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  • Dr. Bertha Wu

JOURNAL CLUB - MARCH 2022

Updated: Nov 3, 2023

Journal Club Podcast for March 2022

Dr Bertha Wu Prof Peter Cameron Dr Myles Sri Ganeshan

Editor: Dr David McCreary


Welcome to this month’s journal club podcast. We are joined by Professor Peter Cameron, Academic Director for the Alfred Emergency and Trauma Centre, and Dr Myles Ganeshan, Alfred Research Fellow.


This month we reviewed three papers, covering a range of topics that are finally, not COVID related!

The first paper we reviewed looked at the effect of early intra-arrest transport and extracorporeal cardiopulmonary resuscitation on functional neurological outcome in refractory out of hospital cardiac arrests. This was a single centre, randomized control trial published in JAMA just last month in February 2022 by Belohlavek et al.


The second paper we reviewed looked at whether delivering low-intensity mental health outreach programs online prevents self-harm in adult outpatients who have suicidal ideation. It was also published in JAMA in February 2022 by Simon GE et al. Yes it’s a bit of a left-field study to cover in our journal club! But was an interesting read.


The last paper we reviewed looked at the effect of using bougie versus endotracheal tube with stylet on first pass successful tracheal intubation. It was published in JAMA in December 2021 by Driver BE et al.


PAPER 1: EFFECT OF INTRA-ARREST TRANSPORT, EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION, AND IMMEDIATE INVASIVE ASSESSMENT AND TREATMENT ON FUNCTIONAL NEUROLOGICAL OUTCOME IN REFRACTORY OUT-OF-HOSPITAL CARDIAC ARREST

READ IT HERE


CLINICAL QUESTION:

In patients with witnessed refractory out-of-hospital cardiac arrest, does early intra-arrest transport, ECPR and invasive assessment and treatment improve outcomes compared with standard resuscitation?


DESIGN

Single centre, randomized clinical trial in Prague over 8 years – March 2013- October 2020.


POPULATION

Adults aged 18-25yrs receiving ongoing resus for witnessed OHCA of presumed cardiac etiology + received a minimum of 5 min of ACLS without ROSC + ECPR team was available at cardiac centre.


Planned sample size 285 → 256 participants enrolled.


INTERVENTION

Invasive strategy group (n=124) – mechanical compression initiated followed by intra-arrest transport to a cardiac centre for ECPR and immediate invasive assessment and treatment.


COMPARISON

Regular advanced cardiac life support continued on-site in the standard strategy group (n=132).


OUTCOMES

Participants were observed until death or day 180.


Primary outcome: survival with a good neurological outcome (using Cerebral Performance Scale CPC  - defined as CPC 1-2 at 180 days


Secondary outcomes: neurological recovery at 30 days – no need for pharmacological or mechanical cardiac support for at least 24 hours

FINDINGS

256 patients were enrolled with all participants completing the trial. 31.5% in the invasive strategy group and 22% in the standard strategy group surviving to 180 days with good neurologic outcome. The difference of 9.5% was not found to be significant with p value of 0.09. At 30 days, neurologic recovery had occurred in 30.6% in the invasive strategy group, and in 18.2% in the standard strategy group; a statistically significant difference of 12.4% (p 0.02). Cardiac recovery had occurred in 43.5% and 34.1% respectively; again not a significant difference. Bleeding occurred more frequently in the invasive strategy group, occurring in 31% of the invasive strategy group vs 15% of the standard strategy group.


AUTHORS' CONCLUSIONS

Among patients with refractory OHCA, the bundle of early intra-arrest transport, ECPR, and invasive assessment and treatment did not significantly improve survival with neurologically favourable outcome