To me, #AwakeningHope means this: I explain The diagnosis And proposed treatment plan. I then explain the range of possible outcomes. I explain the most likely scenario, the worst case scenario, and the best case scenario.
I then explain that MY APPROACH is to take the best case scenario and never let it go. I explain that visualization goes all long way in making things come true. I encourage my families to work with us to create every opportunity to for the best case scenario to come true.
1/ This is a very important and courageous study. Forever cardiologists have shunned emergency PCI for cardiac arrest because it will mess up their numbers. Even with STEMI.
2/ Interventional cardiologists are graded by mortality rates. So OHCA patients have always been a PCI do-not-touch scenario. Even though we know that many arrests result from ACS.
3/ This led to an incredible realization for me, according to the great Karl Kern, that acute coronary occlusions do not always lead to STEMI. Cardiologists rely on STEMI to trigger emergency PCI because it is specific and reliable for ACS.
1/ So now it's the cataclysmic TTM -2 trial, just published in @NEJM. How can a world changing trial like HACA published in 2002 now be effectively reversed almost 20 years later? I will explain.
2/ Lots of head scratching. Hard to understand. But I am not surprised. It's a pattern that we have seen before with goal directed therapy for sepsis and intensive insulin therapy for hyperglycemia. The answer is that a trial's results depend very much on the clinical milieu
3/ When Manny Rivers published his EGDT classic in the @nejm in 2001, the milieu was bad sepsis therapy. The control group was neglected, under-resuscitated, anemic nursing home patients. I remember these shocky patients in the in ER those days, waiting for hours for an ICU bed.