Vasopressin and Steroids for IHCA?

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In 2009 and 2013 investigators published studies that demonstrated improved outcomes in patients with IHCA who received vasopressin and steroids in addition to epinephrine.  However, both US and European cardiac arrest guidelines have not endorsed these medications due to lack of additional evidence.  In this podcast we discuss the recently published VAM-IHCA trial, which evaluated vasopressin and steroids for patients …

Milrinone or Dobutamine for Cardiogenic Shock?

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Hemodynamic management of patients with cardiogenic shock centers on vasopressors, inotropes, and mechanical circulatory devices.  With respect to inotropic medications, there is little data to guide optimal management and selection of agents.  In this podcast we discuss the results of a recent trial that compared milrinone with dobutamine for patients with cardiogenic shock.  Which agent was the winner?

The TOMAHAWK Study

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The COACT trial demonstrated no improvement in 90-day mortality for post-arrest patients without evidence of an ST-segment elevation MI who were randomized to immediate or delayed coronary angiography.  However, the COACT Trial included only OHCA with a shockable rhythm and overall had a very low number of patients that had an acute thrombus at the time of angiography.  In this …

The BaSICS Trial – Implications for Fluid Resuscitation

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The administration of IVFs is nearly universal in critically ill patients.  In recent years, several studies have suggested improved outcomes with the use of balanced crystalloids solutions in contrast to 0.9% NS.  In this podcast, we discuss the recently published BaSICS Trial that evaluated Plasma-Lyte 148 with 0.9% NS in critically ill patients.  Does this study provide practice-changing evidence to …

The ED-AWARENESS Study

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Ventilated ED patients may be at high risk for awareness with paralysis, thereby increasing the risk of long-term psychological sequelae.  In this podcast, we discuss the results of the recently published ED-AWARENESS Study and its implications for managing the ventilated ED patient.

The TTM2 Trial

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Current international guidelines recommend TTM for adult patients with ROSC from OHCA who remain comatose or unable to follow verbal commands.  However, the overall level of evidence for this recommendation remains of low certainty.  In this podcast, we discuss the results of the recently published TTM2 Trial and its implications on the management of post-cardiac arrest patients.

Mechanical Ventilation in the Patient with ARDS

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More than 3 million patients develop ARDS each year across the globe.  Like any therapy, mechanical ventilation can induce further lung injury and cause patient harm if misapplied.  In this podcast we bring you up to speed on the latest, evidence-based titration of mechanical ventilation in patients with ARDS.

ECMO for Cardiac Arrest and Massive PE

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Despite continued advances in resuscitation, favorable outcomes for patients with OHCA who receive standard resuscitation remain dismal.  In recent years there has been significant interest in the use of ECMO for OHCA.  However, the evidence demonstrating the efficacy of ECMO in OHCA remains limited.  In this podcast we review the recent ARREST Trial, which evaluated ECMO-facilitated resuscitation in OHCA.  In …

COVID-19 Updates March 2021

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In recent weeks, there have been several important studies and guidelines published that have served to improve our understanding of treating critically ill patients with COVID-19 infection.  In this podcast, we highlight the latest update from the SSC and discuss studies on convalescent plasma and IL-6 antagonists.

The HOT-ICU Study

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Critically ill patients with acute hypoxic respiratory failure receive supplemental oxygen as a component of their treatment.  In recent years, exposure to high levels of FiO2 with resultant “hyperoxia” have been associated with increased mortality in critically ill patients.  At present, there is no clinical practice guideline on oxygenation targets for adult patients with hypoxic respiratory failure.  In this podcast, we discuss the …