Updates on Advanced life supprot by Theresa OLASVEENGEN
Vasopressors and Drugs : recent trial outcomes.
#LIVES2022
@ESICM #als #resuscitation
Vasopressors and Drugs : recent trial outcomes.
#LIVES2022
@ESICM #als #resuscitation
@ESICM 2020 ILCOR consensus : strong recommendation to use "ADRENALINE" in cardiac arrest, if you dont have it "LIDOCAINE".
Adrenaline to placebo comparison is mainly 1 older trial with latest PARAMEDIC 2
pubmed.ncbi.nlm.nih.gov/30980877/
Adrenaline to placebo comparison is mainly 1 older trial with latest PARAMEDIC 2
pubmed.ncbi.nlm.nih.gov/30980877/
@ESICM PARAMEDIC 2 - big study
8007 pts, adrenaline 4000, placebo 3999
- a lot of discussion post trial
- need a nuanced interpretation.
- 19 "more good" survivors and 5 "more bad" survivors in adrenaline arm.
nejm.org/doi/full/10.10…
8007 pts, adrenaline 4000, placebo 3999
- a lot of discussion post trial
- need a nuanced interpretation.
- 19 "more good" survivors and 5 "more bad" survivors in adrenaline arm.
nejm.org/doi/full/10.10…
@ESICM In terms of Amiodarone, again smaller studies. ROSC and Good survival : minimal benefits.
pubmed.ncbi.nlm.nih.gov/30179691/
pubmed.ncbi.nlm.nih.gov/30179691/
@ESICM ALPS study : big study 2000 pts , amidoarone vs placebo. not a lot of improvement.
nejm.org/doi/full/10.10…
nejm.org/doi/full/10.10…
@ESICM So should we bin these drugs.
A lot depends on "TIME"
The earlier you give the more likely to work
pubmed.ncbi.nlm.nih.gov/31912202/
A lot depends on "TIME"
The earlier you give the more likely to work
pubmed.ncbi.nlm.nih.gov/31912202/
Giving amiodarone later may cause more harm 
ahajournals.org/doi/10.1161/JA…
This is "INTERESTING" different effects. thought to be due to sicker hard when given later. so more likely harm from alpha effects.
#LIVES2022
This is "INTERESTING" different effects. thought to be due to sicker hard when given later. so more likely harm from alpha effects.
#LIVES2022
OKAY. now "ROUTE". IV vs. IO
for adrenaline it doesnt matter : pubmed.ncbi.nlm.nih.gov/32002593/
what abotu adrenaline?
IO amidoarone DOES NOT SEEM TO work. only IV.
for adrenaline it doesnt matter : pubmed.ncbi.nlm.nih.gov/32002593/
what abotu adrenaline?
IO amidoarone DOES NOT SEEM TO work. only IV.
Above " i meant to say " what about "amiodarone" !
apologies.. problems with life tweeting.
pubmed.ncbi.nlm.nih.gov/31941354/
apologies.. problems with life tweeting.
pubmed.ncbi.nlm.nih.gov/31941354/
currently being tested out IV vs. IO in warwick.ac.uk/fac/sci/med/re…
PARAMEDIC 3 trial.
Next : how about "Calcium " for a bit of inotropic and vasopressor effect
PARAMEDIC 3 trial.
Next : how about "Calcium " for a bit of inotropic and vasopressor effect
cocatrial.dk
More commonly used in North America, equipoise thus for test out in RCT.
Danish study 397 patients randomised to 198 saline and 193 to calcium chloride.
Calcium ROSC 19% vs. Saline 27%
- safety board stopped as "harm"
#LIVES2022
More commonly used in North America, equipoise thus for test out in RCT.
Danish study 397 patients randomised to 198 saline and 193 to calcium chloride.
Calcium ROSC 19% vs. Saline 27%
- safety board stopped as "harm"
#LIVES2022
Next: Vasopressin and methylprednisolone.
Small study done in Greece to motivate and looks promising
501 patients randomised 237 in vasopressin 20 IU + methlyprednisolone 40mg given after adrenaline. up to 4 doses of vasopressin.
placebo (normal saline)
NO difference
#LIVES2022
Small study done in Greece to motivate and looks promising
501 patients randomised 237 in vasopressin 20 IU + methlyprednisolone 40mg given after adrenaline. up to 4 doses of vasopressin.
placebo (normal saline)
NO difference
#LIVES2022
MAIN points : adrenaline and amiodarone(lidcaone if you dont have amiodarone) remain the only recommended drugs in cardiac arrest but their effects are under-whelming.
Important knowledge gaps still.
Important knowledge gaps still.
Q: adrenaline - time is important but what about DOSE? 1mg dose need to be tested.
A: paradox is that 1mg is a massive dose. and very variable effect depending on patient own body weight.
#LIVES2022
#cardiacarrest #ROSC #resuscitation
A: paradox is that 1mg is a massive dose. and very variable effect depending on patient own body weight.
#LIVES2022
#cardiacarrest #ROSC #resuscitation
Q: Ethics of paramedics 2 trial
A: difficult topic and complex area. and a lot of ethical questions and nuances that are unique to each patient individual situations. this can be extrapolated to icu care too. but hard to discount strategies that may improve ROSC.
#LIVES2022
A: difficult topic and complex area. and a lot of ethical questions and nuances that are unique to each patient individual situations. this can be extrapolated to icu care too. but hard to discount strategies that may improve ROSC.
#LIVES2022
@UnrollHelper unroll
• • •
Missing some Tweet in this thread? You can try to
force a refresh
