EM:RAP Mini – Zack & Joe recap AHA 2014: ‘bleeding edge’ interventions in the ED

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In this short segment that was generously produced and offered by the EM:RAP team, Zack and Joe recap some the the big topics from the American Heart Association 2014 conference in Chicago.  There were a few topics that hit home for the Resuscitationist:

1. REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) – is this ready for prime time yet? well, Zack recently placed a REBOA catheter in a patient with non-compressible blunt trauma to the pelvis at Sharp Memorial Hospital. Its a hot topic right now and was also reviewed in the December 2014 issue of EM:RAP with Stuart Swadron and Kenji Inaba.

2. TTM: Targeted Temperature Management – 33 degrees or 36 degrees after ROSC without RONF? Controversy brews over the ideal temperature for these patients.

3. ECMO at the cutting edge:

• Paris: pre-hospital ECMO?
• Vienna: Load & Go trumps Stay & Play in France

4. TTM for trauma? Sam Tisherman and Pat Kochanek from the Unversity of Pittsburgh  have partnered with Tom Scalea’s team at Maryland Shock Trauma and have established a new trial: EPR-CAT (Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma).  This study takes patients with hemorrhagic cardiac arrest, replaces the blood volume with 10 degrees cold saline, takes them to the OR to fix the holes, then puts them on ECMO to resuscitate them.

5. Mechanical chest compression devices: we acknowledge that the trials have shown neither statistical benefit or harm, but for those of us doing extreme resuscitation of the medical arrest, their are intangible benefits that must be considered.

Bibliography:

REBOA –  Brenner M et al. J Trauma Acute Care Surg. 2013 Sep;75(3):506

TTM– Nielsen N et al. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest.  N Engl J Med 2013; 369:2197-2206

Mech CC Device – Rubertsson S.  Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest.  JAMA. 2014;311(1):53-61

*Thanks to Mel and the entire EM:RAP team for producing this EM:RAP mini and allowing us to repost it. If you aren’t already an EM:RAP subscriber, we can’t emphasize enough the value of this fantastic educational experience. Please consider subscribing to EM:RAP. (No disclosures; Mel doesn’t pay us to say that! its just a damn-good show!)