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The ARREST Trial compared extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to advanced cardiac life support (ACLS) treatment in patients with out-of-hospital cardiac arrest (OHCA). This month’s Concise Critical Appraisal takes a deep dive into the trial, published in The Lancet.
From Critical Care Explorations. In-hospital cardiac arrest survival among coronavirus disease 2019 patients has been reported to range from 0% to 12% -- significantly lower than reported prepandemic in-hospital cardiac arrest survival rates of approximately 20% to 25% in the United States for non–coronavirus disease 2019 patients. In this multi-center study, the authors report a 22% survival to discharge after in-hospital cardiac arrest in coronavirus disease 2019 patients, a survival rate similar with before the coronavirus disease 2019 pandemic.
This is a presentation from the 47th Critical Care Congress on Optimal Timing for Cannulation in Venovenous ECMO.
The average annual incidence of pediatric in-hospital cardiac arrest (IHCA) has recently been estimated at more than 15,000 cases.1 Survival rates for pediatric patients who have had pulseless cardiac arrest have remained below 50% for the past decade.2,3 The American Heart Association currently recommends epinephrine, the cornerstone medication for cardiac arrest, dosed every 3 to 5 minutes in adult and pediatric cardiac arrest, although there is conflicting evidence about whether this is the best interval.4,5 Epinephrine is believed to acutely increase coronary perfusion pressure by increasing diastolic blood pressure (DBP).
From Critical Care Medicine. The authors investigated the incidence, characteristics, and outcomes of in-hospital cardiac arrest in patients with coronavirus disease 2019 and describe the characteristics and outcomes for patients with in-hospital cardiac arrest within the ICU, compared with non-ICU patients with in-hospital cardiac arrest.
Perkins et al (N Engl J Med. 2018;379:711-721) set out to examine the effects of epinephrine during OHCA.
From Critical Care Medicine. In this review article, the authors compared the rates of cardiac injury by angiotensin converting enzyme-2–binding viruses from viruses that do not bind to angiotensin-converting enzyme-2.
Levy et al (J Am Coll Cardiol. 2018;72:173-182) conducted a prospective, double-blind, multicenter RCT comparing epinephrine to norepinephrine in the setting of CS in patients who underwent AMI treated with percutaneous coronary intervention.
From Critical Care Explorations In this descriptive statistical study, heart rate variability measures were found to be statistically different across critically ill patients infected with severe acute respiratory syndrome coronavirus 2 and distinct from bacterial sepsis.
Although several trials have examined in-hospital cardiac arrest (IHCA), only two trials in the past decade have examined the use of vasopressin and glucocorticoids for IHCA. Both trials found improved survival and favorable neurologic outcome with a vasopressin-epinephrine-methylprednisolone combination. Because of a lack of additional supporting evidence, neither the American nor European international guidelines have recommended this combination for IHCA. This Concise Critical Appraisal examines an article by Andersen et al that attempted to validate the results of these trials.
From Critical Care Explorations. The authors describe outcomes with high-flow oxygen delivered through nasal cannula and noninvasive positive pressure ventilation in coronavirus disease 2019 acute hypoxemic respiratory failure and identify individual factors associated with noninvasive respiratory support failure.
From Critical Care Medicine This study shows how early percutaneous tracheostomy was safe and effective in coronavirus disease 2019 patients, giving a good chance of survival and of weaning from tracheostomy cannula at ICU discharge.
From Critical Care Medicine In this editorial, the authors discuss the risks of healthcare professionals performing cardiopulmonary resuscitation on coronavirus disease 2019 patients.
From Critical Care Medicine In this editorial, the author discusses the seeming benefits of using almitrine for severe hypoxia in patients with coronavirus disease 19 induced acute respiratory distress syndrome.
From Critical Care Medicine. This Editorial was written in response to the article by Chotalia et al. “Right Ventricular Dysfunction and Its Association With Mortality in Coronavirus Disease 2019 Acute Respiratory Distress Syndrome.”
Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on September 9, 2020.
This resource details how manage hypotension. This is SCCM curated COVID-19 microlearning content.
From Critical Care Medicine The authors describe the characteristics and outcomes of in-hospital cardiac arrest in coronavirus disease 2019 patients in rural Southwest Georgia.
From Critical Care Medicine. This online letter to the editor was written in response to " Is Cardiopulmonary Resuscitation Futile in Coronavirus Disease 2019 Patients Experiencing In-Hospital Cardiac Arrest?" by Shah et al.
From Critical Care Medicine In this Letter to the Editor, the author discusses the difficulties to ascertain in ICU settings the exact VTE incidence, incidence rate, or prevalence due to various reasons, including the absence of uniform screening at ICU admission to exclude patients with prior VTE, absence of systematic assessment with varying screening guided by clinicians’ suspicion, and varying follow-up time. In addition, the burden of venous thromboembolism in critically ill patients is discussed.
From Critical Care Explorations In this Letter to the Editor, the authors discuss their study in which they hypothesized that a significant proportion of coronavirus disease 2019 patients has evidence of pulmonary hypertension associated with elevated left heart filling pressure on transthoracic echocardiography.
From Critical Care Medicine. This online letter to the editor was written in response to the article “Is Cardiopulmonary Resuscitation Futile in Coronavirus Disease 2019 Patients Experiencing In-Hospital Cardiac Arrest? By Shah et al.
COVID-19 is associated with a high prevalence of coagulopathy and venous thromboembolism. Host B. Kyle Enfield, MD, FCCM, talks with Jerrold H. Levy, MD, FAHA, FCCM, about what clinicians need to know about this serious problem and how it impacts care delivery (Iba et al. Crit Care Med. 2020;48:1358-1364).