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Showing posts from July, 2012

Laryngeal View During Laryngoscopy: A Randomized Trial Comparing Cricoid Pressure, Backward-Upward-Rightward Pressure, and Bimanual Laryngoscopy

Landmark Series
Levitan RM, Kinkle WC, Levin WJ, Everett WW. Ann Emerg Med. 2006 Jun.;47(6):548–55.
PubMed Link

This U.S. study evaluated manipulation techniques for direct laryngoscopy during endotracheal intubation in 1,530 comparisons performed by 104 physicians in fresh cadavers. Bimanual laryngoscopy improved laryngeal view compared to cricoid pressure, backward-upward-rightward pressure, and no manipulation. JC attendees expressed considerable support for the technique of bimanual laryngoscopy where the laryngeal view was unsatisfactory.

Early versus Later Rhythm Analysis in Patients with Out-of-Hospital Cardiac Arrest

Methodology: 4.5/5    
Usefulness: 4/5 Stiell IG, Nichol G, Leroux BG, Rea TD, Ornato JP, Powell J, Christenson J, Callaway CW, Kudenchuk PJ, Aufderheide TP, Idris AH, Daya MR, Wang HE, Morrison LJ, Davis D, Andrusiek D, Stephens S, Cheskes S, Schmicker RH, Fowler R, Vaillancourt C, Hostler D, Zive D, Pirrallo RG, Vilke GM, Sopko G, Weisfeldt M; ROC Investigators. N Engl J Med. 2011 Sep 1;365(9):787-97. Article Link

This large cluster randomized trial conducted by the ROC Consortium enrolled 9,933 Canadian and U.S. out-of-hospital cardiac arrest patients and found no difference in outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. This was a real-life effectiveness (pragmatic) trial conducted in difficult circumstances that, despite some problems with protocol compliance, has definitively shown that there is no reason to delay analysis and defibrillation for OOHCA patients. 
By Dr. Ian Stiell

International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences

Methodology: 2/5     Usefulness: 3/5 Lotrionte M, Biondi-Zoccai G, Imazio M, Castagno D, Moretti C, Abbate A, Agostoni P, Brucato AL, Di Pasquale P, Raatikka M, Sangiorgi G, Laudito A, Sheiban I, Gaita F. Am Heart J. 2010 Oct;160(4):662-70. Review Article Link
This study was a systematic review of current pharmacologic treatments of acute pericarditis or its recurrence and it found that there were lower rates of treatment failure and recurrences with the use of colchicine in addition to NSAIDS but that the use of steroids was associated higher rates of recurrences. The main weakness of this systematic review was that it combined results from RCTs and retrospective chart reviews with large clinical heterogeneity and therefore it was difficult to draw strong conclusions from its results to apply clinically. 
By Dr. Anita Lai

Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials

Methodology: 4/5    
Usefulness: 4.5/5
Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, Albers GW, Kaste M, Marler JR, Hamilton SA, Tilley BC, Davis SM, Donnan GA, Hacke W; ECASS, ATLANTIS, NINDS and EPITHET rt-PA Study Group, Allen K, Mau J, Meier D, del Zoppo G, De Silva DA, Butcher KS, Parsons MW, Barber PA, Levi C, Bladin C, Byrnes G. Lancet. 2010 May 15;375(9727):1695-703 Article Link
This pooled analysis of 8 large double-blind randomized controlled trials of IV t-PA in acute stroke found that there is increased odds of a significant benefit with regard to 3-month functional outcome in acute stroke patients if treated with t-PA within 4.5 hours of stroke onset.  Serious hemorrhage rates were found to be independent of onset to treatment time (OTT), however mortality increased as the OTT increased, most notably after 4.5 hours. The group recognized this study, and in particular the trial ECASS III, as a practice-changer, which led to the Canadian stroke guidelines expans…

Sublingual buprenorphine in acute pain management: a double-blind randomized clinical trial

Methodology: 3.5/5    
Usefulness: 2/5 Jalili M, Fathi M, Moradi-Lakeh M, Zehtabchi S. Ann Emerg Med. 2012 Apr;59(4):276-80. PubMed Link
This double blind, double dummy RCT compared sublingual Buprenorphine (0.4 mg) to IV Morphine (5 mg) for acute pain in adults presenting to the ED with acute fractures and found similar efficacy and side effects. While this was the first RCT to look at the use of SL Buprenorphine in the ED, numerous methodological weaknesses and small sample size precluded the ability to infer any equivalence to IV morphine in this population.
By Dr. Laura Francis