Cardiology

Machines better for CPR

This meta-analysis of 12 studies of out-of-hospital cardiac arrest found that machine-delivered CPR was associated with ~1.5 times the odds of return of spontaneous circulation compared to human CPR. This may also be true for in-hospital arrest but needs further research (abstract).

Continue warfarin for pacer/ICD procedures

In this trial of patients on warfarin undergoing a pacer/ICD procedure, they were randomized to continue warfarin perioperatively, or receive heparin bridge therapy. The study was stopped early when the heparin group suffered 4 times more device pocket hematomas than the warfarin group. Based on this well done trial, warfarin should be continued perioperatively in patients undergoing pacers/ICDs (abstract).

CABG vs PCI: depends on the patient

This large randomized trial found lower mortality with CABG (vs PCI) in patients with diabetes, heart failure, peripheral arterial disease, or tobacco use; but those with none of these risk factors had lower mortality with PCI (abstract).

Perioperative beta blockers

This large retrospective analysis of VA medical centers found that patients who received perioperative beta blockers (for noncardiac surgery) had significantly lower 30 day mortality if their revised cardiac risk index was 2 or higher. This study adds more evidence base to the practice of continuing or starting perioperative beta blockers in those with a RCRI of 2 or more (abstract).