Journal Club- May 2013: Does pre-hospital advanced airway management lead to worse patient outcomes?

Perhaps one of the most controversial topics in EM and prehospital literature was tackled by residents Tony Mueller and Eric Ernest (with faculty leader Dr Muelleman) a few weeks ago at an evening journal club dinner hosted at Dr Larsen’s house.  In their parsing out of the literature, the two residents debated whether recent evidence truly suggests poorer outcomes for patients who receive advanced airways by EMS prior to hospital arrival.  Many paramedics learn how to intubate unstable patients as part of their training, and are currently able to do so if a patient meets certain criteria.  Much has yet to be determined as why poorer outcomes are being noticed more often in cardiac-arrested patients with EMS-placed airways, although longer time-to-ED and more frequent CPR pauses have been suggested.  

The articles:
#1 Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA. 2013 Jan 16;309(3):257-66. doi: 10.1001/jama.2012.187612.

#2  Advanced airway management does not improve outcome of out-of-hospital cardiac arrest. Hanif MA et al. Acad Emerg Med. (2010)

In addition to a great discussion, residents, faculty, families, and pets alike all got to enjoy great food, drinks, swimming, smores, and a bonfire graciously hosted by the Larsen family at their farm west of Omaha.   Here are a few images from the night:

Knowledge bombs

Knowledge bombs

Dr Muelleman

Dr Muelleman

Journal Club

Journal Club

179

181

 

SAEM Atlanta 2013

Our intern class, upcoming chief residents, and a number of faculty all recently enjoyed a trip down to Atlanta, GA, site of this year’s annual meeting of the Society of Academic Emergency Medicine.  First year resident, Peter Anaradian, presented an awesome Clinical Pathologic Conference (CPC) on a unique ED presentation of hepatocellular carcinoma, while staff MD, Dr Aaron Barksdale was charged with deciphering a tough case highly suspicious for Paget-Schroetter disease.  2nd year resident, Nick Daniel, made his presence felt in the clinical photo submission contest, with a classic presentation of flexor tenosynovitis.   We were also fortunate to have medical student and future EM-cardiology-guru Andrew Keralis represent UNMC with his phenomenal abstract presentation, “Risk Stratification of Acute Chest Pain in an Emergency Setting: ST Segment Change on aVL Lead as a Predictor of Future MI”.   Great job, fellas!

Whilst our days in Atlanta were spent primarily filling our brains with an abundance of EM knowledge bombs by national leaders in our field, the evenings afforded us the chance to bond and discuss the day over delicious southern (and also brazilian?) cuisine and libations.    While this might have afforded us a few extra hours on the treadmill once back at home, I think we can all say that our experience in Atlanta was an awesome and worthwhile one.  Next up, ACEP Seattle!

Atlanta

Atlanta

Peter Anaradian at the CPC

Peter Anaradian at the CPC

Peter Anaradian after his CPC

Peter Anaradian after his CPC

Dr Barksdale after his CPC

Dr Barksdale giving his CPC response

Dr Barksdale after his CPC

Dr Barksdale after his CPC

Andrew Keralis

Andrew Keralis

Andrew Keralis

Andrew Keralis

Andrew Keralis and Dr Branecki

Andrew Keralis and Dr Branecki

Dr Daniel's case photo submission

Dr Daniel’s case photo submission

Erica, Andrew B, Kalin

Erica, Andrew B, Kalin

Cheese

Cheese

Chris, Peter

Chris, Peter

Andrew K, TJ, Linnaus

Andrew K, TJ, Linnaus

You rapscallions you.

You rapscallions you.

Meat-sweats.

Meat-sweats.

Chiefs representing at the Residency/Fellowship fair

Chiefs representing at the Residency/Fellowship fair

SAEM Residency/Fellowship Fair

SAEM Residency/Fellowship Fair