A new multicenter trial published in NEJM, commonly known as the “TTM2” trial, evaluated treating patients resuscitated from out-of-hospital cardiac arrest with targeted temperature management to 33C versus controlled normothermia, and found that outcomes were equivalent.  Does this mean the end of TTM as we know it?  In this podcast, Dr. Benjamin Abella presents a comprehensive argument why he believes that such pronouncements are premature and not consistent with the larger body of...

Electrocardiography (ECG) represents a central diagnostic tool in the post-arrest evaluation of patients resuscitated from out-of-hospital cardiac arrest (OHCA), and it should be acquired immediately after achievement of ROSC to identify the need for an urgent coronary angiography, which is indicated only in the case of ST-segment elevation myocardial infarction (STEMI). While resuscitation guidelines are clear in the recommendation and importance of obtaining an ECG during the post-ROSC...

While we have focused on the science of targeted temperature management and other care strategies for critically ill survivors, it is important for us to remember that real people experience cardiac arrest and the consequences. In this unique episode, Dr. Benjamin Abella interviews Kristin Flanary, who jumped into action to provide 10 minutes of bystander CPR to her husband, Dr. Will Flanary, who has thankfully made a full recovery. You may know Kristin and Will as @lglaucomflecken and...

The role of oxygenation during critical illness remains a major question.  Is extra oxygen harmful or helpful? What oxygen levels should we target, both for respiratory failure and for patients after cardiac arrest? Dr. Benjamin Abella discusses these topics, and reviews a hot-of-the-press work from European investigators (the “HOT-ICU”) trial, published in New England Journal of Medicine this month. The paper evaluates two different oxygen targets for patients with respiratory failure –...

Critical illness from COVID19 remains a major challenge to health systems worldwide. When patients progress to in-hospital cardiac arrest (IHCA), what is the chance of survival?  Studies have so far revealing conflicting answers to this important question.  What is the role of post-arrest care bundles, including TTM, in the care process?  Dr. Felipe Teran will lead a conversation with Dr. Oscar Mitchell, who served as the lead author in a new multicenter study of COVID19 IHCA survival, to be...

Dr. Felipe Teran joins Drs. Cindy Hsu and Hans van Schuppen to discuss recent guidance regarding cardiac arrest resuscitation during the COVID-19 pandemic. Key publications referenced in this episode:  Couper K, Taylor-Phillips S, Grove A, et al. COVID-19 in cardiac arrest and infection risk to rescuers: A systematic review. Resuscitation. 2020; 151:59-66. https://pubmed.ncbi.nlm.nih.gov/32325096/ Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in...

Dr. Felipe Teran discusses the recent studies pertainig to OHCA during the COVID-19 pandemic.   Key publications referenced in this episode: Baldi E et al. Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy. N Engl J Med 2020 Apr 29; [e-pub]. (https://doi.org/10.1056/NEJMc2010418) Marijon E, Karam N, Jost D, et al. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. Lancet Public Health. 2020 Sayre MR,...

Dr. Abella discusses a very recent American Heart Association scientific statement on cardiac arrest survivorship, increasingly recognized as an important topic around the globe. While many studies have evaluated survival to hospital discharge, or even survival at 90 or 180 days post-arrest – survival is not enough. Increasing data suggest that even among “good” neurologic survivors (those with Cerebral Performance Category 1 or 2), life-limited challenges remain, including depression, PTSD,...

Drs. Teran and Abella discuss a hot-off-the-press survey study by Maciel CB et al (Critical Care Medicine, 2020), probing physician perspectives and practice on post-arrest neurologic assessment and prognostication. Do all of us follow the international guidelines for this phase of care? What are points of confusion in current “real world” practice?  Join us to answer these questions and hear about key action items for all of us who manage post-arrest care. Key reading: Neuroprognostication...

Drs. Abella and Teran discuss the scientific literature surrounding gender differences in care during and following cardiac arrest. From differences in bystander CPR provision for public cardiac arrests to post-arrest DNR status and cardiac catheterization; listen to hear more.   Key publications for this episode: Lindgren E et al. Gender differences in utilization of coronary angiography and angiographic findings after out-of-hospital cardiac arrest: A registry study. Resuscitation. 2019...

Drs. Robert Neumar and Cindy Hsu (both at University of Michigan) continue their discussion with Dr. Felipe Teran following the plenary “Year in Review” presentation by Dr. Neumar at the American Heart Association Resuscitation Science Symposium (ReSS) in Philadelphia. If you missed ReSS, this is your chance to hear summaries of the top studies that impacted cardiac arrest and post-arrest care in the past 12 months. Note that this is the second part of a two-part podcast: Check your earlier...

Resuscitation Science Top Studies of 2019: Part 1 of 2 Drs. Robert Neumar and Cindy Hsu (both at University of Michigan) are guest presenters in this special TTM Academy Podcast, hosted by Dr. Felipe Teran. They recap the plenary “Year in Review” presentation by Dr. Neumar at the American Heart Association Resuscitation Science Symposium (ReSS) in Philadelphia. If you missed ReSS, this is your chance to hear summaries of the top studies that impacted cardiac arrest and post-arrest care in the...

Drs. Teran and Abella discuss the role of transesophageal echocardiography (TEE) in the resuscitation of cardiac arrest patients.  Listen for details of how this cutting-edge application of TEE could play a role in improving arrest diagnostics, CPR quality and possibly arrest outcomes.   Key Reading: Teran F et al. “Evaluation of out-of-hospital cardiac arrest using transesophageal echocardiography in the emergency department.” Resuscitation. 2019 Apr;137:140-147....

Earlier this week, results from the HYPERION trial were published in the New England Journal of Medicine. Drs. Abella and Teran discuss the use of TTM for patients resuscitated from cardiac arrest with a non-shockable initial rhythm.   Suggested Readings: Lascarrou JB et at., “Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm.” N Engl J Med. 2019 Oct 2.https://www.ncbi.nlm.nih.gov/pubmed/31577396 Perman SM et al., “The Utility of Therapeutic Hypothermia for...

Following the success of Episode 6, which discussed the scientific evidence for ECMO in cardiac arrest, we decided to take a deeper look at the implementation of ECMO in the ED. Drs. Felipe Teran and Joseph Tonna discuss the utilization of ECMO for refractory cardiac arrest, the expansion of hospital ECMO programs to the emergency department and implementation of an ECMO program for cardiac arrest. This episode was recorded on location in Salt Lake City, Utah.   Key Reading: Tonna JE et al.,...

Drs. Teran and Abella discuss the role of TTM for patients following cardiac arrest caused by opioid overdose. Several recent observational studies are reviewed to understand the demographics of patients who suffer opioid-related cardiac arrest, their outcomes, and whether TTM may be beneficial during post-arrest for these patients.   Key readings: Salcido DD et al, “Regional incidence and outcome of out-of-hospital cardiac arrest associated with overdose.” Resuscitation 2016;...

Following resuscitation from cardiac arrest, accurate evaluation of neurological recovery can help guide patient care and family decisions. In this podcast, Drs. Teran and Abella discuss a recent investigation into the use of MRI imaging in prognostication following resuscitation from arrest.   Key reading for this podcast: Wallin E et al, "Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest."Acta Anaesthesiol Scand. 2018...

Episode 8 – Oxygen Delivery After Cardiac Arrest Resuscitation   During cardiac arrest resuscitation, most patients are intubated and placed on 100% oxygen. In this podcast, Drs. Teran and Abella discuss recent investigations that suggest that too much oxygen may worsen post-arrest injury. Global resuscitation guidelines suggest down-titration of oxygen as tolerated to maintain adequate O2 saturation, but it’s not clear how well this is done- many patients are left on high oxygen “dose” for...

Drs. Felipe Teran and Ben Abella discuss an important recent publication in Annals of Emergency Medicine by Elmer et al, in which some of the strongest evidence to date are presented that support the concept of “cardiac arrest centers”, much like trauma or stroke centers. This has been proposed before (Nichol G et al, Circulation 2010 – see below) – but evidence is now accumulating in support of the idea. Key readings: Nichol G et al, “Regional systems of care for out-of-hospital cardiac...

Drs. Benjamin Abella, John Greenwood and Felipe Teran discuss the use of ECMO (extra corporeal membrane oxygenation) for cardaic arrest patients.    Referenced article: Weisfeldt ML, Becker LB.  Resuscitation after cardiac arrest: a 3-phase time-sensitive model. JAMA. 2002 Dec 18;288(23):3035-8. https://doi.org/10.1001/jama.288.23.3035  

Dr. Felipe Teran discusses with Dr. Ramani Balu the importance of post-arrest neurological monitoring.   The Online TTM Course is now OPEN! Visit upenn.cloud-cme.com/ttmonline for more information or to register.

Dr. Abella discusses the recent publication in JAMA regarding the PRINCESS trial of intra-arrest brain cooling. JAMA Article: https://doi.org/10.1001/jama.2019.4149 Pre-hospital cold saline:  https://doi.org/10.1001/jama.2013.282173   TTM Academy: https://pennmedonline.upenn.edu/ttmacademy/    

Dr. Abella discusses neuroprognostication following cardiac arrest and how long to continue care before considering withdrawl. TTM Academy: www.med.upenn.edu/resuscitation/ttm-academy.html For updates: text TTM to 31996 or email [email protected]  ** TTM Academy podcasts are intended for medical education only and should not be used for clinical decision making.

Dr. Abella discusses the recent publication - Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. For the full article abstract visit: https://www.nejm.org/doi/full/10.1056/NEJMoa1816897   ** TTM Academy podcasts are intended for medical education only and should not be used for clinical decision making.