Welcome to the 153rd 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
Duggan LV. Transtracheal jet ventilation in the ‘can’t intubate can’t oxygenate’ emergency: a systematic review. Br J Anaesth. 2016.PMID 27566790
- All major guidelines for emergency airway management include the use of transtracheal jet ventilation as a mean of oxygenation. The NAP 4 study documented a high failure rate when used in the CICO setting. After a very comprehensive literature review the authors of this paper the authors identified 44 studies of both emergency and elective use of transtracheal jet ventilation and found a similar high failure rate of 42% (device failure 38%, barotrauma 39% and miscellaneous complications 9%) of transtracheal jet ventilation in emergency settings. They boldly but justifiably question the recommendation of transtracheal jet ventilation in the CICO situation
- Recommended by Soren Rudolph
Thomas L. Schlenk et al. Electric Fans Don’t Cool Elders Exposed to Extreme Heat and Humidity. JAMA 2016. PMID 27599335
- An interesting paper (‘m sure with many variables difficult to control for) about simple recommendations that probably don’t help, and living in a climate in Brisbane in summer like this, circulating hot wet air doesn’t help evaporative cooling occur.
- Recommended by Daman Langguth
Sharifi M et al. Pulseless electrical activity in pulmonary embolism treated with thrombolysis (from the “PEAPETT” study). The American journal of emergency medicine. 2016. PMID 27422214
- This is a retrospective study looking at a group of 23 patients who had all been referred to a specialist cardiovascular team after a PEA cardiovascular arrest secondary to PE (20 diagnosed by CT and 3 by right heart strain on bedside echo) and who received tPA. 4 of the 20 CTs were done after the arrest and tPA had been given. The patients all received 50mg of tPA followed by heparin. Return of spontaneous circulation and hemodynamic stability was achieved within 15 minutes for 22 of the 23 patients. At 22 month follow-up, 20 of 23 patients were still alive. There were no major or minor bleeding events recorded. This group was relatively sick, with a mean age of 72, lots of comorbidities, and 22% having a cancer history. Of course, there is no comparison group and this is a select group of patients that was actually referred, so I wouldn’t pay too much attention to the specific numbers, but these outcomes are way better than normal PEA.
- Recommended by Justin Morgenstern
Smith JD et al. Effectiveness of N95 respirators versus surgical masks in protecting healthcare workers from acute respiratory infection: a systematic review and meta-analysis. CMAJ : Canadian Medical Association journal. 2016. PMID 26952529
- This systematic review identified 29 studies, 6 of which were appropriate for the quantitative meta-analysis. N95 masks did not appear to be protective in any of the clinical outcomes: influenza like illness, lab confirmed respiratory infection, or days off work. However, the masks do seem to work in laboratory settings, so perhaps the reason that they don’t work in the real world is that we don’t wear them properly? Also, the confidence intervals here are relatively large and all the point estimates come down on the side of N95s being better. Given the extra expense and annoyance, this probably warrants a high quality large RCT, but for now the best answer is simply: we don’t know. Bottom line: N95 masks might not be any better than surgical masks, but we really can’t be sure at this point.
- Recommended by Justin Morgenstern
Stratta EC, et al. Ethical erosion in newly qualified doctors: perceptions of empathy decline. Int J Med Educ. 2016. PMID 27608488
- A heart-wrenching open access paper looking at the changing attitudes of junior doctors towards patients and their reflections of the care they see role-modelled by seniors. 9 doctors consented to semi-structured interviews in which they described their perceptions of empathy, its value in clinical practice and its erosion with increasing exposure to the working world of medicine. Even with the possibility of a selection bias in the respondents, the paper still leaves us with important questions; who are we, as doctors? Is this part of the medical professional’s journey essential – if not, how can we avoid it? And how can we prevent it in the first place?
- Recommended by Natalie May