ResusX:Podcast

For decades, we’ve been told vasopressors belong only through central lines — but what if that’s not the whole story? In this episode, we unpack a groundbreaking multicenter study from Addis Ababa that dares to challenge convention. Researchers followed 250 patients in shock, tracking survival outcomes, complications, and safety when vasopressors were given peripherally instead of through central access. The result? A strikingly low extravasation rate of just 1.2%, with all complications occurring only after five days of infusion. For short-term management, the data suggests — peripheral might be not only feasible, but safe. We’ll explore what this means for critical care teams everywhere — especially in resource-limited settings where central access isn’t always an option. Is it time to rewrite the playbook for shock management? What are the risks, the predictors of survival, and the real-world tradeoffs? Tune in as we dig into the data, the debates, and the bedside lessons from this landmark study — and ask the question every critical care clinician should be thinking about: Are we overcomplicating vasopressor delivery? Science meets practicality. Evidence meets the frontline. And the future of shock resuscitation might just look a little different.

Why are we still arguing about the best way to give fluids to patients with traumatic brain injury (TBI)? 🤔 This seems like a basic question, but the answer is complex and could mean the difference between life and death at the bedside. A recent comprehensive review article from the Journal of Clinical Medicine dives deep into the clinical and physiological challenges of fluid resuscitation in TBI patients. The authors conducted a non-systematic literature review of studies over the last two decades, focusing on fluid management, types of fluids, and transfusion strategies. The research highlights a critical paradox: while hypotension (low blood pressure) is a known killer in TBI, giving too much fluid can be just as deadly by worsening cerebral edema.                   The key takeaway? There is no one-size-fits-all approach. For fluid choice, the review argues against using balanced crystalloids like Ringer's lactate, suggesting they could worsen cerebral edema due to their relative hypotonicity. Instead, normal saline is often the preferred first-line fluid . As for blood transfusions, the data is contradictory. While some studies suggest a liberal transfusion strategy (aiming for a higher hemoglobin target) improves outcomes, others found no benefit and even a higher risk of adverse events    . This means that transfusion decisions should be highly individualized, based on the patient's specific physiological parameters, not a fixed number    .  This research is a wake-up call for frontline clinicians. It reminds us that blindly following protocols can be harmful. Every fluid bag, every pressor drip, and every unit of blood must be a thoughtful, personalized decision guided by robust hemodynamic and neuromonitoring .  Want to know how to make smarter, more precise fluid decisions for your TBI patients? Tune in to this episode as we break down the latest evidence and translate it into actionable steps for your daily practice.

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.