The use of AEDs in hospitals is enticing since they are easy to use, and they have reduced out of hospital cardiac death. In this large analysis of the NRCPR database, 18% of patients had shockable rhythms, and 18% survived to hospital discharge. Of those with shockable rhythms, AED use did not reduce in-hospital mortality. And overall, the use of AEDs increased in-hospital mortality, due to an increased risk of mortality among patients with non-shockable rhythms. Use of AEDs in hospitals may not be beneficial, where the majority of arrests are not due to shockable rhythms, whereby AEDs may interfere with appropriate care (abstract).
My patient was a 69 year old lady with metastatic small cell lung cancer. She was on experimental chemotherapy and was admitted from clinic with worsening lower extremity edema and a new oxygen requirement. She underwent a chest and abdominal CT that revealed new pulmonary masses, tumor and a mass invading her right pulmonary artery, […]
The large multi-center ICU trial randomized ICUs to 1 of 3 strategies: MRSA screening/isolation, MRSA screening/isolation/decolonization, or global decolonization (5 days BID nasal mupiricin and daily chlorhexidine bathing). The hazard ratios for MRSA isolates in the 3 groups were 0.92, 0.75, 0.63 respectively. The hazard ratios for any bloodstream infection in the 3 groups were […]
This trial found no difference in patient outcomes (mortality or LOS) if admitted during a time of 24/7 intensivist coverage, or during a time with only daytime intensivist coverage (with home call at night) in a medical ICU. This study does not show a patient benefit to a 24/7 intensivist staffing model in an academic […]