Prof. Jerry Nolan - a giant of resuscitation - discusses why we can't replicate the trial outcomes in cooling post-cardiac arrest.... #SOA21 A thread ๐Ÿงต๐Ÿ‘‡ Image
Jerry Nolan presenting! We know for sure that hypothermia BEFORE something like cardiac surgery is protective. As well as pre-cooling prior to cardiac arrest! #SOA21 ImageImage
Many animal studies. Mimic the clinical conditions of cardiac arrest. #SOA21 The timings here are important - mean no (asystole) /low-flow (CPR) times. Hypothermia induction times immediate OR delayed up to 60mins. Hypothermia improved neuro outcome and reduced mortality by 67%. ImageImage
How do we move on from these studies? These ones (below) were unblinded, which was quite a problem. #SOA21 Image
Mortality/Neuro outcome no different.... #SOA21 Image
Is fever harmful after cardiac arrest? Maybe. No huge evidence base for this. #SOA21 Image
One of few RCT's recently to show benefit for hypothermia... just one patient would have changed this study though... (Frag index, if you believe in it) #SOA21 Image
And so this all led on to TTM2... not significantly different. #SOA21 ... leading to a barrage of discussion points from around the world.... saying TTM2 etc do not represent "our sorts of" cardiac arrest patients. ImageImage
Bystander CPR, Time to cooling, ICU patients(not register patients), non-standardised post-arrest care - SO MANY variables.... #SOA21
Is the key to understanding why we can't replicate, the time to target temp? FIVE HOURS??? in most studies. ?Too long? #SOA21 Image
Giving cold IV fluid intra-arrest though may be harmful.... so... #SOA21 Image
Intranasal cooling!!! #SOA21 ~700 patients. Could data show trend towards being quicker in transnasal group? Faster temp reduction? ImageImage
So: this is a bioplausible phenomenon, but this hasn't been born out in clinical trials (yet?). No high-certainty evidence that fever control results in better outcomes.... that will be looked at closer in TTM3 (which has just got funding...) #SOA21 Image

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More from @Gas_Craic

8 Dec
What were the most impactful non-COVID papers over the past 2 years? Let's delve in and take a look. #SOA21 Image
Finally an opportunity to not talk about COVID! #SOA21 ImageImageImage
TOMAHAWK - immediate vs delayed/selective angio. 3 years to conduct the trial in 31 ICUs. 554 patients. 'Worse' survival in immediate angiograph? Not SS, but close... #SOA21 ImageImageImageImage
Read 27 tweets
8 Dec
We've looked at bats for a long time.... #SOA21 They have strong interferon responses, but not strong inflammation.... Image
So what happens instead? #SOA21 They will tolerate high levels of viraemia with little symptoms. Bats are old... 65million years ago - they appeared at the end of the dinosaurs! They are far longer lived that other mammals. Senescence is late - more towards end of life. Image
Read 14 tweets
7 Dec
Organophosphate poisoning, toxicology, dengue, snake bites and malaria.... sure what could go wrong? #SOA21 @ICS_updates Drs. Chacko, Yacoub, Bhaumik and Dondorp tell us more.... ๐Ÿงต๐Ÿ‘‡๐Ÿ˜˜ Image
Let's go to India - Tamil Nadu. ImageImage
I'd advise anyone not overly family with Organophosphates to start here: ncbi.nlm.nih.gov/books/NBK49986โ€ฆ #SOA21
Read 43 tweets
7 Dec
Biomarker guided abx treatments in sepsis. We catch up with Drs/Profs: Paul Dark, Stacy Todd, Enitan Carrol, Jonathan Sandoe and Matthew Stevenson on this large area of research @ICS_updates #SOA21 Image
So, do biomarkers have any utility in guiding abx use in sepsis? We can measure, usually, these ones fairly easily: #SOA21 Image
In around 2014, commissioned review in PCT. Seemed to suggest a shorter duration in abx use when PCT used.... tenuous data though. #SOA21 Low quality. Little evidence from UK... how does this fit into NHS practice in the realms of stewardship? ImageImage
Read 13 tweets
7 Dec
@iceman_ex, myself and @dr_mattmorgan talk about how to keep yourself intellectually safe on Social Media at #SOA21 (full talk at soa.ics.ac.uk)

A thread ๐Ÿงต๐Ÿ‘‡ Image
There's been a lot that's gone on over the past few years that's exposed the well known 'darker' side of social media. Traditional paradigms of knowledge dissemination have changed (if not disappeared). Much higher tech-savy population. #SOA21
This has democratised the discussion space to an extent. It allows for *anybody* (lit. anybody) to get involved. #SOA21
Read 17 tweets
6 Dec
Is COVID-19 hyperinflammation, or a cytokine storm in a teacup? @DrPujaMehta1 's fab talk from #SOA21 today! Image
Main Q = "Hyperinflation contributing to worse outcomes for some patients with COVID-19" - clinical similarities to sHLH seen. Viruses are the most common trigger of sHLH. Early reports from China suggested cytokine profile was similar to sHLH in terms of COVID severity. #SOA21 Image
We now know some things work and some things don't.... in certain populations. #SOA21 Image
Read 28 tweets

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