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NEWS - Critical Care & Emergencies

Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry) – The BMJ (free)

Related guideline: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association / American Stroke Association (free PDF) AND Summary for ED-relevant care: 2018 AHA/ASA Ischemic Stroke Updates – emDocs (free)

“In routine clinical practice, endovascular treatment for patients with acute ischemic stroke is at least as effective and safe as in the setting of a randomized controlled trial”.


N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department – Journal of the Americana College of Cardiology (link to abstract – $ for full-text)

Commentary: NT-proBNP cutpoints validated for diagnosing and ruling out heart failure in the ED – ACP Hospitalist (free)

Related review: BNP in the emergency department: The evidence – First10EM (free)

“In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF”.


New Guide to Infection Control in The Hospital – International Society for Infectious Diseases (free)

A free, online resource on the principles and interventions needed to reduce healthcare associated infections, with suggested control measures across different resource levels.


Balanced Crystalloids versus Saline in Critically Ill Adults – New England Journal of Medicine (free)

Related article: Balanced Crystalloids versus Saline in Noncritically Ill Adults – New England Journal of Medicine (free)

Commentary: Balanced Crystalloids May Be Better Than Saline for Critically Ill Patients – NEJM Physician’s First Watch (free)

“Balanced crystalloids may be superior to saline in critically ill patients — but not in patients hospitalized outside an ICU” (from Physician’s First Watch)


Reproducibility of clinical research in critical care: a scoping review – BMC Medicine (free)

“Reproducibility in Critical Care trials from NEJM, Lancet, JAMA. Bottom line:

-Attempt to reproduce previous findings: 42%

-Original studies reported larger effects

-Inconsistency with the original: 56%” (via @otavio_ranzani see Tweet)


Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium: The REDUCE Randomized Clinical Trial – JAMA (free)

Prophylactic haloperidol in this population with elevated risk of delirium did not reduce mortality or any of the 15 prespecified secondary outcomes, including delirium incidence, 28-day delirium-free and coma-free days, duration of mechanical ventilation, and ICU and hospital length of stay.


Outcomes of non-invasive diagnostic modalities for the detection of coronary artery disease: network meta-analysis of diagnostic randomised controlled trials – The BMJ (free)

Among patients with low risk acute coronary syndrome, stress echocardiography, cardiovascular magnetic resonance, and exercise electrocardiograms resulted in fewer invasive referrals for coronary angiography than coronary computed tomographic angiography, without apparent impact on the future risk of myocardial infarction. Similarly, for outpatients with suspected stable angina, an initial strategy based on functional testing might be preferable, resulting in fewer referrals for invasive coronary angiography and revascularization, without a statistically significant difference in the future risk of MI.


Opinion: Stories about tragic flu deaths wrongly portray Tamiflu as a panacea – HealthNewsReview (free)

Related: Tamiflu and Relenza: getting the full evidence picture – Cochrane Library (free)

“The review confirms small benefits on symptom relief, namely shortening duration of symptoms by half a day on average. However, there is little evidence to support any belief that use of NIs reduces hospital admission or the risk of developing confirmed pneumonia”. (from Cochrane)


Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries: No benefit of sodium bicarbonate or acetylcysteine for prevention of complications after angiography: The PRESERVE trial – 2 Minute Medicine (free) AND Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine – NEJM Resident 360 (free)

“Among patients at high risk for renal complications who were undergoing angiography, there was no benefit of intravenous sodium bicarbonate over intravenous sodium chloride or of oral acetylcysteine over placebo for the prevention of death, need for dialysis, or persistent decline in kidney function at 90 days or for the prevention of contrast-associated acute kidney injury”.


Infographic: ATLS Trauma Update 2018 (free) (via @CritCareReviews)


Peritoneal dialysis for acute kidney injury – Cochrane Library (link to abstract – $ for full-text)


2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association (free PDF)

Commentaries: More stroke patients eligible for crucial treatments under new guidelines – American Heart Association News (free) AND More stroke patients may receive crucial treatments under new guideline – AHA/ASA Newsroom (free)

“A new guideline for treating acute ischemic stroke recommends an increased treatment window for mechanical clot removal from six hours to up to 24 hours in certain patients with clots in large vessels”. (from AHA/ASA Newsroom)


Association of Time to Treatment With Short-term Outcomes for Pediatric Patients With Refractory Convulsive Status Epilepticus – JAMA Neurology (free for a period)

Editorial: Time May Be of the Essence in the Treatment of Pediatric Patients With Refractory Convulsive Status Epilepticus (free)

Commentary: Delays Raise Death Risk in Kids with Status Epilepticus – MedPage Today (free registration required)

“These findings may change the perception of acute seizure and status epilepticus treatment, tentatively converting it into an extremely time-sensitive emergency that is similar to stroke or other cardiovascular events”.


Adjunctive Glucocorticoid Therapy in Patients with Septic Shock – New England Journal of Medicine (free)

Commentaries: The Definitive Word on Steroids in Septic Shock – Emergency Medicine Literature of Note (free) AND Adrenal – The Bottom Line (free)

“For the primary outcome, there was no statistically significance difference in mortality at 90 days – 27.9% in the hydrocortisone cohort, and 28.8% with placebo. Looking at secondary outcomes, the results here tended to favor hydrocortisone – a slightly faster resolution of shock, shorter ICU stays, and, oddly, decreased transfusion requirements”. (from Emergency Medicine Literature of Note Blog)


Critical Care Reviews Book 2018 (free PDF)

“The Critical Care Reviews Book summarizes, critiques and puts in context the biggest trials of the year”.


Which stent is best for heart attacks? – Evidently Cochrane (free)

Original article: Drug-eluting stents versus bare-metal stents for acute coronary syndrome – Cochrane Library (free)

“The current review suggests that using DES rather than BMS may reduce the need for future coronary procedures but there is no evidence that it saves lives or reduces major cardiovascular events”.


Chemical venous thromboembolism prophylaxis in neurosurgical patients: an updated systematic review and meta-analysis – Journal of Neurosurgery (link to abstract – $ for full-text)

Chemical venous thromboembolism prophylaxis seems to be effective and safe in neurosurgical patients.

Source: EvidenceAlerts


Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial – The Lancet (free)

Commentaries: Learning from TARDIS: time for more focused trials in stroke prevention – The Lancet (free) AND Triple Antiplatelets for Reducing Dependency After Ischaemic Stroke – TARDIS – American College of Cardiology, Latest in Cardiology (free)

“Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice”.


The use of probiotics to prevent Clostridium difficile diarrhea associated with antibiotic use – Cochrane Library (free)

See related meta-analysis: Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection

“Based on this systematic review and meta-analysis of 31 randomized controlled trials including 8672 patients, moderate certainty evidence suggests that probiotics are effective for preventing C. difficile-associated diarrhea”


Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study – Journal of the American Heart Association (free)

“Composite rates of recurrence and major bleeding were 12.4% in patients who initiated NOACs within 2 days after acute stroke, 2.1% in those who initiated NOACs between 3 and 14 days, and 9.1% in patients who initiated NOACs >14 days after acute stroke. Future randomized studies to assess timing of initiation and choice of agent in patients with acute stroke and AF are warranted”.


Is treatment with corticosteroids beneficial and safe for people with pneumonia? – The Cochrane Library (free)

Related: Corticosteroids for Pneumonia: Ready for Primetime? – emDocs (free)

“Corticosteroid therapy reduced mortality and morbidity in adults with severe CAP; the number needed to treat for an additional beneficial outcome was 18 patients (95% CI 12 to 49) to prevent one death. Corticosteroid therapy reduced morbidity, but not mortality, for adults and children with non-severe CAP”


All-cause mortality and major cardiovascular outcomes comparing percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: a meta-analysis of short-term and long-term randomised trials – OpenHeart (free)

“PCI is associated with a reduction in the risk of major cardiovascular outcomes at short-term follow-up in patients with LMCA stenosis; but at long term, MACCE rate is increased for PCI”


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