Research and Reviews in the Fastlane 116

This article raises the question of how important MIC is and whether we should be developing and testing alternate ways to assess antibiotic efficacy. Recommended by: Anand Swaminathan Emergency Medicine Piazza G et al. A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. JACC Cardiovasc Interv 2015; 24;8(10):1382-92. PMID: 26315743 This is simple prospective data on a highly selected group of patients with massive or sub massive PEs. There were almost as many authors as patients here… You got into the trial based on the CT signs of severity. They allowed up to 14 days of symptoms prior to enrolment which seems a tad long. The intervention here was a device with tpa into the clot itself. All got heparin too. The idea is that you only get 1mg/hr of tpa so the dose is tiny and much better directed. Primary outcome was lots of surrogate end point stuff – important but not really what we want to know They ended up with 160 pts (80% sub massive, 20% massive) and everyone did great. 3% overall mortality. All the numbers and even the repeat CTPA (!!!) got better. It does seem relatively safe and there no head bleeds in 160 pts. The bigger question is can we get the same good outcomes without having to do this? Does improving the numbers make the actual patient better. We’ll have to wait for that study… Recommended by: Andy ...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Infectious Disease Intensive Care Pediatrics Radiology Respiratory critical care examination R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs