Amal Mattu's 2011 Articles You've Gotta Know!
Amal Mattu's 2011 Articles You've Gotta Know!
This year was once again a banner year in terms of clinically useful publications related to the practice of emergency medicine. Therefore, I am going to use this year-end installment of Medscape Viewpoints to present a few of my favorite articles of the year, those articles that I think "you've gotta know!"
I must admit my bias in this selection process -- I am not generally a big believer in the concept of "groundbreaking" new articles. Too many times in past years we have seen publications touted as groundbreaking, advocating approaches and therapies that are shot down years later. Notable examples include steroids for spinal cord injury, amiodarone for cardiac arrest, nesiritide for decompensated heart failure, and drotrecogin alfa (better known by its brand name Xigris®) for sepsis.
Therefore, rather than trying to find articles that are groundbreaking, I have chosen articles that simply provide important support for other recent advances, articles that challenge long-held practice, or articles that suggest simple concepts that can improve patient care. The list is by no means comprehensive and none of these trials are perfect. However, I believe these simple articles and the concepts that they endorse will improve patient care.
Stub D, Hengel C, Chan W, et al.
Am J Cardiol. 2011;107:522-527
The management of cardiac arrest has received considerable attention for decades. Unfortunately, despite the many years of (and dollars spent on) research, the only 2 therapies that have been proven clearly effective for patients in cardiac arrest are rapid defibrillation and proper compressions. Attention has now begun to turn toward postarrest care, which we are discovering may play an even greater role in outcome than most interventions during cardiac arrest.
Induced hypothermia is accepted as a critical intervention in postarrest patients with return of spontaneous circulation (ROSC), and increasing data support the concept of rapid cardiac catheterization and percutaneous intervention as well.
Stub and colleagues have provided further support for the combination of induced hypothermia with rapid coronary intervention. Patients receiving this combined intervention were compared against a historical control that received only traditional supportive therapy. Survival (64% vs 39%) and improved neurological survival (57% vs 29%) were both significantly improved with the combined intervention. Of note, patients with cardiac arrest were incorporated into the interventions regardless of whether their ECG demonstrated evidence of ST-segment elevation myocardial infarction (STEMI). In the coming years I anticipate that there will be an even greater push for patients with ROSC after cardiac arrest to be treated with combination-induced hypothermia plus early coronary intervention, regardless of whether their ECG demonstrates STEMI.
Abstract
Introduction
This year was once again a banner year in terms of clinically useful publications related to the practice of emergency medicine. Therefore, I am going to use this year-end installment of Medscape Viewpoints to present a few of my favorite articles of the year, those articles that I think "you've gotta know!"
I must admit my bias in this selection process -- I am not generally a big believer in the concept of "groundbreaking" new articles. Too many times in past years we have seen publications touted as groundbreaking, advocating approaches and therapies that are shot down years later. Notable examples include steroids for spinal cord injury, amiodarone for cardiac arrest, nesiritide for decompensated heart failure, and drotrecogin alfa (better known by its brand name Xigris®) for sepsis.
Therefore, rather than trying to find articles that are groundbreaking, I have chosen articles that simply provide important support for other recent advances, articles that challenge long-held practice, or articles that suggest simple concepts that can improve patient care. The list is by no means comprehensive and none of these trials are perfect. However, I believe these simple articles and the concepts that they endorse will improve patient care.
Usefulness of Cooling and Coronary Catheterization to Improve Survival in Out-of-Hospital Cardiac Arrest
Stub D, Hengel C, Chan W, et al.
Am J Cardiol. 2011;107:522-527
The management of cardiac arrest has received considerable attention for decades. Unfortunately, despite the many years of (and dollars spent on) research, the only 2 therapies that have been proven clearly effective for patients in cardiac arrest are rapid defibrillation and proper compressions. Attention has now begun to turn toward postarrest care, which we are discovering may play an even greater role in outcome than most interventions during cardiac arrest.
Induced hypothermia is accepted as a critical intervention in postarrest patients with return of spontaneous circulation (ROSC), and increasing data support the concept of rapid cardiac catheterization and percutaneous intervention as well.
Stub and colleagues have provided further support for the combination of induced hypothermia with rapid coronary intervention. Patients receiving this combined intervention were compared against a historical control that received only traditional supportive therapy. Survival (64% vs 39%) and improved neurological survival (57% vs 29%) were both significantly improved with the combined intervention. Of note, patients with cardiac arrest were incorporated into the interventions regardless of whether their ECG demonstrated evidence of ST-segment elevation myocardial infarction (STEMI). In the coming years I anticipate that there will be an even greater push for patients with ROSC after cardiac arrest to be treated with combination-induced hypothermia plus early coronary intervention, regardless of whether their ECG demonstrates STEMI.
Abstract
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