|Author||Topic||Study Title||Year||Journal||Summary (one-liner)||PubMed Link|
|Keh et al.||Hemodynamics||Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis: The HYPRESS Randomized Clinical Trial||2016||JAMA||This multicenter RCT showed that, "among adults with severe sepsis not in septic shock, use of hydrocortisone compared with placebo did not reduce the risk of septic shock within 14 days."|
|Sakles et al.|
|First Pass Success Without Hypoxemia Is Increased With the Use of Apneic Oxygenation During Rapid Sequence Intubation in the Emergency Department.||2016|
Acad Emerg Med
|"Apneic oxygenation is a straightforward intervention that should be used during the apneic phase of rapid sequence intubation as it increases first pass success without hypoxemia."|
|Patel et al.|
|Effect of Noninvasive Ventilation Delivered by Helmet vs Face Mask on the Rate of Endotracheal Intubation in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial||2016||JAMA||This single center RCT showed that "among patients with ARDS, treatment with helmet noninvasive ventilation (NIV) resulted in a significant reduction of intubation rates. There was also a statistically significant reduction in 90-day mortality with helmet NIV."|
Girardis et al.
|Effect of Conservative vs Conventional Oxygen Therapy on Mortality Among Patients in an Intensive Care Unit: The Oxygen-ICU Randomized Clinical Trial.||2016||JAMA||This single center RCT showed that "among critically ill patients with an ICU length of stay of 72 hours or longer, a conservative protocol for oxygen therapy vs conventional therapy resulted in lower ICU mortality."|
|Juttler et al.||Neuro||Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. (DESTINY II).||2014||NEJM||This multicenter RCT showed that hemicraniectomy increased survival without severe disability (defined as modified Rankin score <5) among patients 61 years of age or older with a complete or subtotal space occupying middle-cerebral-artery infarction. All survivors in both groups had at least moderate dsability (mRS 3) while initially presenting with mRS of 0 or 1.|
Hofmeijer et al.
|Neuro||Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial.||2009||Lancet||"Surgical decompression reduces case fatality and poor outcome (modified Rankin score of 4-6) in patients with space-occupying infarctions who are treated within 48 h of stroke onset."|
Berkhemer et al.
|Neuro||A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke (MR CLEAN)||2015||NEJM||IA treatment of stroke due to embolus in proximal anterior circulation(distal intracranial carotid artery, middle cerebral artery (M1 or M2), or anterior cerebral artery (A1 or A2). ) improved functional outcomes at 90 days compared to conservative management. No change in mortality seen.|
Anderson et al
|Neuro||Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage (INTERACT 2)||2013||NEJM||In patients with ICH, early intensive blood pressure control (SBP<140) compared to conservative BP control (SBP<180) did not show a significant decrease in mortality or major disability. Intensive SBP control did show a decrease in the risk of disability and an improvement in quality of life outcomes.|
Amarenco et al
|Neuro||High-Dose Atorvastatin after Stroke or Transient Ischemic Attack (SPARCL)||2006||NEJM||In patients with recent CVA or TIA, without known coronary artery disease, high dose statin therapy with 80 mg of Atorvastatin a day reduced the incidence of recurrent stroke or cardiovascular events. It may however increase the incidence of hemorrhagic stroke.|
Molyneux et al.
International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial
|2002||Lancet||In patients with ruptured intracranial aneurysm, endovascular coiled resulted in signficantly better survival free of disability at 1 year when compared with traditional neurosurgical clipping. The data also suggested low rates of further bleeding with either treatment option though somewhat more frequent with endovascular coiling.|
|Patel et al.||Anticoagulation||Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation (ROCKET - AF)||2011||NEJM||In patients with nonvalvular atrial fibrillation, rivoraxaban was a noninferior means of anticoagulation when compared with warfarin in preventing stroke or systemic embolism. Additionally, the study showed no significant between-group difference in the risk of major bleeding, but intracranial and fatal bleeding occured less frequently in patients treated with rivoraxaban.|
Valgimigli et al.
Short- versus Long-term Duration of Dual-Antiplatelet Therapy After Coronary
24-months of clopidogrel therapy in patients with DES or BMS was not significantly more effects than a 6-month
clopidogrel course in reducing all-cause mortality.
|Wyse et al||CCU||A comparison of rate control and rhythm control in patients with atrial fibrillation. (AFFIRM)||2002||NEJM||In nonvalvular atrial fibrillation there was no difference in survival benefit between rate or rhythm control. However, rhythm control did trend toward increased mortality.|
|Granger et al||CCU||Apixaban versus warfarin in patients with atrial fibrillation. (ARISTOTLE)||2011||NEJM||"In patients with atrial fibrillation, apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality."|
Van Gelder et al
|CCU||Lenient versus Strict Rate Control in Patients with Atrial Fibrillation. (RACE II)||2010||NEJM||For patients with permanent atrial fibrillation, a leneient rate control goal (HR <110) was non inferior to a strict rate control (HR<80) at preventing cardiovascular events.|
|Gorlin et al.||CCU||The effect of digoxin on mortality and morbidity in patients with heart failure. (DIG)||1997||NEJM||Though digoxin did not reduce overall mortality, it reduced the rate of hospitalization overall and in the setting of worsening heart failure.|
|Pitt et al||CCU||The effect of spironolactone on morbidity and mortality in patients with severe heart failure. (RALES)||1999||NEJM||For patients with ischemic and nonischemic heart failure with a reduced ejection fraction (HFrEF with EF<35%) and classified as NYHA III-IV symptomatically, spironolactone resulted in a 30% reduction in all-cause mortality within significant increase risk of serious hyperkalemia or renal failure.|
Holcomb et al
Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. (PROPPR)
"Among patients with severe trauma and major bleeding, early administration of plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio did not result in significant differences in mortality at 24 hours or at 30 days. However, more patients in the 1:1:1 group achieved hemostasis and fewer experienced death due to exsanguination by 24 hours. Even though there was an increased use of plasma and platelets transfused in the 1:1:1 group, no other safety differences were identified between the 2 groups."
|Haan et al||Trauma||Splenic Embolization Revisited: A Multicenter Review||2005||J Trauma|
Splenic embolization is an important tool that can be used for splenic salvage. Major complications include bleeding,
splenic abscesses, and arterial injury.
|Kozar et al||Trauma|
Complications of nonoperative management of high-grade blunt hepatic injuries
High grade blunt liver injuries can be managed non-operatively. Complications, such as bleeding, liver abscess,
and biliary complications, which may need to be managed by operative strategies should be expected with grade 4
and 5 blunt hepatic injuries.
Knudson et al
Outcome after major renovascular injuries: a Western trauma association
|2000||J Trauma||In patients with renovascular injury, factors that were associated with poor outcomes included blunt injury |
(vs. penetrating injury), grade V injury (vs grade IV injury), and attempted arterial repair
(vs attempted venous repair). These patients may be better off by having an immediate nephrectomy.
|DuBose et al||Trauma||Management of post-traumatic retained hemothorax.||2012||J Trauma|
Hemothorax after chest tube placement can be observed if its size is less than or equal to 300cc. A hemothorax > 900 cc
in size will likely need a thoracotomy.
Velhamos et al
Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury.
|2003||J Trauma||Normal ECG and TnI on admission and 8 hours later can be used to rule out significant blunt cardiac injury.|
|Sierink et al||Trauma|
Immediate total-body CT scanning versus conventional imaging and selective
CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial
Immediate total-body CT scanning has not been shown to improve survival and is associated with higher radiation
exposure. However it does increase direct medical costs.
Connelly et al.
Thrombelastography-Based Dosing of Enoxaparin for Thromboprophylaxis in
Trauma and Surgical Patients.
|2016||JAMA Surg||No significant difference in venous thromboembolism (VTE) incidence in patients admitted to the trauma service receiving |
standard dosing of enoxaparin vs enoxaparin dosing guided by thrombelastogram (TEG).
Holcomb et all
The Prospective, Observational, Multicenter, Major Trauma Transfusion
Early infusion and higher plasma and platelet ratios are associated with decreased mortality. The association is
strongest in the first 6 hours.
Williams-Johnson et al
Effects of tranexamic acid on death, vascular occlusive events, and blood
transfusion in trauma patients with significant haemorrhage (CRASH-2) a
randomised, placebo-controlled trial.
Tranexamic acid should be considered for use in bleeding trauma patients due to the reduction in all-cause mortality
and risk of bleeding found in this study.
|Jolly et al.||Cardiac|
Radial vs. Femoral Access for Coronary Angiography and Intervention in Patients
with Acute Coronary Syndrome: a randomized, parallel group, multicenter trial (RIVAL)
Radial and femoral approaches are both safe and effective for PCI. However, the radial approach is associated
with a lower-rate of local vascular complications.
Bøhmer et al.
Efficacy and Safety of Immediate Angioplasty Versus Ischemia-Guided Management
After Thrombolysis in Acute Myocardial Infarction in Areas With Very Long
Transfer Distances: Results of the NORDISTEMI (NORwegian study on DIstrict treatment of ST-elevation myocardial infarction).
In patients with acute STEMI receiving thrombolytic therapy, early PCI is associated with decreased mortality,
reinfarction, and CVA compared to conservative management.
Farkouh et al.
Strategies for Multivessel Revascularization in Patients with Diabetes (FREEDOM)
In patients with diabetes and multivessel coronary artery disease, CABG is superior to PCI with DES in that CABG
significantly reduces the rates of death and MI, with a higher rate of stroke.
|Wald et al||Cardiac||Randomized Trial of Preventive Angioplasty in Myocardial Infarction. (PRAMI)||2013||NEJM|
In patients with acute STEMI and multi-vessel CAD diagnosed at the time of emergent PCI, preventive PCI of
non-infarct vessels with major stenoses significantly reduced the risk of death from cardiac causes, nonfatal MI,
or refractory angina as compared to PCI limited to infarct vessel.
|Svilaas et al.||Cardiac||Thrombus Aspiration during Percutaneous Coronary Intervention (TAPAS)||2008||NEJM|
In patients with STEMI, thrombus-aspiration PCI is associated with
better reperfusion and better clinical outcomes than conventional-PCI.