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- Rapid Sequence Induction and Intubation
- pulmonary embolism
- emergency ambulance systems
- cardiac care
This month’s update is from the ED team at the University Hospital Coventry. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches, to identify the five most interesting and relevant recently published papers. Below we highlight the main findings, key limitations and clinical bottom line for each paper.
The papers are ranked as:
Worth a peek—interesting, but not yet ready for prime time.
Head turner—new concepts.
Game changer—this paper could/should change practice.
Emergency vs delayed coronary angiogram in survivors of out-of-hospital cardiac arrest (EMERGE) by Hauw-Berlemont et al1
Topic: cardiac arrest
Rating: worth a peek
Current practice is to perform urgent coronary angiogram (CAG) in patients who had an out-of-hospital cardiac arrest (OHCA) with post-resuscitation ST-segment elevation and no other obvious cause of arrest. However, consensus is lacking on whether patients with no ST-segment elevation should undergo CAG. Three prior trials have suggested no benefit because the rate of acute coronary lesion is much lower.
This French multicentre randomised controlled trial differed from prior studies in that it included patients with non-shockable rhythms. Adult patients who were resuscitated after cardiac arrest were randomised to emergency CAG (straight to catheterisation laboratory) or delayed CAG (after 48–96 hours) Primary outcome measures were 180-day survival and cerebral performance category 1 or 2. The study was underpowered as the initial enrolment objective was not met and funding was withdrawn. Of the 141 patients allocated to the emergency CAG group, 89% received CAG and mean time was 2 hours from OHCA. Of the 138 patients allocated to delayed CAG, only 54% received the intervention; among these, mean time to procedure was 65 hours from OHCA. Reasons for not undergoing a delayed CAG included early death from a neurological or cardiorespiratory aetiology.
There was no difference …
Twitter @leechcaroline, @imogenvirgo, @drarungeorge
Contributors All authors have contributed in line with the ICMJE guidelines.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.