ResusX:Podcast

Are we giving our older patients with out-of-hospital cardiac arrest (OHCA) a fair shot? ⏱️ Current guidelines say an ECPR initiation time of up to 60 minutes is acceptable, but is that really the case for everyone? This is a question clinicians grapple with every day at the bedside. A new nationwide observational study from South Korea tackles this head-on, analyzing data from 483 adult patients who received ECPR for non-traumatic OHCA. The study found that while both age and time to ECPR independently predict survival, the combination of the two is critical. The key takeaway? The "golden hour" for ECPR may not apply to our elderly patients. The results are practice-changing and frankly, a wake-up call. The study found that in patients over 65, the probability of survival plummeted to less than 10% when ECPR was delayed beyond just 21 minutes. For their younger counterparts, a 10% survival rate was maintained for nearly twice as long, up to 38 minutes    . This finding suggests that for older patients, the effective window for ECPR is much shorter than previously thought . The authors recommend a sense of urgency, urging clinicians to activate ECPR in carefully selected elderly patients almost immediately upon hospital arrival    .  This isn't just about a new number; it's about re-evaluating our clinical protocols and embracing an age-specific approach to resuscitation. Tune in as we break down the data and discuss what this means for your next OHCA case.

When it comes to saving lives in the ICU, every breath counts. But what’s the best way to deliver that breath—pressure-controlled ventilation (PCV) or volume-controlled ventilation (VCV)? In this episode, we dive into a new systematic review and meta-analysis that put these two ventilator modes head-to-head in over 1,100 patients with acute respiratory failure. The findings may surprise you: while both modes showed no major differences in barotrauma or overall mortality, PCV hinted at a slight edge in reducing deaths among patients with ARDS. What does this mean for frontline clinicians? Could PCV be the more patient-friendly option when seconds matter? Join us as we unpack the data, discuss the implications for practice, and explore where future research needs to go. Tune in for a deep dive into ventilator strategies that could shape critical care worldwide.

When a patient crashes with acute cardiogenic pulmonary edema, emergency teams need fast, effective solutions. For years, non-invasive ventilation (NIV) has been the gold standard — but could high-flow nasal cannula (HFNC) be just as good? In this episode, we break down a prospective, randomized trial published in the American Journal of Emergency Medicine (Dec 2025) that compared HFNC head-to-head with NIV in the ED. The results? No difference in survival, respiratory rates, or dyspnea scores between the two therapies. We’ll explore: Why HFNC may rival NIV for managing ACPE The surprising equivalence in clinical outcomes at 30, 60, and 120 minutes Patient comfort and tolerability — where HFNC may hold the edge What this means for ED practice, protocols, and future airway management If you’re an emergency physician, intensivist, or resuscitationist, this study has big implications: it suggests you may have more flexibility — and your patients, more comfort — than ever before.

When a patient is crashing and every second counts, airway decisions can mean life or death. For decades, clinicians have fiercely debated: should you reach for etomidate, the hemodynamic workhorse, or ketamine, the pressure-friendly multitasker? In this episode, we dive deep into a new systematic review and meta-analysis that just might end the controversy once and for all. The surprising truth? Survival doesn’t change no matter which drug you choose. We’ll unpack: Why this finding is a game-changer for emergency physicians, intensivists, and resuscitationists. What the evidence really says about mortality, intubation success, and cardiac arrest risk. The nuances of post-induction hypotension and why it might not be the dealbreaker it once seemed. How this study frees you to make airway decisions based on patient context and clinical judgment—not dogma. Whether you’re on the front lines of the ED, running codes in the ICU, or training the next generation of airway masters, this episode will leave you with clarity, confidence, and a renewed perspective on one of emergency medicine’s longest-running debates.

When major abdominal surgery pushes patients to the brink, timing is everything, especially with norepinephrine. Could giving it earlier to high-risk patients prevent dangerous drops in blood pressure and reduce complications? A new randomized controlled trial, published in Anesthesiology (2025), put this to the test, comparing early, low-dose norepinephrine infusion against standard care in high-risk surgical patients. The results may surprise you: early norepinephrine not only stabilized blood pressure faster but also significantly reduced postoperative complications without increasing adverse events. In this episode, we break down what “early” really means, why the trial’s pragmatic design matters, and how this could reshape perioperative hemodynamic management in major surgery. Key takeaways: • Early norepinephrine led to more stable intraoperative blood pressure • Reduced risk of postoperative complications in high-risk patients • No significant increase in adverse events compared to standard care This isn’t just about drugs, it’s about redefining timing in critical surgical care. Want to dig deeper? Check out the full study: Trocheris-Fumery O, Flet T, Scetbon C, et al. Early Use of Norepinephrine in High-Risk Patients Undergoing Major Abdominal Surgery: A Randomized Controlled Trial. Anesthesiology. 2025. doi:10.1097/ALN.0000000000005704

When it comes to getting patients off mechanical ventilation, clinical judgment isn’t always enough. What if you could use a real-time, bedside tool to boost your confidence—and your success rate? In this episode, we dive into the power of diaphragmatic ultrasound in predicting successful weaning from mechanical ventilation. Based on the latest meta-analysis, we break down how measuring diaphragm function—like excursion and thickening fraction—can provide moderate-to-high diagnostic accuracy in identifying who’s ready to breathe on their own. Find out: Why traditional predictors aren’t cutting it What makes diaphragmatic ultrasound a game-changer And whether this tool should become your new go-to in the ICU Based on the article of Tashiro, N., Nishiwaki, H., Ikeda, T. et al. titled "Clinical utility of diaphragmatic ultrasound for mechanical ventilator liberation in adults: a systematic review and meta-analysis" from j Intensive Care.

Can IV vitamin C really save lives in the PICU? It’s been a hot topic in critical care circles for years—but the VITACIPS trial just delivered a powerful dose of clarity. In this episode, we dive into the results of this rigorous study and what they mean for treating children in septic shock. Spoiler: it’s not the magic bullet many hoped for. We break down key findings, clinical implications, and why this trial is a turning point in how we think about adjunct therapies in pediatrics. Whether you're treating pediatric patients or just curious about how cutting-edge research shapes real-world care, this one’s worth the listen. Based on the article: “Vitamin C Versus Placebo in Pediatric Septic Shock (VITACIPS) – A Randomised Controlled Trial” by Jhuma Sankar et al., Journal of Intensive Care Medicine.

What happens when a patient in the ICU suddenly can't breathe—and the usual airway tools just won’t cut it? In this episode, we break down the high-stakes world of difficult airway management where seconds matter and lives hang in the balance. From using checklists like LEMON to deploying advanced gear like video laryngoscopes and rescue devices, this isn’t just medicine—it’s a strategic, lifesaving playbook in action. We explore the latest evidence, essential algorithms, and game-changing tools that are helping clinicians stay calm, stay sharp, and save lives when the pressure is highest. Whether you're on the frontlines or just curious how modern medicine handles its toughest challenges, this is an episode you don’t want to miss. Based on the article: “Difficult Airway Management in the Intensive Care Unit: A Narrative Review of Algorithms and Strategies” by Talha Liaqat et al., Journal of Clinical Medicine.

When seconds count and precision matters—like during surgery—getting accurate, continuous blood pressure readings is critical. That’s where radial artery cannulation comes in. But while traditional methods rely on “feeling the pulse,” they’re not always reliable, especially in tough cases. Enter a game-changing technique: ultrasound-guided Dynamic Needle Tip Positioning (DNTP). In this episode, we dive into a powerful new study that compares old-school palpation to DNTP and the results are stunning: an 88.5% first-pass success rate, fewer attempts, less time, and reduced equipment use with the ultrasound approach. We explore why this matters for patient safety, comfort, and clinical efficiency—and how this could redefine arterial cannulation in the OR. Could this be the new gold standard for arterial access? Tune in and find out. Read the full study: "Palpation versus Ultrasound-Guided Dynamic Needle Tip Positioning Technique for Radial Artery Cannulation" by Sujan Dhakal et al. in Annals of Cardiac Anaesthesia.

When someone is critically ill, whether battling sepsis, ARDS, or severe pneumonia, corticosteroids have long been a debated topic. A massive new meta-analysis pooling data from over 10,000 ICU patients finally brings clarity. The headline: early, low-dose, prolonged steroid therapy cuts short-term mortality by roughly 15%, slashes ICU stays by 2 days, reduces time on ventilators by over 4 days, and boosts ventilator-free days—all without increasing infection or bleeding risks. Sure, there’s a slight uptick in hyperglycemia, but that’s a small price for improved survival and recovery  What does this mean for frontline clinicians? Think “early, gentle, and sustained.” Start steroids within the first 72 hours, keep them on for at least a week, and tailor doses to lower than 400 mg of hydrocortisone per day. Most surprisingly, even septic shock patients benefit most when hydrocortisone is paired with fludrocortisone Want to see the full picture? Check out the study: “Efficacy and safety of corticosteroids in critically ill patients” by Lei Cao et al. in BMC Anesthesiology (July 2025).