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VAM-IHCA Trial Results Livestream

Wednesday September 29th

Follow-Up Podcast

Chief investigator Lars Andersen joins Rob Mac Sweeney to address some of the questions and comments that arose following the presentation and publication of the VAM-IHCA trial results, investigating vasopressin and methylprednisolone for in-hospital cardiac arrest.

Added October 13th, 2021



Viewer's Questions

Panel Discussion

Critical Care Reviews Trial Results Livestream


Dexamethasone 12 mg versus 6 mg for patients with COVID-19 and severe hypoxia: an international, randomized, blinded trial

How do we interpret a trial with an apparent substantial mortality effect, but which fails to reach the predefined level of statistical significance?

With a faculty consisting of trialists, clinicians, methodologists, and a statistician, we have the perfect group to discuss the implications of the COVID STEROID-2 trial.

Thursday October 21st

19:30 - 21:10 (UTC+1)

Free to View

Critical Care Reviews Blog

Exploring the why of critical care trials

Critical care trials are fascinating to ponder. Some report findings of benefit, many report an inconclusive answer or apparent lack of efficacy. Some report harm. This blog will explore the why of critical care trials - why was this intervention successful, why was this intervention ineffective, why was the intervention harmful.

If you'd like to join us for a weekly in-depth exploration of the latest major critical care trials, then please register for the free weekly newsletter here

Blog 1: The REST Trial

First up for review at the blog is the REST trial. Why did the REST trial¹ fail to clearly demonstrate benefit with the addition of an ECCO₂R  device in invasively mechanically ventilated patients with acute hypoxaemic respiratory failure?

Added October 4th

Latest REMAP-CAP Podcast

Prof Alistair Nichol talks about the latest investigative agent to be added to the REMAP-CAP portfolio - ivermectin. With a huge amount of controversy surrounding this agent worldwide, Prof Nichol elequently describes why this major international trial has decided it is worth a valuable place in this platform trial.

Upcoming Trial Results Livestreams


Dexamethasone 12 mg versus 6 mg for patients with COVID-19 and severe hypoxia: an international, randomized, blinded trial

PLUS Trial

Plasma-Lyte 148® versUs Saline Study

CCR Livestreams
  • Freely accessible without the need for registration

  • With independent external expert opinion and discussion

  • The latest evidence brought to you immediately

  • Typically 90 minutes to 2 hours in length

Recent Trial Result Livestreams


Unedited video: the scientific session starts at 30:15


Unedited video: the scientific session starts at 32:28

COVID Anticoagulation

Unedited video: the scientific session starts at 1:30:16

One Week in August

Fluid Type and Rate


This Brazilian 2x2 factorial trial will randomise ICU patients at moderate to high risk for death or AKI to receive a balanced crystalloid solution (Plasma-Lyte®) or 0.9% saline and to receive crystalloids by rapid bolus infusion (999 mL/h) or slow infusion (333 mL/h) whenever plasma expansion is needed.

Tuesday, August 10th, 18:30 UTC

Oxygenation Strategies in COVID-19


To date, it's been unclear how patients with severe COVID-19 requiring non-invasive respiratory support should be managed. With over 1200 patients, the UK RECOVERY-RS trial is now the largest global non-invasive respiratory support trial for COVID-19, and compares CPAP with high flow nasal oxygen with standard care.

Thursday, August 5th, 18:30 UTC

Multiplatform RCT

Anticoagulation in COVID-19

The ACTIV4-a, ATTACC, & REMAP-CAP investigators will present the results of this multi-platform trial, in which critically ill adults were randomized to receive therapeutic anticoagulation with heparin or pharmacological thromboprophylaxis as per local usual care.The preprint of the main paper was published on March 12th in MedRxiv.

Wednesday, August 4th, 20:30 UTC


Newsletter 512

The 512th Critical Care Reviews Newsletter, featuring the best critical care literature from the past 7 seven days, is now out.

Added October 3rd

Image:  Solen Feyissa | UnSplash

Journal Watch

Check out our journal watch, which is updated daily, to stay up-to-date with the latest critical care literature. The weekly newsletter contains a summary of the papers highlighted over the previous 7 days and is emailed to registered users every Sunday night.

Patient receiving ECMO

Image:  Tomatheart | Shutterstock

Observational Study

Multisystem Inflammatory Syndrome

Patient receiving ECMO

Image:  Tomatheart | Shutterstock

Observational Study

Multisystem Inflammatory Syndrome

Image:  FaiPloypilin | Shutterstock

Ventilation during Cardiopulmonary Bypass

Randomised Controlled Trial

Image:  Victor Josan | Shutterstock

COVID-19 Pathophysiology

Narrative Review

Image:  samunella | Shutterstock

Vaccine-Induced Thrombotic Thrombocytopaenia

Case Series

Image:  Kiryl Lis | Shutterstock

Liberation from Mechanical Ventilation

Randomised Controlled Trial

Image: Tho-Ge | Pixabay

International Intubation Practice

Observational Study

Image:  tungtaechit | Shutterstock

International Weaning Practice

Observational Study

Image: Shutterstock | KILO LUX

Albumin in Cirrhosis

Randomised Controlled Trial

In 777 patients, albumin infusions to increase the albumin level to a target of 30 g per liter or more did not improve the composite primary outcome of new infection, kidney dysfunction, or death between days 3 and 15, but resulted in increased adverse events

Added March 4th

Image: Shutterstock | Casa nayafana

Hepatorenal Syndrome

Randomised Controlled Trial

In 300 adults with cirrhosis and HRS-1, terlipressin was more effective in improving renal function but resulted in less liver transplantation (23% vs 29%) a higher 90-day mortality (51% vs 45%).

Added March 4th

Image: Shutterstock

Recovery of Consciousness

Observational Study

In 17,470 patients in the Traumatic Brain Injury Model Systems National Database, 7,547 (57%) suffered an initial loss of consciousness, which persisted to rehabilitation in 2,058 patients (12%). Of this group of 2,058 comatose patients, 82% (n = 1674) subsequently recovered consciousness during inpatient rehabilitation.

Added March 1st

Image: Shutterstock

Convalescent Plasma

Meta Analyses

In a systematic review of 4 published trials including 1060 patients with confirmed or treated COVID-19 in any treatment setting, the use of convalescent plasma  was not associated with a significant reduction in all-cause mortality; risk ration 0.93 (95% CI, 0.63 to 1.38).

Added February 27th

Image: Shutterstock

Organ Donation

Position Statement

This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation.

Added February 27th

Image: Shutterstock

RECOVERY - Dexamethasone arm

Randomised Controlled Trial

Originally published in provisional format last Summer, the full paper of the RECOVERY trial - dexamethasone arm, is now out. In 6425 hospitalised patients with COVID-19, treatment with 10 mg IV dexamethasone for up to 10 days resulted in a lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone.

Added February 25rd

Image: Shutterstock


Randomised Controlled Trial

The BACLOREA trial, initial presented at eCCR21, reported a decrease in agitation-related events with baclofen in 314 mechanically ventilated patients with alcohol misuse disorder (19.7% vs. 29.7% with placebo), but a  longer  length of mechanical ventilation (9 vs 8 days) and stay in the ICU (14 vs 11 days.

Added February 23rd

Image: Shutterstock

The VICTAS Trial

Randomised Controlled Trial

The VICTAS trial, comparing treatment with vitamin C, thiamine, and hydrocortisone with placebo in 501 patients with septic shock, reported no significant difference in ventilator- and vasopressor-free days (25 vs 26 , respectively) at 30 days. Funding was withdrawn after just 501 out of a planned 2000 patients were recruited.

Added February 23rd

Upcoming CCR Hosted Major Trial Results

We'll bring these important results to you live and free

Anticoagulation in COVID-19

The ACTIV4-a, ATTACC, & REMAP-CAP investigators will present the results of this multi-platform trial examining therapeutic & prophylactic anti- coagulation in patients with COVID-19. The interim analysis was released January 28th and is available via the link below.

TTM post Cardiac Arrest

Originally planned for CCR21, which became eCCR21, but delayed into the Spring, the long awaited results of the follow-up trial to the landmark targeted temperature management after out-of-hospital cardiac arrest is out soon. Is the avoidance of fever the critical aspect of TTM? The results are due very soon.

Balanced IV Fluid Solutions

This massive 11,000 patient trial from Brazil was also scheduled for CCR21, but was unavoidably delayed due to the pandemic. Comparing Plasma-Lyte 148 with 0.9% saline, it's almost ready for release now and we're delighted to be hosting this major trial result later this Spring.

Latest Major RCTs

Vitamin D for COVID-19


In a Brazilian two-centre, blinded RCT in 240 patients with moderate or severe COVID-19, Murai and colleagues reported that a single oral dose of 200 000 IU vitamin D3 did not significantly change the median (IQR) length of hospitalisation; vitamin D3 group, 7.0 (4.0-10.0) days, vs. placebo group, 7.0 (5.0-13.0) days; log-rank, P = 0.59; unadjusted HR, 1.07; 95% CI, 0.82-1.39; P = 0.62.

JAMA 2021;epublished February 17th

Image: Dimitri Karastelev | Unsplash


Transfusion Thresholds in Myocardial Infarction

In 668 patients with acute myocardial infarction and a hemoglobin level between 7 and 10 g/dL, a red cell transfusion threshold of ≤8 g/dL was found to be non-inferior to a threshold of  ≤10 g/dL, with the composite MACE outcome (all-cause death, stroke, recurrent myocardial infarction, or emergency revascularization) at 30 days occurring in 11% vs 14%, respectively.

JAMA 2021;325(6):552-560. Published February 9th

Image:  Katsiuba Volha | Shutterstock


Fluids After Bypass Study

Fluid Optimisation

In 715 patients undergoing cardiopulmonary bypass and randomised to a protocol-guided strategy, using stroke volume variation to guide the administration of bolus fluids, or to usual care fluid administration, until desedation or up to 24 hours, there was no difference in the primary outcome of ICU length of stay; (median/IQR) intervention group; 27.9 hr (21.8–53.5 hr) vs control, 25.6 hr (21.9–64.6 hr); p = 0.95.

Crit Care Med 2021;epublished January 28th

Image:  MAD.vertise  |  Shutterstock

MENDS2 Trial

ICU Sedation

In 432 ventilated adults with sepsis, randomised to receive IV sedation with either dexmedetomidine (0.2 to 1.5 μg/kg/hr) or propofol (5 to 50 μg/kg/min), there was no difference between groups in the primary outcome of days alive without delirium or coma during the 14-day intervention period; 10.7 vs. 10.8 days; OR, 0.96; 95% CI, 0.74 to 1.26; respectively. There were also no differences in secondary outcomes, including mortality.

N Engl J Med 2021;epublished February 2nd

Image:  Shutterstock

Hypothermia for TBI with refractory intracranial hypertension


In adult patients suffering a traumatic brain injury, with a GCS score of 4 to 8, and initial ICP ≥ 25 mm Hg, the implementation of long-term mild hypothermia group (34–35 °C for 5 days), in comparison with normothermia group at 37 °C, did not improve the proportion with a favorable outcome (OR 1·55, 95%CI 0·91–2·64; P = 0·105) or mortality (P = 0·111) at 6 months.

EClinicalMedicine 2021;epublished January 28th

Resumption of Cardiac Activity after Withdrawal of Life-Sustaining Measures


In a prospective study in 20 ICUs in 3 countries, amongst 631 patients who underwent continued monitoring after planned withdrawal of life-sustaining support, 14% of patients had a resumption of cardiac activity after a period of pulselessness. Just 1 percent were observed clinically. The longest period to resumption of cardaic activity was 4 minutes 20 seconds.

N Engl J Med 2021; 384:345-352  |  January 28th, 2021

Image: SURIYO CINNABUT  |  Shutterstock

HOT-ICU Trial Results


In a Danish led, international, multi-centre, randomised controlled trial trial in 2928 adults with acute hypoxaemic respiratory failure, targetting a PaO2 of 8 kPa, in comparison with 12 kPa, did not improve the primary outcome of 90-day mortality (42.9% vs 42.4%; adjusted risk ratio, 1.02; 95% CI, 0.94 to 1.11; P=0.64).

Presented at eCCR21. Video available at eCCR21 webpage

N Engl J Med 2021;epublished January 20th

Image:  AndaPhoto  |  Shutterstock

Tocilizumab in patients with severe or critical COVID-19

COVID-19 Tocilizumab

In a Brazilian randomised controlled trial involving 9 hospitals, the use of tocilizumab as a single intravenous infusion of 8 mg/kg plus standard care (n=65) versus standard care alone (n=64), resulted in suimilar levels of mechanical ventilation at day 15 (28% vs. 20; (odds ratio 1.54, 95% CI0.66 to 3.66; P=0.32).), respectively, and increased mortality (17% vs. 3%; odds ratio 6.42, 95% CI,1.59 to 43.2).

BMJ 2021;372:n84, published January 20th

Image: M Morea | Shutterstock


Methylprednisolone for COVID-19

Methylprednisolone pulse for hospitalised severe COVID-19 patients

Plasma Therapy for Covid-19

The Prevention of Severe Covid-19 in Older Adults

RELAx Trial

PEEP Levels in Non-ARDS

Sodium Nitrite for OOHCA

Effect of Out-of-Hospital Sodium Nitrite on Survival to Hospital Admission After Cardiac Arrest


Tocilizumab & sarilumab reduce mortality in severe COVID-19

January 8th

In a pre-print paper, the REMAP-CAP trial investigators have reported efficacy with interleukin 6 receptor anatgonists in critically ill patients with COVID-19. Hospital mortality was 28.0% (98/350) for tocilizumab, 22.2% (10/45) for sarilumab and 35.8% (142/397) for control.

Preprint January 7th

RECOVERY Trial Halts Convalescent Plasma Arm

January 15th 21:00

In 10,406 randomised patients, with 1873 reported deaths, there was no significant difference in the primary endpoint of 28-day mortality -18% convalescent plasma vs. 18% usual care alone; risk ratio 1.04 [95% confidence interval 0.95-1.14]; p=0.34.

Prof Peter Horby, Tweet, Jan 15th

Therapeutic Anticoagualtion halted across 3 COVID-19 Trials

December 22nd

Three large randomised controlled trials, ATTACC, @ACTIV4a, and REMAP-CAP, have, for futility, halted recruitment to their therapeutic anticoagulation arms in critically ill patients with COVID-19.

Other Recent RCTS of Note

Inhaled Heparin for ARDS

In this multi-centre, blinded Australian trial, 25 000 IU of nebulised heparin administered 6 hourly while invasively ventilated, did not significantly alter the primary outcome of functional outcomes (SF-36) at 60 days; survivors in the heparin group (n=97) mean 53·6 vs control 48·7; difference 4·9 [95% CI –4·8 to 14·5]; p=0·32).

Procalcitonin to Reduce Long-Term Infection-associated Adverse Events in Sepsis

In this trial PCT-guided antimicrobial treatment in sepsis was effective in reducing infection-associated adverse events like infections by multidrug-resistant organisms and Clostridioides difficile, as well as in-hospital and 28-day mortality.

Am J Respir Crit Care Med 2021;202(3):202–210

January 17th 2021

Infant Intubation

First-attempt success rate of video laryngoscopy in small infants

Lancet 2020;396(10266):1905-1913


Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants

In 1824 infants born prematurely between 22 and 26 weeks and weighing less than 1000 g, a higher hemoglobin threshold for red-cell transfusion did not improve survival without neurodevelopmental impairment at 22 to 26 months of age, corrected for prematurity

N Engl J Med 2020;383:2639-2651

Latest Guidelines

Surviving Sepsis Campaign COVID-19 Update

Crit Care Med 2021;epublished January 28th

Image:  AHMETOZER35 | Shutterstock


  • In
    • Systemic corticosteroids
    • Venous thromboprophylaxis
  • Out
    • Hydroxychloroquine


  • In
    • Dexamethasone as perferred steroid
    • Remdesevir in non-ventilated critically ill
  • Out
    • Convalescent plasma   (outside clinical trials)
    • Therapeutic anticoagulation  (outside clinical trials)
    • Remdesevir in ventilated critically ill
  • No recommendation
    • Awake prone positioning.
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