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Emerg Med J 2005;22:190-191 doi:10.1136/emj.2004.022798
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  1. J P Wyatt1,
  2. W Slater2
  1. 1Department of Accident and Emergency, Royal Cornwall Hospital, Treliske, Truro, Cornwall TR1 3LJ, UK
  2. 2Emergency Department, Ninewells Hospital, Dundee
  1. Correspondence to:
 Mr Wyatt 
 Department of Accident and Emergency, Royal Cornwall Hospital, Treliske, Truro, Cornwall TR1 3LJ, UK; jonathan.wyattrcht.cornwall.nhs.uk

    Edited by Jonathan Wyatt; this scan coordinated by Fiona Beech

    Etomidate or midazolam for prehospital RSI?‣

    The authors conducted a retrospective case note review of consecutive rapid sequence intubations (RSI) at an American university–based air medical programme. They reviewed 112 rapid sequence intubations with etomidate and 97 with midazolam. The intubation success rates were comparable: 98% with etomidate and 99% with midazolam. The number of hypotensive episodes with etomidate (7 out of 74) and midazolam (3 out of 56) were not significantly different, although data were not available for some patients. The authors conclude that there was a good success rate and a low incidence of hypotension with both agents, but point out that the mean dose of midazolam used was considerably less than recommended for induction.

    ▴ Swanson ER, Fosnocht DE, Jensen SC. Comparison of etomidate and midazolam for prehospital rapid-sequence intubation. Prehosp Emerg Care2004;8:273–9.

    MRC CRASH trial results ‣

    The corticosteroid randomisation after significant head injury (CRASH) trial enrolled more than 10,000 emergency patients with impaired consciousness. The trial was stopped in May 2004 when it unexpectedly revealed excess mortality in patients treated with methylprednisolone compared with those given placebo. The cause of the excess deaths remains unclear. The results of this trial raise questions about the effectiveness of steroids in patients with other injuries.

    ▴ CRASH trial collaborators. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial. Lancet2004;364:1321–8.

    Beta blockers during cardiopulmonary resuscitation ‣

    The authors propose that global myocardial ischaemia during cardiac arrest accounts for post-resuscitation myocardial dysfunction and that beta-1 adrenergic effects of epinephrine make this worse, and therefore that beta adrenergic blockade during cardiac arrest may favourably improve myocardial oxygen consumption, minimising myocardial ischaemia and improving survival. To investigate this, the researchers performed a prospective randomised controlled trial on rats in whom ventricular fibrillation was induced. The rats were randomised to receive either esmolol or placebo during resuscitation. Esmolol administration during resuscitation reduced the number of shocks required, minimised …

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