TOP, MUST-READ CARDIAC ARREST TRIALS OF 2023 🫀⚡️

We summarized in this infographic 4 important multi-center RCTs published in 2023 in the fields of cardiac arrest and CPR

Concomitantly published with a concise review in @ResusJournal

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🧵1/4

#FOAMcc sciencedirect.com/science/articl…
@ClaudioSandron3 @jas_soar @ERC_resus @erc_young @JerryPNolan @CritCareReviews @NickJohnsonMD @nickmmark @expensivecare @iceman_ex #1

The #INCEPTIONtrial

First multi-center RCT on #ECPR from The Netherlands 🇳🇱

➡️ ECPR and conventional CPR had similar survival with good neurological outcome at 30 days (20% vs 16%, P=0.52) and at 6 months

🔗 @NEJM

#FOAMcc nejm.org/doi/full/10.10…

https://twitter.com/tscquizzato/status/1618514989010284544

🫀👀 Looking into the heart of the problem of refractory cardiac arrest

How coronary occlusion severity impacts the responsiveness of OHCA patients to resuscitation is a growing area of interest, fueled in these years by the use of ECPR that allowed previously unrecoverable patients to survive

🔗🧵 Read our editorial & thread /11
@ClaudioSandron3 @ResusJournal @jas_soar @Pipes_n_pumps @EduardArgudo @krychtiukmd @DrCheskes @precordialthump @laertezz @expensivecare 2/

CAD is the leading underlying triggering factor of OHCA but likelihood of acute coronary occlusion is highly variable across OHCA patients

>20 years of research have shown that prevalence is highest in shockable rhythm+STEMI and lowest in non-shockable and no STEMI

👇

https://twitter.com/tscquizzato/status/1667552256705658881

WHAT ARE THE FINDINGS OF CAG AFTER OHCA?🫀

We performed a SRMA of 128 studies (>62k pts) to describe angiographic features in resuscitated and refractory OHCAs

We found that
🔸 significant CAD is present in 75%
🔸 CAD is more severe in refractory OHCA
🔸 CAD is common also in… twitter.com/i/web/status/1… @giovannilandoni @NickJohnsonMD @expensivecare @Pipes_n_pumps @EduardArgudo @CritCareReviews @jas_soar @krychtiukmd @PabloJ @proftomquinn 2/

Although the high frequency of CAD in OHCAs is well known and numerous studies were published, use and findings of CAG are variable and often described only in some subgroups of patients

Type/frequency of coronary lesions in OHCA pts were not summarized before

#ResusTwitter

🔸ECPR improves survival with good neuro outcome🔸

We just published the first meta-analysis of 4 RCTs

➡️ More OHCA patients had good neuro outcome when randomized to #ECPR (27% vs 18%, p=0.02)

🧵 Learn more in the thread /11

🔗 onlinelibrary.wiley.com/doi/full/10.11…

#FOAMcc #ResusTwitter 2/

In refractory OHCA, VA-#ECMO during ongoing CPR, known as #ECPR, can restore and maintain organ perfusion limiting brain injury

Growing evidence suggest that this approach can improve survival and neuro outcome

#FOAMcc #ResusTwitter

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

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

https://twitter.com/tscquizzato/status/1496765510150770688

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 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

*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 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.