Tag: resuscitation
How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed?
Resuscitation teams at hospitals with high IHCA survival differ from non–top-performing hospitals. Our findings suggest core elements of successful resuscitation teams that are associated with better outcomes and form the... read more
pH-guided Fluid Resuscitation and BICAR-ICU
The use of bicarbonate is a source of eternal disagreement. Bicarbonate has a shameful history of being abused in situations where it's unhelpful (e.g. cardiac arrest). This has impugned its reputation, giving it an aura... read more
Silent Space
Exhausted at the end of a busy week on service in the intensive care unit (ICU), the fellow and I are on our way to the conference room to debrief the week. The overhead code alarm disrupts the temporary lull in activity... read more
Withdrawing vs. Not Offering Cardiopulmonary Resuscitation: Is There a Difference?
In light of the SCC's Cuthbertson v. Rasouli decision, the distinction between withdrawing and not offering a medical treatment is increasingly relevant. Because CPR is a "default" treatment for cardiac arrest, it requires... read more
Preventing Harmful Delays with POCUS During Cardiac Arrest
With the integration of bedside echocardiography into cardiac arrest, we now have a real-time tool to help us glean some of this critical missing information, as well as offer procedural guidance and prognostic data. However,... read more
Haemoglobin concentration and volume of intravenous fluids in septic shock in the ARISE trial
Haemoglobin concentration decreases during resuscitation from septic shock, and has a significant but weak association with the volume of intravenous fluids administered. Median (IQR) haemoglobin concentration at baseline... read more
No Requirement for Targeted Theophylline Levels for Diuretic Effect of Aminophylline in Critically Ill Children
Aminophylline administration provided a measure of increased diuresis, regardless of dosage, and theophylline trough levels. Therefore, achieving a prescribed therapeutic trough level may not be necessary for full diuretic... read more
Moving Albumin Into the Small Volume Resuscitation Era
Physicians have an intense 70-year history of enthusiasm, skepticism, fear, and reconciliation with albumin products since their market introduction in the late 1940s. Despite its cumbersome production method and costs, albumin... read more
Functional Status Change Among Children With ECMO to Support Cardiopulmonary Resuscitation in a Pediatric Cardiac ICU
This is the first extracorporeal cardiopulmonary resuscitation report to examine changes in Functional Status Scale from admission (baseline) to discharge as a measure of overall functional outcome. Half of surviving patients... read more
Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock
In injured patients at risk for hemorrhagic shock, the prehospital administration of thawed plasma was safe and resulted in lower 30-day mortality and a lower median prothrombin-time ratio than standard-care resuscitation.... read more
Chest Compression Rates and Pediatric In-hospital Cardiac Arrest Survival Outcomes
Non-compliance with compression rate Guidelines was common in this multicenter cohort. Among ICU patients, slightly lower rates were associated with improved outcomes compared to Guidelines.Prospective observational study... read more
Thai cave rescue: The drug that allowed boys to survive rescue mission
Thai schoolboys were rescued from the cave using dissociative ketamine plus positive-pressure facemask ventilation (to prevent water from leaking into their masks), so they basically used delayed sequence intubation strategy.... read more
Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock
Sepsis results in disruption of the endothelial glycocalyx layer and damage to the microvasculature, resulting in interstitial accumulation of fluid and subsequently edema. Fluid resuscitation is a mainstay in the initial... read more
Treatment of Acute Non-Anion Gap Metabolic Acidosis
Acute non-anion gap metabolic acidosis is now recognized to be as a common cause of metabolic acidosis, particularly in the ICU. Further examination of its impact on cellular function and clinical outcome are needed. Most... read more
Nine Reasons to Quit Using Normal Saline for Resuscitation
Saline vs. balanced solutions has been a topic of ongoing debate. Two fresh studies will illuminate this: the SMART and SALT-ED trials. This post summarizes current knowledge, beginning with physiology and working our way... read more
The Fluid Debate: Balanced or Unbalanced
Consider using balanced fluids in your ED unless you are treating a patient at risk for cerebral edema, or a patient with a chloride responsive metabolic alkalosis, e.g. from gastric losses. Although the superiority of balanced... read more
AKI and Mild Therapeutic Hypothermia in Patients After Cardiopulmonary Resuscitation
The aim of this study was to investigate the influence of mild therapeutic hypothermia (MTH) on the incidence of and recovery from acute kidney injury (AKI). Mild therapeutic hypothermia seems to have a protective effect... read more
Hemodynamic Support of Pediatric and Neonatal Septic Shock
Margaret Parker, MD, MCCM, speaks with Joseph A. Carcillo, MD, about the article, "American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock," published... read more
Haemostatic Resuscitation in Trauma: The Next Generation
The next generation of haemostatic resuscitation aims at applying a ratio 1:1:1 driven strategy while using antifibrinolytics, haemostatic monitoring and avoiding critical fibrinogen deficiency by substitution. Mortality... read more
Patient Remains Awake for 90 Minutes of CPR
A man undergoing CPR, exhibited signs of conscious awareness for 90 minutes before the medical team stopped the life-sustaining procedure, according to a new case report. The 69-year-old man was admitted to a hospital in... read more
Strategies for Intravenous Fluid Resuscitation in Trauma Patients
Fluids are drugs and should be managed as such. Appropriate early fluid resuscitation in trauma patients is a challenging task. Care should be taken in selecting both the type and volume to promote appropriate perfusion and... read more
Abnormal Saline and the History of Intravenous Fluids
Two new clinical trials together involving nearly 30,000 patients support previous observational evidence that the most common solution used for intravenous fluid therapy in the world is associated with kidney damage. Both... read more
