A new multicenter trial published in NEJM, commonly known as the “TTM2” trial, evaluated treating patients resuscitated from out-of-hospital cardiac arrest with targeted temperature management to 33C versus controlled normothermia, and found that outcomes were equivalent.  Does this mean the end of TTM as we know it?  In this podcast, Dr. Benjamin Abella presents a comprehensive argument why he believes that such pronouncements are premature and not consistent with the larger body of laboratory and clinical science over the past 20 years. He discusses TTM2 in context of recent work f ..read more

Electrocardiography (ECG) represents a central diagnostic tool in the post-arrest evaluation of patients resuscitated from out-of-hospital cardiac arrest (OHCA), and it should be acquired immediately after achievement of ROSC to identify the need for an urgent coronary angiography, which is indicated only in the case of ST-segment elevation myocardial infarction (STEMI). While resuscitation guidelines are clear in the recommendation and importance of obtaining an ECG during the post-ROSC phase, they don’t provide specific instructions about the best time for ECG acquisition after ROSC.   ..read more

While we have focused on the science of targeted temperature management and other care strategies for critically ill survivors, it is important for us to remember that real people experience cardiac arrest and the consequences. In this unique episode, Dr. Benjamin Abella interviews Kristin Flanary, who jumped into action to provide 10 minutes of bystander CPR to her husband, Dr. Will Flanary, who has thankfully made a full recovery. You may know Kristin and Will as @lglaucomflecken and @dglaucomflecken , well-known on twitter – we are grateful that Kristin has chosen to go public with her stor ..read more

The role of oxygenation during critical illness remains a major question.  Is extra oxygen harmful or helpful? What oxygen levels should we target, both for respiratory failure and for patients after cardiac arrest? Dr. Benjamin Abella discusses these topics, and reviews a hot-of-the-press work from European investigators (the “HOT-ICU”) trial, published in New England Journal of Medicine this month. The paper evaluates two different oxygen targets for patients with respiratory failure – implications for this work as it pertains to cardiac arrest will be discussed.   Key publications ..read more

Critical illness from COVID19 remains a major challenge to health systems worldwide. When patients progress to in-hospital cardiac arrest (IHCA), what is the chance of survival?  Studies have so far revealing conflicting answers to this important question.  What is the role of post-arrest care bundles, including TTM, in the care process?  Dr. Felipe Teran will lead a conversation with Dr. Oscar Mitchell, who served as the lead author in a new multicenter study of COVID19 IHCA survival, to be presented as a late-breaking abstract at the Resuscitation Science Symposium.   Key ..read more

Dr. Felipe Teran joins Drs. Cindy Hsu and Hans van Schuppen to discuss recent guidance regarding cardiac arrest resuscitation during the COVID-19 pandemic. Key publications referenced in this episode:  Couper K, Taylor-Phillips S, Grove A, et al. COVID-19 in cardiac arrest and infection risk to rescuers: A systematic review. Resuscitation. 2020; 151:59-66. https://pubmed.ncbi.nlm.nih.gov/32325096/ Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Car ..read more

Dr. Felipe Teran discusses the recent studies pertainig to OHCA during the COVID-19 pandemic.   Key publications referenced in this episode: Baldi E et al. Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy. N Engl J Med 2020 Apr 29; [e-pub]. (https://doi.org/10.1056/NEJMc2010418) Marijon E, Karam N, Jost D, et al. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. Lancet Public Health. 2020 Sayre MR, Barnard LM, Counts CR, et al. Prevalence of COVID-19 in Out-of-Hospital Cardiac Arrest: Impli ..read more

Dr. Abella discusses a very recent American Heart Association scientific statement on cardiac arrest survivorship, increasingly recognized as an important topic around the globe. While many studies have evaluated survival to hospital discharge, or even survival at 90 or 180 days post-arrest – survival is not enough. Increasing data suggest that even among “good” neurologic survivors (those with Cerebral Performance Category 1 or 2), life-limited challenges remain, including depression, PTSD, cognitive deficits and other challenges to quality of life.   Key readings:  Sawyer KN, et al. Sudden C ..read more

Drs. Teran and Abella discuss a hot-off-the-press survey study by Maciel CB et al (Critical Care Medicine, 2020), probing physician perspectives and practice on post-arrest neurologic assessment and prognostication. Do all of us follow the international guidelines for this phase of care? What are points of confusion in current “real world” practice?  Join us to answer these questions and hear about key action items for all of us who manage post-arrest care. Key reading: Neuroprognostication Practices in Postcardiac Arrest Patients: An International Survey of Critical Care Providers. Maciel CB ..read more

Drs. Abella and Teran discuss the scientific literature surrounding gender differences in care during and following cardiac arrest. From differences in bystander CPR provision for public cardiac arrests to post-arrest DNR status and cardiac catheterization; listen to hear more.   Key publications for this episode: Lindgren E et al. Gender differences in utilization of coronary angiography and angiographic findings after out-of-hospital cardiac arrest: A registry study. Resuscitation. 2019 Oct;143:189-195. https://www.ncbi.nlm.nih.gov/pubmed/31330199 Perman SM et al. Sex Differences in "Do Not ..read more