R&R In The FASTLANE 177

Welcome to the 177th 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

Cypel M, et al. Bilateral pneumonectomy to treat uncontrolled sepsis in a patient awaiting lung transplantation. J Thorac Cardiovasc Surg. 2016. PMID: 28017368

• A novel procedure in a young 32 year old mother with Cystic fibrosis who was dying of refractory septic shock. Source control was performed in the form of bilateral pneumonectomies and the patient maintained on VV ECMO and Nova lung with PA to LA configuration. She survived without lungs for 6 days before receiving a lung transplant and is now recovering well.
• Recommended by: Nudrat Rashid

Kitamura T, et al. Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan. N Engl J Med. 2016. PMID: 27783922

• Automated electronic defibrillators profoundly increase survival when used by lay bystanders and a shock is provided. However, it took an installed base of half a million AEDs in Japan to save ~200 lives per year.
• Recommended by: Ryan Radecki
• Read more: Just How Many Lives Do AEDs Save? (Emlitofnote)

Hammer MM, Litt HI. Risk of pulmonary embolism after a prior negative CT pulmonary angiogram. Am J Emerg Med. 2016. PMID: 27435874

• This study has some frustrating findings: they looked at 318 patients who got a CTPA within 2 weeks of a negative CTPA and found a 5% positive rate. Is CTPA like a stress test, where we just can’t predict plaque rupture? Are people who get CTPAs people who other docs are also worried about PE? Or are we just ordering too many CTPAs? How many of these were false postives or negatives? Sadly, as with most clinical research on pulmonary embolism, I am let with more questions than answers (but we probably order too many CTPAs).
• Recommended by: Seth Trueger

Luck RP, et al. Cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations. Pediatr Emerg Care. 2008. PMID: 18347489 

• Removing sutures from children seems like it should be easy… well, we know that it isn’t always. This article (and others) support the use of absorbable sutures, particularly in children.
• Recommended by: Sean M. Fox

Vase H et al. The Impella CP Device for Acute Mechanical Circulatory Support In Refractory Cardiac Arrest. Resuscitation 2016. PMID: 27751862

• ECMO is all the rage when it comes to mechanical support in patients with cardiac arrest but what about using an Impella device? This is essentially a case series of 8 patients with refractory PEA arrest who had an intra-arrest Impella device placed. 4 survived to discharge and all 4 were neurologically intact (CPC 1 or 2). Clearly, larger, prospective and optimally randomized trials are needed but this may represent another possible intervention in refractory arrest.
• Recommended by: Anand Swaminathan