R&R In The FASTLANE 151

Welcome to the 151st 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 5 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

Cameron JI, et al. One-Year Outcomes in Caregivers of Critically Ill Patients. N Engl J Med. 2016. PMID: 27168433

• A great insight into the caregivers of patients who survive a critical illness showing that the caregivers own heath suffers. A larger percentage (70%) of these caregivers were women. 61% of caregivers were spouses. A high proportion of these care givers reported depressive symptoms which persisted in the period of assessment of a year. Depressive symptoms were associated with the caregivers being younger with less social supports or less control over life or with less personal growth.
• Recommended by: Nudrat Rashid

Moore LJ, et al. Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for noncompressible truncal hemorrhage. J Trauma Acute Care Surg. 2015. PMID: 26402524

•  REBOA appears to be the wave of the future for patients with massive hemorrhage. This study takes data from a trauma registry and shows a survival rate for resuscitative thoracotomy (RT) of 9.7% vs. 37.5% for REBOA. There are a number of issues with this study due to the retrospective design. Additionally, the RT group was more likely to be dead on presentation in comparison to the REBOA group (71% vs. 38% without vital signs). While this data supports REBOA use, a prospective study should be undertaken to gauge the benefit of this modality.
• Recommended by: Anand Swaminathan

Sadek S, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: An additional resuscitation option for uncontrolled catastrophic haemorrhage. Resuscitation. 2016. PMID: 27377669

•  Resuscitative Endovascular Ballon Occlusion of the Aorta (REBOA) has been gaining popularity for treating non-compressible hemorrhage in trauma patient although absolute indications are still debated. Technical advances have made prehospital REBOA possible. This case presentation from the London HEMS describes the first prehospital use of zone 3 REBOA in a patient with pelvic fracture. The case demonstrates the feasibility of prehospital REBOA, which in this case successfully controlled severe non-compressible hemorrhage.
• Recommended by: Soren Rudolph

Friedman BW, et al. Diphenhydramine as Adjuvant Therapy for Acute Migraine: An Emergency Department-Based Randomized Clinical Trial. Ann Emerg Med. 2016. PMID: 26320523

• Looks like diphenhydramine doesn’t help all-comers with migraines in the ED. My bet is there might be a subset of patients it does help; if the patient has had it before and requests it, sure. But no longer a routine part of my migraine cocktail.
• Recommended by: Seth Trueger

Pasupathy S, et al. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015. PMID: 25587100

•  This is a common and interesting topic; this paper is a systematic review of the characteristics of patients who presented with a suspected MI (based on enzymes) and end up having non-obstructive coronary arteries (MINOCA). The prevalence of MINOCA is about 6% and is more common in males, with median age of 55. When comparing patients with obstructive vs. non-obstructive, the latter have are more likely to be female, young and with less CV risk factors. Also important to consider other diagnoses such as myocarditis, thrombophilia, and coronary artery dissection/spasm.
• Recommended by: Ryan P Radecki