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pearl
2
BIS use in elderly patients targeting a BIS of 40-60 may reduce post-operative delirium and post-operative cognitive decline at 3 months.
Chan MT, Cheng BC, Lee TM et al. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013 Jan 1; 25 (1): 334233-42.
  Daniel Jolley
pearl
1
There is no benefit of blood salvage during or after total knee or hip replacement surgery for patients with pre-operative Hb over 13 g/dL.
So-Osman C, Nelissen RG, Koopman-van AW et al. Patient Blood Management in Elective Total Hip- and Knee-replacement Surgery (Part 2): A Randomized Controlled Trial on Blood Salvage as Transfusion Alternative Using a Restrictive Transfusion Policy in Patients with a Preoperative Hemoglobin above 13 g/dl. Anesthesiology. 2014 Apr 1;120(4):852-60.
  Daniel Jolley
comment
0
Important though not to rush to cause and effect – a higher PaCO₂ may simply reflect better systemic perfusion and thus the greater offloading of tissue PaCO₂ in those recovering better after their arrest, or similar reflection of systemic cellular metabolic function vs dysfunction.
Vaahersalo J, Bendel S, Reinikainen M et al. Arterial Blood Gas Tensions After Resuscitation From Out-of-Hospital Cardiac Arrest: Associations With Long-Term Neurological Outcome. Crit. Care Med. 2014 Jun 1;42(6):1463-70.
  Daniel Jolley
summary
1
In patients resuscitated after out-of-hospital cardiac arrest, mean 24 hour PaCO₂ predicted good outcome, specifically time spent with PaCO₂ > 45 mmHg. No similar associations could be found between mean 24 h PaO₂ and outcome.
Vaahersalo J, Bendel S, Reinikainen M et al. Arterial Blood Gas Tensions After Resuscitation From Out-of-Hospital Cardiac Arrest: Associations With Long-Term Neurological Outcome. Crit. Care Med. 2014 Jun 1;42(6):1463-70.
  Daniel Jolley
pearl
1
Pre-hospital 12-lead ECG may improve short-term mortality and time to primary cardiac intervention in patients suffering acute myocardial infarct.
Nam J, Caners K, Bowen JM et al. Systematic Review and Meta-analysis of the Benefits of Out-of-Hospital 12-Lead ECG and Advance Notification in ST-Segment Elevation Myocardial Infarction Patients. Ann Emerg Med. 2014 Aug 1; 64 (2): 176-86, 186.e1-9.
  Daniel Jolley
pearl
1
Survival after compression-only CPR is comparable to standard CPR if the cause of arrest is cardiac.
Yao L, Wang P, Zhou L et al. Compression-only cardiopulmonary resuscitation vs standard cardiopulmonary resuscitation: an updated meta-analysis of observational studies. Am J Emerg Med. 2014 Jun 1;32(6):517-23.
  Daniel Jolley
summary
1
Comparing PECARN, CATCH, and CHALICE Rules for Children With Minor Head Injury along with two modalities of physician judgement showed significant variation in the sensitivities and specificities of the five modalities. Only physician practice and PECARN identified all traumatic brain injuries at a cost of lower specificity compared with CHALICE.
Easter JS, Bakes K, Dhaliwal J et al. Comparison of PECARN, CATCH, and CHALICE Rules for Children With Minor Head Injury: A Prospective Cohort Study. Ann Emerg Med. 2014 Aug 1; 64 (2): 145152.e1525145-52, 152.e1-5.
  Daniel Jolley
pearl
1
Initiating therapeutic hypothermia for out-of-hospital cardiac arrest pre-hospital does not improve survival or neurological outcome.
Hunter BR, O'Donnell DP, Allgood KL et al. No Benefit to Prehospital Initiation of Therapeutic Hypothermia in Out-of-hospital Cardiac Arrest: A Systematic Review and Meta-analysis. Acad Emerg Med. 2014 Apr 1;21(4):355-64.
  Daniel Jolley
summary
1
For emergency medical services with low VF survival rates (<20%), early rhythm analysis improves survival, whereas in services where VF survival rates are high (>20%) delayed rhythm analysis with focus on immediate CPR instead improves survival.
Rea T, Prince D, Morrison L et al. Association Between Survival and Early Versus Later Rhythm Analysis in Out-of-Hospital Cardiac Arrest: Do Agency-Level Factors Influence Outcomes? Ann Emerg Med. 2014 Jul 1; 64 (1): 1-8.
  Daniel Jolley
summary
1
Modelling implementation of a clinical decision rule to identify children at very low risk of significant intra-abdominal injury after blunt trauma:
• Saved on average US$55 per child.
• Avoided a CT scan in 1 in 10 children.
• Missed 1 in 2,000 intra-abdominal injuries requiring acute intervention.
Nishijima DK, Yang Z, Clark JA et al. A Cost-effectiveness Analysis Comparing a Clinical Decision Rule Versus Usual Care to Risk Stratify Children for Intraabdominal Injury After Blunt Torso Trauma. Acad Emerg Med. 2013 Nov 1; 20 (11): 1131-8.
  Daniel Jolley