The Resus Room September 2024; papers of the month
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Sep 1, 2024 This month's discussion dives into groundbreaking research on dual sequential defibrillation, focusing on how shock interval timings can improve outcomes for patients with refractory ventricular fibrillation. The hosts also tackle the best prognostication tools for upper GI bleeds, analyzing their effectiveness in clinical settings. Lastly, the potential risks associated with tranexamic acid use in trauma patients are evaluated, highlighting concerns over venous thromboembolism and the discrepancies in clinical practices across countries.
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Timing Matters For Dual Shocks
- Shorter intervals between dual sequential defibrillation (DSD) shocks may improve VF termination and ROSC rates.
- Animal data and this human retrospective cohort suggest intervals <75 ms are associated with higher termination, warranting further study.
Evidence Still Early And Confounded
- Retrospective data show an association between almost-simultaneous shocks and VF termination but are limited by small numbers and confounding.
- Larger studies treating interval as a continuous variable would clarify whether a true dose–response exists.
Apply DSD Carefully, Not As Standard
- Do treat short DSD intervals (<75 ms) as promising but not practice-changing yet due to small sample sizes.
- Try to deliver shocks as close to simultaneous as feasible and follow local governance when using DSD.