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Journal and News Scan

Source: EMCrit Blog
Author(s): Joe Novak

Joe Novak, MD was an F-15 Combat Pilot and now is an Emergency Physician. In this fantastic lecture, he brings the concepts of Combat Aviation to the art of Resuscitation.

The Boldface

aka the no-shitters things that must be absolutely incorporated into your memory and available for immediate execution. You should not need to think about what to do in these situations.


Cognitive unloading and guarantee of the performance of critical actions. Use after addressing the boldface

Prioritization of Attention and Tasks

In combat aviation:

  1. Aviate
  2. Navigate
  3. Communicate

In EM & Critical Care:

  1. Resuscitate
  2. Differentiate
  3. Communicate

The Cross-Check

Keep coming back to the global patient picture before diving into any minutiae

Efficient and Unambiguous Communication

  • Directive
  • Descriptive
  • Informative

Click on the vimeo video near the end to hear his full lecture 


Source: Journal of Gastrointestinal Surgery
Author(s): P Schollaert, R Crott, C Bertrand, L D'Hondt, T Vander Borght, B Krug

This metanalysis identified 26 eligible studies that assess the predictive value of PET for survival after induction therapy.  Complete metabolic response was associated with a 50% decrease in mortality and in tumor recurrence compared to no response.   

Source: Journal of Gastrointestinal Surgery
Author(s): NW Bronson, RA Luna, JG Hunter, JP Dolan

This retrospective single institution review assessed the incidence of hiatal hernia after minimally invasive esophagectomy (MIE).  Of 114 patients followed, 9 (8%) developed herniation, of whom 5 were symptomatic.  All were repaired laparoscopically, except 2 who underwent emergent surgery, with good results.

Source: Journal of Gastrointestinal Surgery
Author(s): Y Vigneswaran, AK Yetasook, J-C Zhao, W Denham, JG Linn, MB Ujiki

POEM is being increasingly used for primary treatment of achalasia.  This study evaluated POEM use for retreatment of 5 achalasia patients after prior laparoscopic esophageal myotomy and compared their results to 3 patients who underwent redo laparoscopic surgery.  Both groups had similar low complication rates and improved symptoms at intermediate-term follow-up.  The authors conclude that POEM is feasible for reoperative surgery for achalasia. 

Source: JACC Cardiovascular Interventions
Author(s): Fassa AA, Himbert D, Brochet E, Depoix JP, Cheong AP, Alkhoder S, Nataf P, Vahanian A.

Interesting images of one of the very few reports on transeptal mitral valve implantation, in this case with a SAPIEN XT valve. The valve was implanted in a 72-year old female patient with previous aortic valve replacement and tricuspid valve annuloplasty. She had symptomatic mitral stenosis with severe calcification of the mitral annulus.

Source: Annals of Surgery
Author(s): Haugen AS, Søfteland E, Almeland SK, Sevdalis N, Vonen B, Eide GE, Nortvedt MW, Harthug S.

Stepped wedged cluster randomized control trial from the World Health Organization comparing outcomes in those who received a Checklist.  Implementation of the WHO Surgical Safey Checklist decreased morbidty and hospital length of stay.

Source: Journal of the American College of Cardiology
Author(s): Darryl Abrams; Alain Combes; Daniel Brodie

In this extensive review, the authors focus on extracorproreal membrane oxygenation (ECMO), both for cardiac and respiratory failure. They describe the explosive increase in ECMO use, the expanding indications, and the need for more evidence-based use. Moreover, they review the cannulation strategies, current indications and potential future applications.

Source: International Journal of Cardiology
Author(s): Stabile E, Pucciarelli A, Cota L, Sorropago G, Tesorio T, Salemme L, Popusoi G, Ambrosini V, Cioppa A, Agrusta M, Catapano D, Moscariello C, Trimarco B, Esposito G, Rubino P.

Traditionally, patients undergoing TAVI are treated with dual antiplatelet therapy (DAPT). This strategy in not based on strong evidence.  In this paper, the authors describe their findings in a randomized trial comparing outcomes (morbidity and mortality) in two groups of patients undergoing TAVI, one treated with aspirin only (ASA group) and another treated with aspirin and clopidogrel or ticlopidine (DAPT group). There were no significant differences in “all cause” and “cardiovascular” mortality at six months or in the VARC (Valve Academic Research Consortium) combined safety endpoints at 30 days. Nevertheless, at 30 days, vascular complications were significantly more frequent in the in the DAPT group. Based on their data, the authors suggest that, in patients undergoing TAVI, vascular complications may be reduced by the adoption of an antiplatelet therapy based only on aspirin.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): S Wang, Y Tachimori, H IGaki, H Nakazato, T Kishino

Pts undergoing salvage esophagectomy after definitive chemoradiotherapy were evaluated for perdictors of survival.  5-year survival was 30%, which was related to tumor recurrence rather than residual tumor, complete resection, N status, M status, and dissection of more than 15 nodes.  Additional neck dissection was not found to provide additional benefit.

Source: Journal of Clinical Oncology
Author(s): AG Sacher, LW Le, NB Leighl

This study evaluated over 200 RTCs of systemic therapy for NSCLC.  There has been a steady increase in the number of trials reporting outcomes for progression-free survival.  Over 50% of trials now report a positive outcome without meeting the primary endpoint of the trial.  Although the sample size of the trials is increasing, the magnitude of reported survival gain is decreasing (now 2.5 mos).