Discover and read the best of Twitter Threads about #ccr23
Most recents (8)
We've just presented and published a multicenter RCT at #CCR23 and in @JAMA_current!
Continuous vs Intermittent Meropenem Administration in Critically Ill Patients with Sepsis: The #MERCYtrial!
🔗 jamanetwork.com/journals/jama/…
This 🧵 will explain the study in detail /11
#FOAMcc
Continuous vs Intermittent Meropenem Administration in Critically Ill Patients with Sepsis: The #MERCYtrial!
🔗 jamanetwork.com/journals/jama/…
This 🧵 will explain the study in detail /11
#FOAMcc
2/
β-lactams (e.g., #meropenem), are typically given intermittently, but continuous administration can provide constant serum levels and may improve outcomes.
In fact, several meta-analyses reported reduced mortality when administered continuously.
β-lactams (e.g., #meropenem), are typically given intermittently, but continuous administration can provide constant serum levels and may improve outcomes.
In fact, several meta-analyses reported reduced mortality when administered continuously.
3/
Therefore, we conducted a multinational, double-blind, randomized controlled trial to test the hypothesis that continuous administration of #meropenem, compared with intermittent administration, would improve clinically relevant outcomes in critically ill pts with #sepsis
Therefore, we conducted a multinational, double-blind, randomized controlled trial to test the hypothesis that continuous administration of #meropenem, compared with intermittent administration, would improve clinically relevant outcomes in critically ill pts with #sepsis
🚨🚑🚁🏥 Ergebnisse des @UKREBOATrial präsentiert am #CCR23:
Frage: Profitieren Patient:innen mit schwerstem Trauma und nicht kompressibler Torso-Blutung von Standard Care & #REBOA versus Standard Care ohne REBOA?
Design: prospektiv randomisierte multicenter Studie in den UK.
Frage: Profitieren Patient:innen mit schwerstem Trauma und nicht kompressibler Torso-Blutung von Standard Care & #REBOA versus Standard Care ohne REBOA?
Design: prospektiv randomisierte multicenter Studie in den UK.
Primary Outcome: 90 Tage Mortalität
Secondary Outcomes: Mortalität nach 3,6, 24 Stunden, in hospital, etc.
geplante Sample Size: 120
geplante Interimsanalysen nach 40 und 80 Patient:innen.
Abbruch der Studie nach der zweiten Interimsanalyse (90 Einschlüsse).
Secondary Outcomes: Mortalität nach 3,6, 24 Stunden, in hospital, etc.
geplante Sample Size: 120
geplante Interimsanalysen nach 40 und 80 Patient:innen.
Abbruch der Studie nach der zweiten Interimsanalyse (90 Einschlüsse).
Baseline Daten:
Medianes Alter 46 Interventionsgruppe,
39 Kontrollgruppe,
61/77 % männlich, >85% stumpfes Trauma,
Medianer ISS 41:
also eine Kohorte von wirklich Schwerstverletzten, wie wir sie auch in 🇪🇺 erwarten würden.
Medianes Alter 46 Interventionsgruppe,
39 Kontrollgruppe,
61/77 % männlich, >85% stumpfes Trauma,
Medianer ISS 41:
also eine Kohorte von wirklich Schwerstverletzten, wie wir sie auch in 🇪🇺 erwarten würden.
The @PATCHTrial, led by @RussellGruen, a study of pre-hospital TXA for severe trauma in adults at high risk of acute traumatic coagulopathy treated in advanced trauma systems, has been published today in @NEJM. #CCR23 Here’s a summary of what we did...
nejm.org/doi/full/10.10…
nejm.org/doi/full/10.10…
...& what we found (and a Poll to ask what you think).
@karimbrohi @HawkmoonHEMS @CritCareReviews @QldAmbulance @NSWAmbulance @AmbulanceVic @MedSTAR_SA @MazurStef @AmbVicMedic @ClinResearchNZ @HRCNewZealand @nhmrc @WgtnFree @StJohnNZ @VACAR_AV
@karimbrohi @HawkmoonHEMS @CritCareReviews @QldAmbulance @NSWAmbulance @AmbulanceVic @MedSTAR_SA @MazurStef @AmbVicMedic @ClinResearchNZ @HRCNewZealand @nhmrc @WgtnFree @StJohnNZ @VACAR_AV
The effect of in-hospital TXA in trauma was evaluated in the Clinical Randomisation of an Antifibrinolytic in Significant Hemorrhage (CRASH)-2 trial. TXA,
administered within 3 hours of injury, was reported to reduce 28-day mortality
thelancet.com/journals/lance…
administered within 3 hours of injury, was reported to reduce 28-day mortality
thelancet.com/journals/lance…
➡️ Antimicrobial therapy has been used for millennia
➡️ Treating severe infections can be lifesaving
➡️ However, the widespread use of antimicrobials also has downsides
A 🧵
1/16
➡️ Treating severe infections can be lifesaving
➡️ However, the widespread use of antimicrobials also has downsides
A 🧵
1/16
➡️ Throughout history, honey, herbs & metals were often used
➡️ One of the earliest known antimicrobial therapies was the topical use of mouldy bread
➡️ This intervention has been recorded in many ancient civilisations, including Egypt, China, Serbia, Greece & Rome
2/16
➡️ One of the earliest known antimicrobial therapies was the topical use of mouldy bread
➡️ This intervention has been recorded in many ancient civilisations, including Egypt, China, Serbia, Greece & Rome
2/16
➡️ Mercury was used for epidemic diseases since the 1300s & especially syphilis
➡️ However, the treatment could be worse than the disease, with mercury poisoning possible
➡️ Treatment could last years, leading to the saying “A night with Venus, a lifetime with mercury”"
3/16
➡️ However, the treatment could be worse than the disease, with mercury poisoning possible
➡️ Treatment could last years, leading to the saying “A night with Venus, a lifetime with mercury”"
3/16
➡️ Throughout history, the most mystical substance of all has been blood
➡️ It has been coveted and desired
➡️ Fought for and defended
➡️ Stolen, yet freely given
A 🧵
1/16
➡️ It has been coveted and desired
➡️ Fought for and defended
➡️ Stolen, yet freely given
A 🧵
1/16
➡️ Blood has always been a symbol of power
➡️ In Greek mythology, ichor, the blood of the Gods, was a golden fluid
➡️ It was immortal, pure, & untainted by human weaknesses
➡️ The Gods derived their divine powers & longevity from it
2/16
➡️ In Greek mythology, ichor, the blood of the Gods, was a golden fluid
➡️ It was immortal, pure, & untainted by human weaknesses
➡️ The Gods derived their divine powers & longevity from it
2/16
➡️ Blood has been revered for its restorative properties
➡️ Elizabeth Báthory, a 16th-century Hungarian noblewoman, allegedly killed hundreds of young girls & women
➡️ She bathed in their blood to maintain her youth & beauty
3/16
➡️ Elizabeth Báthory, a 16th-century Hungarian noblewoman, allegedly killed hundreds of young girls & women
➡️ She bathed in their blood to maintain her youth & beauty
3/16
➡️ There are ~ 5.8 million trauma deaths per year globally
➡️ Trauma is the largest cause of death below the age of 50
➡️ One-third of severely injured trauma patients are coagulopathic at hospital arrival
➡️ Fibrinogen is often used, but is it effective?
a short 🧵
1/10
➡️ Trauma is the largest cause of death below the age of 50
➡️ One-third of severely injured trauma patients are coagulopathic at hospital arrival
➡️ Fibrinogen is often used, but is it effective?
a short 🧵
1/10
➡️ Trauma-induced coagulopathy is due to inflammation & shock
➡️ It is worsened by hypothermia, acidosis, and hemodilution
➡️ Coagulopathy due to hemorrhage is strongly associated with mortality
➡️ 1/3 of early trauma deaths are due to uncontrolled haemorrhage
2/10
➡️ It is worsened by hypothermia, acidosis, and hemodilution
➡️ Coagulopathy due to hemorrhage is strongly associated with mortality
➡️ 1/3 of early trauma deaths are due to uncontrolled haemorrhage
2/10
➡️ Fibrinogen is depleted early during major bleeding
➡️ It can be replaced with fresh frozen plasma, cryoprecipitate or fibrinogen concentrate
➡️ Cryoprecipitate includes fibrinogen, factor VIII coagulant, von Willebrand factor, fibronectin & factor XIII
3/10
➡️ It can be replaced with fresh frozen plasma, cryoprecipitate or fibrinogen concentrate
➡️ Cryoprecipitate includes fibrinogen, factor VIII coagulant, von Willebrand factor, fibronectin & factor XIII
3/10
➡️ Death has always fascinated human civilisations
➡️ Not just the ending of a life, but either preparation for the afterlife or attempts to restore an existing life
A 🧵
1/28
➡️ Not just the ending of a life, but either preparation for the afterlife or attempts to restore an existing life
A 🧵
1/28
➡️ Ancient Egyptians preserved corpses via mummification for an afterlife
➡️ They removed internal organs, used embalming fluids, linen bandages, & intricate coffins
➡️ The wealthy had pyramids
➡️ Relatives, staff & pets were buried alive for the journey to the afterlife
2/28
➡️ They removed internal organs, used embalming fluids, linen bandages, & intricate coffins
➡️ The wealthy had pyramids
➡️ Relatives, staff & pets were buried alive for the journey to the afterlife
2/28
➡️ In Greek Mythology, the River Styx separated the worlds of the living & dead
➡️ Charon, the Ferryman, required payment from the deceased for passage
➡️ The dead were buried with a coin
➡️ Those unable to pay were left to wander the river bank for 100 years
3/28
➡️ Charon, the Ferryman, required payment from the deceased for passage
➡️ The dead were buried with a coin
➡️ Those unable to pay were left to wander the river bank for 100 years
3/28
1/13
➡️ REBOA is an exciting "new" therapy for non-compressible torso haemorrhage
➡️ It's used across the world, but without robust evidence
➡️ Does it work? Is it beneficial?
➡️ A thread...
➡️ REBOA is an exciting "new" therapy for non-compressible torso haemorrhage
➡️ It's used across the world, but without robust evidence
➡️ Does it work? Is it beneficial?
➡️ A thread...
2/13
🚩 Uncontrollable haemorrhage accounts for
➡️ > 80% of combat deaths
➡️ ~ 40% of civilian trauma-related deaths
🚩 Many have been determined to be preventable deaths
🚩 ~ 67% of fatal bleeding occurs in the torso region
🚩 Uncontrollable haemorrhage accounts for
➡️ > 80% of combat deaths
➡️ ~ 40% of civilian trauma-related deaths
🚩 Many have been determined to be preventable deaths
🚩 ~ 67% of fatal bleeding occurs in the torso region
3/13
Emergency thoracotomy (ET) has a long history in resuscitation
🚩 1880 - Paul Niehans first documented ET in human cardiac arrest
🚩 1901 - Kristian Ingelsrud performed the first successful resuscitation
🚩 1953 - Stephenson had 28% survival in 1200 cardiac arrests
Emergency thoracotomy (ET) has a long history in resuscitation
🚩 1880 - Paul Niehans first documented ET in human cardiac arrest
🚩 1901 - Kristian Ingelsrud performed the first successful resuscitation
🚩 1953 - Stephenson had 28% survival in 1200 cardiac arrests
