Journal of the American College of Emergency Physicians open
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J Am Coll Emerg Physicians Open · Feb 2021
ReviewExtracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: a scoping review.
Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging concept in cardiac arrest and cardiopulmonary resuscitation. Recent research has documented a significant improvement in favorable outcomes, notable survival to discharge, and neurologically intact survival. ⋯ This scoping review highlights the need for high-quality studies to increase the level of evidence and reduce knowledge gaps to change the paradigm of care for patients with shock-refractory cardiac arrest.
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J Am Coll Emerg Physicians Open · Feb 2021
ReviewExtracorporeal cardiopulmonary resuscitation for adults with shock-refractory cardiac arrest.
Veno-arterial extracorporeal membrane oxygenation has increasingly emerged as a feasible treatment to mitigate the progressive multiorgan dysfunction that occurs during cardiac arrest, in support of further resuscitation efforts. ⋯ Current clinical evidence is mostly drawn from observational studies, with their potential for confounding selection bias. Although studies without controls cannot supplant case-control or cohort studies, several ECPR studies without a control group show successful resuscitation with impressive results that may provide valuable information to inform a comparison.
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J Am Coll Emerg Physicians Open · Oct 2020
ReviewEmergency medicine in Norway: The road to specialty recognition.
Emergency medicine (EM) in most of Europe is a much newer specialty than in the United States. Until recently, emergency departments (EDs) in Norway were staffed with unsupervised interns, leading to a government report in 2008 that called for change. ⋯ Norway faced many of the same obstacles as the United States did with implementing the specialty 60 years ago. This article serves as a review of the conflict that may ensue when enacting a change in public policy and a resource to those countries that have yet to implement an emergency medicine specialty.
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J Am Coll Emerg Physicians Open · Jun 2020
ReviewManaging sedation in the mechanically ventilated emergency department patient: a clinical review.
Managing sedation in the ventilated emergency department (ED) patient is increasingly important as critical care unit admissions from EDs increase and hospital crowding results in intubated patients boarding for longer periods. The objectives of this review are 3-fold; (1) describe the historical perspective of how sedation of the ventilated patient has changed, (2) summarize the most commonly used sedation and analgesic agents, and (3) provide a practical approach to sedation and analgesia in mechanically ventilated ED patients. ⋯ Our review of the literature found that the level of sedation and practices of sedation and analgesia in the ED environment have downstream consequences on patient care including overall patient centered outcomes even after the patient has left the ED. It is reasonable to begin with analgesia in isolation, although sedating medications should be used when patients remain uncomfortable and agitated after initial interventions are performed.