Welcome to the 119th 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
Böttiger et al. Influence of EMS-physician presence on survival after out-of-hospital cardiopulmonary resuscitation: systematic review and meta-analysis. Crit Care 2016. PMID 26747085
- The never ending battle between EMS physians and paramedics rages on. In this meta analysis based on 14 studies and a huge number of patients (126829) the authors suggests that EMS-physician-guided CPR in out-of-hospital cardiac arrest is associated with improved survival outcomes. Although meta analysis are only as good as the data allows, and in this meta analysis no RCTs where included (as they do not exist), this represents the best evidence available.
- Recommended by: Soren Rudolph
Grant S et al. Ventilator-assisted preoxygenation: Protocol for combining non-invasive ventilation and apnoeic oxygenation using a portable ventilator. Emerg Med Australas 2016. PMID 26764895
- It’s widely accepted that aggressive pre-oxygenation prior to RSI decreases the risk of intra- and post- procedure hypoxia but what is the optimal method? These authors discuss their approach to ventilator assisted non-invasive pre-oxygenation.The strength of this article is in the detailed explanation of the logistics of applying this intervention. A great primer to adding non-invasive ventilation to your pre-oxygenation approach.
- Recommended by: Anand Swaminathan
Wood CD et al. Evaluation of sixteen anti-motion sickness drugs under controlled laboratory conditions. Aerosp Med. 1968;39(12):1341-4. PMID 4881887
- When NASA spun astronauts around to induce motion sickness, amphetamines and scopolamine were the best at preventing nausea. Promethazine was pretty good, but meclizine was surprisingly bad.
- Recommended by: Ryan Radecki
Nehme Z et al. Effect of supplemental oxygen exposure on myocardial injury in ST-elevation myocardial infarction. Heart 2016. PMID 26740484
- More on the potential harm from supplemental oxygen in MI patients. This study examines the dose-relationship of oxygen therapy and infarct size assess by biomarkers. Excluding hypoxic patients and those with cardiogenic shocks 441 patients with STEMI were randomized to oxygen or room air. Every 100 L increase in oxygen exposure in the first 12 h was associated with significantly increased cTnI and CK of 1,4% and 1,2% respectively.
As the median supplemental oxygen exposure was 1746 L this would result in a 21% increase in infarct size.
- Recommended by: Soren Rudolph
Zuckerman M et al. A review of the toxicologic implications of obesity. J Med Toxicol 2015:11: 342-354. PMID 26108709
- The management of drug overdose in the setting of obesity is complicated by alterations in physiology, pharmacokinetics and comorbidities, potentially placing this patient population at increased risk of drug-related death. This article provides an excellent in-depth dive into these factors and discusses alterations in utilization and dosing of antidotes. Importantly, the authors highlight an overdue need for inclusion of obese subjects in clinical research to better understand drug toxicity in this growing patient population.
- Recommended by: Meghan Spyres