Matthew E. Prekker

A randomized, placebo-controlled trial of aprotinin to reduce primary graft dysfunction following lung transplantation

Herrington CS, Prekker ME, Arrington AK, Susanto D, Baltzell JW, Studenski LL, Radosevich DM, Kelly RF, Shumway SJ, Hertz MI, Bittner HB, Dahlberg PS. A randomized, placebo‐controlled trial of aprotinin to reduce primary graft dysfunction following lung transplantation.u2028Clin Transplant 2011: 25: 90–96.

Endotracheal Intubation with the King Laryngeal Tube™ In Situ Using Video Laryngoscopy and a Bougie: A Retrospective Case Series and Cadaveric Crossover Study

BACKGROUNDnRemoval of a functioning King laryngeal tube (LT) prior to establishing a definitive airway increases the risk of a cant intubate, cant oxygenate scenario. We previously described a technique utilizing video laryngoscopy (VL) and a bougie to intubate around a well-seated King LT with the balloons deflated; if necessary, the balloons can be rapidly re-inflated and ventilation resumed.nnnOBJECTIVEnOur objective is to provide preliminary validation of this technique.nnnMETHODSnEmergency physicians performed all orotracheal intubations in this two-part study. Part 1 consisted of a historical analysis of VL recordings from emergency department (ED) patients intubated with the King LT in place over a two-year period at our institution. In Part 2, we analyzed VL recordings from paired attempts at intubating a cadaver, first with a King LT in place and then with the device removed, with each physician serving as his or her own control. The primary outcome for all analyses was first-pass success.nnnRESULTSnThere were 11 VL recordings of ED patients intubated with the King LT in place (Part 1) and 11 pairs of cadaveric VL recordings (Part 2). The first-pass success rate was 100% in both parts. In Part 1, the median time to intubation was 43xa0s (interquartile range [IQR] 36-60xa0s). In Part 2, the median time to intubation was 23xa0s (IQR 18-35xa0s) with the King LT in place and 17xa0s (IQR 14-18xa0s) with the King LT removed.nnnCONCLUSIONSnEmergency physicians successfully intubated on the first attempt with the King LT in situ. The technique described in this proof-of-concept study seems promising and merits further validation.

Comparison of two glycemic discharge goals in ED patients with hyperglycemia, a randomized trial

STUDY OBJECTIVEnHyperglycemia is commonly encountered in the ED; the importance of glucose reduction in patients well enough to be discharged is unknown.nnnMETHODSnWe conducted a prospective, randomized trial of ED patients with hyperglycemia with a glucose value 400-600u202fmg/dL who were discharged from the ED, excluding those with type 1 diabetes mellitus. Patients were randomly assigned to a discharge glucose goal, <350u202fmg/dL (moderate control) oru202f<u202f600u202fmg/dL (loose control). The primary outcome was ED length of stay.nnnRESULTSnAmong 110 enrolled patients, 57 were assigned to moderate and 53 to loose glycemic control. Median (IQR) length of stay was 211u202fmin (177-288u202fmin) for the moderate group and 216u202fmin (151-269u202fmin) for the loose group (difference, 17u202fmin [95% CI -15 to 49u202fmin]). ED length of stay for those with an actual discharge glucose <350u202fmg/dL was 29u202fmin longer (95% CI -1 to 59u202fmin). Repeat ED visits for hyperglycemia (7% vs 6%), hospitalization for hyperglycemia (0% vs 2%), and hospitalization for any reason (4% vs 8%) did not differ significantly between groups.nnnCONCLUSIONnIn the intention-to-treat analysis, ED length of stay and 7-day outcomes were not significantly different whether moderate or loose glycemic control was pursued. However, the length of stay for those with discharge glucose <350u202fmg/dL was approximately 29u202fmin longer. ED glycemic control did not appear to be associated negative short-term outcomes. Glucose reduction in well-appearing ED patients may consume time and resources without conferring short- or long-term benefits.nnnTRIAL REGISTRATIONnClinicaltrials.govNCT02478190.

Video screen viewing and first intubation attempt success with standard geometry video laryngoscope use

STUDY OBJECTIVESnDirect laryngoscopy (DL) is the traditional approach for emergency intubation but video laryngoscopy (VL) is gaining popularity. Some studies have demonstrated higher first-attempt success with VL, particularly in difficult airways. In real-world settings, physicians choose whether or not to view the video screen when utilizing VL devices for tracheal intubation. Therefore, we sought to determine whether screen viewing is associated with higher intubation first-attempt success in clinical practice.nnnMETHODSnIn this retrospective, observational investigation, we studied consecutive adult emergency department intubations at an urban, academic medical center during the calendar year 2013. Cases were identified from the electronic medical record and analyzed using standard video review methodology. We compared first-attempt success rates when standard geometry Macintosh VL was used, stratified by whether the screen was viewed or not.nnnRESULTSnOf the 593 cases with videos available for review, 515 (87%) were performed with a standard geometry Macintosh video laryngoscope. First-attempt success was not significantly different when the screen was viewed (195/207; 94% [95%CI 91-97]) compared to when the screen was not viewed (284/301; 94% [95%CI 92-97]). The median first-attempt duration was longer when the screen was viewed compared to when the screen was not viewed (45 versus 33u202fs; median difference 12u202fs [95%CI 10-15u202fs]).nnnCONCLUSIONnIn this study of orotracheal intubations performed by emergency physicians with Macintosh-style VL, the first-attempt success rate was high. The success rate was similar whether or not the intubating physician chose to view the video screen.

285: ACTIVE REWARMING AFTER ACCIDENTAL HYPOTHERMIA USING A TARGETED TEMPERATURE MANAGEMENT CATHETER

Crit Care Med 2016 • Volume 44 • Number 12 (Suppl.) comparisons. Quarterly reports were run to identify any periodic variations or incremental effects during protocol transition (late Quarter 1 / early Quarter 2, 2015). Results: Of 1,304 consecutive OOHCA cases in 2014-15, quarterly survival rates remained constant in 2014 (17.4% mean, range 15-20%) but rose steadily during the transition period with an ensuing sustained doubling of survival (36.0%; range 35-37%). Outcome improved across subgroups while response intervals, indications for initiating CPR and bystander CPR rates were unchanged. Regionally in 2015, hospital admission rates were found to remain proportional to neuro-intact discharge. Conclusions: Although a historical-control was used and the relative influence of head/torso-up CPR and impedance threshold device not delineated, the dramatic steady rise in survival rates seen during the two month transition phase and the subsequent sustained doubling of survival chances still makes a compelling case that the combination approach improved OOHCA outcomes.