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Top Circulatory Trials

ALPS

Antiarrthymics in Cardiac Arrest

In 3026 adults with out-of-hospital shock-refractory ventricular fibrillation or pulseless ventricular tachycardia after at least one shock, neither amiodarone (n=974) nor lidocaine (n=993) resulted in a significantly higher rate of survival or favorable neurologic outcome than the rate with placebo (n=1059).

N Engl J Med 2016; 374:1711-1722


IABP-SHOCK II

Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock

In 600 patients with acute myocardial infarction induced cardiogenic shock, the addition of an intra-aortic balloon pump, in addition early revascularisation and best medical management, did not improve 30-day mortality; IABP group, 39.7% vs. control group, 41.3%; relative risk 0.96; 95% CI, 0.79 to 1.17; P=0.69.


CHEST

Hydroxyethyl Starch

In 7000 ICU patients requiring fluid resuscitation, the use of 6% hydroxyethyl starch, in comparison with 0.9% saline, resulted in a higher rate of renal failure (10.4% vs 9.2%) and requirement for renal placement therapy (7% vs 5.8%), although no significant difference in the primary outcome of 90-day mortality (18% vs 17%).

Sections

Fluids

Cardiac Arrest

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Targeted Temperature Management

General

  1. Lascarrou. Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm. N Engl J Med N Engl J Med 2019;381:2327-2337
  2. Nordberg. Effect of trans-nasal evaporative intra-arrest cooling on functional neurologic outcome in out-of-hospital cardiac arrest: the PRINCESS randomized clinical trial. JAMA 2019;321(17):1677–85
  3. Kirkegaardl. Targeted temperature management for 48 vs 24 hours and neurologic outcome after out-of-hospital cardiac arrest: a randomized clinical trial. JAMA 2017;318:341-350
  4. Bernard. Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline: The RINSE Trial (Rapid Infusion of Cold Normal Saline). Circulation 2016;134(11):797-805
  5. Moler. Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest in Children (THAPCA Trial). N Engl J Med 2015;epublished April 25th
  6. Nielsen. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest (TTM study). N Engl J Med 2013;369:2197-2206 
  7. Kim. Effect of Prehospital Induction of Mild Hypothermia on Survival and Neurological Status Among Adults With Cardiac Arrest:  A Randomized Clinical Trial. JAMA 2014;311(1):45-52
  8. Bernard. Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with Induced Hypothermia. N Engl J Med 2002; 346:557-563
  9. The Hypothermia after Cardiac Arrest Study Group. Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest. N Engl J Med 2002; 346:549-556

Method of Temperature Control

  1. Deye. Endovascular versus external targeted temperature management for patients with out-of-hospital cardiac arrest: a randomized, controlled study (ICEREA). Circulation 2015;132(3):182–93

Vasoactive Therapy


Goal Directed therapy




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