HWN Suggests

Die Trying - Intubation of In-Hospital Cardiac Arrests

Sudden IHCA is a high stakes emergency with a high mortality rate. The decision to intubate is difficult to make and varies widely between clinicians. Due to the nature of intubation in cardiac arrest, it is difficult to study, and the studies that do exist are largely observational.

Until this paper, there were no studies of IHCA arrest intubation and survival.

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 How Did I Get Epi Alone? Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrests

We still do not have high-quality, clinically relevant information to support the use of vasopressin, steroid, and epinephrine (VSE) protocol in patients with IHCA. That does not mean VSE should never be used and it will depend also on the clinicians’ judgment. We are now left with a difficult choice, deciding on which drugs can help us resuscitate someone while preserving their quality of life, and more and more it seems these goals are at odds with each other.

 Will Corticosteroids Help if…I Will Survive a .Cardiac Arrest

Physicians will have different levels of evidence to adopt a new treatment into their clinical practice. It would be reasonable to consider using corticosteroids as part of a VSE protocol in patients with IHCA but certainly should not be mandated or made into a quality metric. This is because we only have one relatively small RCT from Greece that was of low risk of bias but has never been replicated.

Articles of Interest

Association Between Tracheal Intubation During In-Hospital Cardiac Arrest and Survival

In patients that have an in-hospital cardiac arrest the use of intubation was associated with an increased mortality. These results were significant in both the unadjusted results and the propensity score-matched analysis. Due to weaknesses in the study design and concerns over possible missed confounding variables, further studies are required.

Beyond the guidelines: an approach to cardiac arrest in the Emergency Department

Cardiac arrest care is protocolized in ACLS for universal access, simplified for those who rarely run codes. As consultants specializing in Emergency Medicine, we should be on the forefront of resuscitation management, using cutting edge technologies and research to advance the field and save lives.

Can we improve cardiac arrest survival in hospitals?

Such poor outcomes are explained, in part, by the serious nature of the illnesses that trigger cardiac arrest. But what is more troubling is evidence by my research team and others that suggests similar patients may have widely variable outcomes across different hospitats.

In-Hospital Cardiac Arrest

In-hospital cardiac arrest is common and associated with a high mortality rate. Despite this, in-hospital cardiac arrest has received little attention compared with other high-risk cardiovascular conditions, such as stroke, myocardial infarction, and out-of-hospital cardiac arrest.

In-Hospital Cardiac Arrest: The First 15 Minutes

As there are currently no RCTs evaluating intubation during the first 15 minutes of an in-hospital cardiac arrest, this study may be some of the current best evidence that supports focusing on the interventions that matter most early on: High-Quality CPR and Defibrillation.

Intubate or not intubate? That is the question…

There is a paucity of good quality published evidence in advanced life support interventions. Hopefully you are already using a hands off technique from intubation maximising early defibrillation and good quality CPR. This paper will probably add or change little to your practice.