2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research

13-Year-Old with Cryptic Abdominal Pain

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New Onset Nystagmus in a Patient with Multiple Sclerosis

CasePresentation: A 50-year-old male with a history of multiple sclerosis with dizziness and nystagmus presented to the emergency department. On physical exam, nystagmus was noted. Computed tomography of the head without contrast was obtained showing a low density in the left frontal lobe. During admission, magnetic resonance imaging (MRI) findings were consistent with Balò’s concentric sclerosis. Discussion: Balò’s concentric sclerosis is a rare, inflammatory demyelinating disease, often considered to be an infrequent variant of multiple sclerosis with alternating rings of healthy myelin and demyelination leading to pathognomonic findings of concentric lamella on T2 or contrast-enhanced T1 MRI imaging

New Onset Nystagmus in a Patient with Multiple Sclerosis

CasePresentation: A 50-year-old male with a history of multiple sclerosis with dizziness and nystagmus presented to the emergency department. On physical exam, nystagmus was noted. Computed tomography of the head without contrast was obtained showing a low density in the left frontal lobe. During admission, magnetic resonance imaging (MRI) findings were consistent with Balò’s concentric sclerosis. Discussion: Balò’s concentric sclerosis is a rare, inflammatory demyelinating disease, often considered to be an infrequent variant of multiple sclerosis with alternating rings of healthy myelin and demyelination leading to pathognomonic findings of concentric lamella on T2 or contrast-enhanced T1 MRI imaging

A call to arms for an out-of-hospital advanced versus basic airway trial

Letter to the editor. The debate surrounding the most appropriate method of airway management in out-of-hospital cardiac arrest (OHCA) continues to evolve, informed by a growing body of observational evidence

Direct Versus Video Laryngoscopy for Intubating Adult Patients with Gastrointestinal Bleeding

Introduction: Video laryngoscopy (VL) has been advocated for several aspects of emergency airway management; however, there are still concerns over its use in select patient populations such as those with large volume hematemesis secondary to gastrointestinal (GI) bleeds. Given the relatively infrequent nature of this disease process, we sought to compare intubation outcomes between VL and traditional direct laryngoscopy (DL) in patients intubated with GI bleeding, using the third iteration of the National Emergency Airway Registry (NEARIII).Methods: We performed a retrospective analysis of a prospectively collected national database (NEARIII) of intubations performed in United States emergency departments (EDs) from July 1, 2002, through December 31, 2012. All cases where the indication for intubation was “GI bleed” were analyzed. We included patient, provider and intubation characteristics. We compared data between intubation attempts initiated as DL and VL using parametric and non-parametric tests when appropriate. Results: We identified 325 intubations, 295 DL and 30 VL. DL and VL cases were similar in terms of age, sex, weight, difficult airway predictors, operator specialty (emergency medicine, anesthesia or other) and level of operator training (post-graduate year 1, 2, etc). Proportion of successful first attempts (DL 261/295 (88.5%) vs. VL 28/30 (93.3%) p=0.58) and Cormack-Lehane grade views (p=0.89) were similar between devices. The need for device change was similar between DL [2/295 (0.7%) and VL 1/30 (3.3%); p=0.15].Conclusion: In this national registry of intubations performed in the ED for patients with GI bleeds, both DL and VL had similar rates of success, glottic views and need to change devices

Direct Versus Video Laryngoscopy for Intubating Adult Patients with Gastrointestinal Bleeding

Introduction: Video laryngoscopy (VL) has been advocated for several aspects of emergency airway management; however, there are still concerns over its use in select patient populations such as those with large volume hematemesis secondary to gastrointestinal (GI) bleeds. Given the relatively infrequent nature of this disease process, we sought to compare intubation outcomes between VL and traditional direct laryngoscopy (DL) in patients intubated with GI bleeding, using the third iteration of the National Emergency Airway Registry (NEARIII). Methods: We performed a retrospective analysis of a prospectively collected national database (NEARIII) of intubations performed in United States emergency departments (EDs) from July 1, 2002, through December 31, 2012. All cases where the indication for intubation was “GI bleed” were analyzed. We included patient, provider and intubation characteristics. We compared data between intubation attempts initiated as DL and VL using parametric and non-parametric tests when appropriate. Results: We identified 325 intubations, 295 DL and 30 VL. DL and VL cases were similar in terms of age, sex, weight, difficult airway predictors, operator specialty (emergency medicine, anesthesia or other) and level of operator training (post-graduate year 1, 2, etc). Proportion of successful first attempts (DL 261/295 (88.5%) vs. VL 28/30 (93.3%) p=0.58) and Cormack-Lehane grade views (p=0.89) were similar between devices. The need for device change was similar between DL [2/295 (0.7%) and VL 1/30 (3.3%); p=0.15]. Conclusion: In this national registry of intubations performed in the ED for patients with GI bleeds, both DL and VL had similar rates of success, glottic views and need to change devices