’s the best way to increase chest compression fraction? Just never stop. So how might continuous chest compression compare to the classic 30:2 CPR ratio?
- This is a huge RCT by the ROC consortium that included 26,148 adult patients with out of hospital cardiac arrest. They compared traditional 30:2 CPR with continuous chest compressions with 10 asynchronous breaths a minute.
- The result: No difference. The primary outcome of survival to hospital discharge occurred in 9.0% of the continuous and 9.7% of the interrupted compression patients.
- Recommended by Justin Morgenstern
Inaba K, et al. Cadaveric comparison of the optimal site for needle decompression of tension pneumothorax by prehospital care providers. Journal of Trauma and Acute Care Surgery 2015. PMID 26488319
- Needle decompression of tension pneumothorax is still taught as 2nd ICS at the mid-clavicular line although several studies have shown this may be inadequate. It turns out, those performing this in the field may not be able to find that space. This study had 25 Navy Corpsmen, 6.7% of whom had previously performed pneumothorax on a real patient, needle decompress cadavers at both the 2nd ICS mid-clavicular line and the 5th ICS anterior axillary line. The misplacement rate at the 5th ICS was 22.0% ves 82.0% at the 2nd ICS (p < 0.001). The participants placed the needles closer to the target spot in the 5th ICS and rated it easier. When will decompression at the 5th ICS anterior axillary line become the default spot?
- Recommended by Lauren Westafer
Jena AB, et al. Physician spending and subsequent risk of malpractice claims: observational study. BMJ 2015. PMID 26538498
- An interesting look at malpractice claims and physician resource utilization in the United States that raises more questions than it answers. The authors examined malpractice claims rates and hospital charges in Florida, finding that across multiple specialties, those physicians with higher charges also had fewer claims. While some may use this data to justify routine utilization of higher resources, a more nuanced examination would see it as one more piece of the puzzle investigating how physicians, patients, and society interact as a whole. Clearly, both the resource utilization and malpractice claims environment in the U.S. are in need of overhaul, and this is an important study for all involved to be aware of.
- Recommended by Jeremy Fried
Levy B et al. Experts’ recommendations for the management of adult patients with cardiogenic shock. Ann Intensive Care 2015 PMID 26152849
- There are no specific international recommendations regarding the management of cardiogenic shock (CS) in critically ill patients. This is a French led expert review of recommendations from the French Intensive Care Society for management of CS. They used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to come up with evidence based recommendations for management of CS.
- Recommended by Salim R. Rezaie