4 RCTs published in the last few hours you can’t miss if you work with critically ill patients:

#1 Fluids in septic shock
#2 Mobilisation and long-term cognitive impairment
#3 NIV for extubation of obese patients
#4 Nutrition before extubation

A thread 🧵👇

#FOAMcc #SCCM2023
#1

#CLOVERStrial compared a restrictive fluid strategy (with early vasopressors) to a liberal one in septic shock patients.

➡️ Restrictive fluid strategy (with early vasopressors) did not result in significantly lower (or higher) mortality

🔗 nej.md/3CWSXBA

#FOAMcc
#2

What’s the effect of early mobilisation on long-term cognitive impairment in ICU survivors after mechanical ventilation?

➡️ Early mobilisation improved long-term cognitive impairment at 1 y (24% vs 43%) but increased adverse events (6%)

🔗 bit.ly/3CYIZQ7

#FOAMcc
#3

Does NIV (alternated with HFNO or standard O2) reduce treatment-failure in obese ICU pts undergoing extubation compared to HFNO or standard O2 alone?

➡️ NIV reduced treatment failure (e.g., reintubation) within 3 days after extubation

🔗 bit.ly/3QQg8mM

#FOAMcc
#4

Does continued enteral nutrition vs fasting (max gastric vacuity) before extubation reduce extubation failure (reintubation or death) within 7d in ICU pts?

➡️ Continued enteral nutrition until extubation was non-inferior to a 6 h fasting

🔗 bit.ly/3kqTup5

#FOAMcc
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More from @tscquizzato

Jan 21
ECPR for OHCA: Pre-hospital or in-hospital?

Happy to share this Editorial written with @Alice_hutin and @giovannilandoni commenting on a SR/MA by @nattiejpk investigating the role of pre-hospital #ECPR.

🧵👇 Learn more in the thread /17

🔗 bit.ly/3ZQQNNG #ResusTwitter
2/

#ECPR is the last rescue therapy when despite high-quality conventional CPR it is not possible to achieve ROSC.

In such situations, OHCA is considered refractory and E-CPR recently demonstrated to improve outcomes in selected patients.

#ResusTwitter
3/

@nattiejpk recently conducted a SRMA published on @JCVAonline investigating effect of preh initiation of #ECPR on low-flow and survival

Most evidence comes from Paris, first EMS applying preh ECPR since 2011 @LionelLamhaut @alice_hutin

#ResusTwitter
Read 18 tweets
Jun 16, 2021
THREAD and my infographic of the #TTM2 trial

#OHCA patients were randomised to #TTM at 33°C or normothermia (<37.8°C) with early fever treatment.

➡️ Mortality and poor neuro outcome at 6 months were not lower in the hypothermia group.

🔗 nejm.org/doi/full/10.10… #FOAMcc Image
Guidelines recommend selecting and maintaining a constant target #TTM between 32 and 36 °C in comatose post-cardiac arrest patients to prevent hypoxic-ischemic brain damage.
(strong recommendation, moderate-quality evidence). #FOAMcc Image
Two RCTs published in 2002 showed an improved survival and neurologic outcome in patients resuscitated from OHCA of presumed cardiac cause and shockable rhythm who underwent hypothermia at 33°C. #FOAMcc Image
Read 6 tweets
Jun 11, 2020
*Thread on #FirstResponders for OHCA*

In the last decade, numerous systems like @pulsepoint @GoodSamApp @SAUVLife @HartslagNu were developed to alert laypersons.

In this review, we provide an overview of published technologies and analyze their impact on pts outcomes.

#FOAMed Image
How does a citizens first responder system work?

Citizens willing to help in case of OHCA can voluntarily register in a first responder network.

When an OHCA occurs, the nearest ones are alerted simultaneously with #EMS dispatch to increase CPR rates before ambulance arrival. ImageImage
Our systematic review found 12 different systems (7 apps, 5 text message systems).

Activation radius varied from 150 m to 5 km. Also activation criteria, training required, technology used, and active time varied between systems and are summarized below 👇 Image
Read 12 tweets

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