A brief critical appraisal of the IRIS trial (Birenbaum 2018)
Despite being described by Sellick almost 60 years ago, there has never been any convincing evidence supporting cricoid pressure during rapid sequence intubation. (Sellick 1961) Based on physiologic reasoning, it is frequently described as being “standard of care”. However, when studied, cricoid pressure doesn’t actually seem to decrease aspiration. (Ellis 2007; Neilipovitz 2007; Fenton 2009). Worse, cricoid pressure has been shown to worsen laryngeal view during intubation, and even completely obstruct the airway. (Allman 1995; Palmer 2000; Levitan 2006; Oh 2013) The result has been a relatively classic debate in medicine between a historical “standard” and science. Unfortunately, the available science has been relatively weak, until now…
Continue reading “Cricoid pressure is dead (Birenbaum 2018)”
So far this week, I have covered 2 large trials looking at airway management strategies in out of hospital cardiac arrest. In both instances, outcomes were similar whatever strategy was employed. Maybe our choice of airway management doesn’t matter? Not so fast, we finish the series with a final RCT, and this time there is a winner. Continue reading “Airway management in cardiac arrest part 3: PART trial (Wang 2018)”
Airway management is cardiac arrest is always a hot topic of debate. Yesterday we looked at AIRWAYS2, demonstrating no difference in survival with good neurologic outcomes between a laryngeal mask airway and intubation. (Benger 2018) However, those are both advanced interventions. Are either required? Where does the mighty bag valve mask fit in? Today we tackle the second paper in our series of 3, comparing BVM to intubation in out of hospital cardiac arrest.
Continue reading “Airway management in cardiac arrest part 2 (Jabre 2018)”
Critical appraisal of the AIRWAYS2 trial (Benger 2018)
You probably don’t need a medical degree to know that breathing is important, and that in order to breathe, you need to have an unobstructed airway that connects your lungs to the world. As a result, when you die, one of our first instincts in medicine is to ensure that you have an open airway. However, if your heart is stopped, fiddling around with the airway will do nothing to restart it. Furthermore, it has never been clear whether advanced airway interventions like intubation are any better than simply maneuvers like a jaw thrust in the context of cardiac arrest. Although emergency physicians love intubating, observational data has suggested that advanced airway management might not be a priority in cardiac arrest. (Hasegawa 2013; Benoit 2015) This week we will cover 3 large RCTs addressing the issue. This is part 1.
Continue reading “Airway management in cardiac arrest part 1: AIRWAYS 2 (Benger 2018)”
A summary of the evidence for (or against) epinephrine (adrenaline) in out of hospital cardiac arrest
The most recent episode of Emergency Medicine Cases Journal Jam takes a look at the evidence for epinephrine in cardiac arrest. (I suppose as I prepare for my move to New Zealand, I should probably get used to using the term adrenaline, but for now I will stick with the Canadian “epinephrine”.) These are the written notes to accompany that podcast.
Continue reading “Epinephrine in out of hospital cardiac arrest: a review of all the evidence”
A monthly (ish) summary of the emergency medicine literature
Given than it has been 3 months since the last version, I think it has officially become ridiculous to call these posts “articles of the month”. This is a summary of the papers Casey and I discussed for the BroomeDocs Journal Club. Most of the papers will have been covered in individual blog posts, but there are always a few gems thrown in to keep things interesting.
Continue reading “Research Roundup (formerly articles of the month)”
A rant about guidelines (and an opportunity to help shape the future of the ILCOR guideline process)
I hate guidelines. I shouldn’t. In theory, summaries of the medical literature that are accessible to practicing clinicians could only be good. Unfortunately, in current practice, medical guidelines are too often biased, unscientific, overreaching, or misleading.
Continue reading “I hate guidelines (but they can improve and you can help)”