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A retrospective study of 336 consecutive patients intubated in the ED examined the relationship between post-intubation hypotension and mortality rates. Post-intubation hypotension was relatively common, occurring in 23% of all cases. It was associated with increased mortality and increased length of hospital stay. The study was conducted in a single, large ED in the USA where etomidate and suxamethonium were the standard RSI drugs. Patients with post-intubation hypotension were more likely to have left ventricular dysfunction, to be taking β-blockers and to have required intubation for respiratory failure. Although post-intubation hypotension was an independent risk factor for death, the design of the study does not allow any comment regarding causality. Further work looking at aggressive correction of hypotension after intubation with vaso-active drugs would be useful (J Crit Care 2012;27:417.e9–13).
Improving arrest outcomes
A very large study of community cardiac arrests in the USA has revealed a major reduction in hospital mortality rates (from 70% to 58%) between 2001 and 2009, despite an increase in the number …