Community-based palliative care reduces emergency department visits

By Bryan J. Huang, MD, FHM

Retrospective cohort study showed that patients receiving community-based palliative care were less likely to seek ED care. The reduction was greater for older patients and for patients living in areas of higher socioeconomic status.

Reference: Spilsbury K, Rosenwax L, Arendts G, Semmens JB. The association of community-based palliative care with reduced emergency department visits in the last year of life varies by patient factors. Ann Emerg Med 2017;69(4):416-25.

Time to intubation after cardiac arrest: Earlier may not be better

By Sarah Horman, MD

In a retrospective, observational, cohort study of 86,628 adults with in-hospital cardiac arrest, intubation during the first 15 minutes was associated with decreased survival, compared with no intubation.

Reference: Andersen, LW, Granfeldt, A, Callaway, CW, et al. Association between Tracheal intubation during adult in-hospital cardiac arrest and survival. JAMA. 2017;317(5):494-506.

DNR orders often not transferred to ED from outside care facilities

By Leslie M. Martin, MD

Prospective chart review of patients presenting from extended care facilities to an urban trauma center found hospital staff did a poor job of noting do not resuscitate preferences, and extended care facilities were inconsistent in providing their patients’ DNR forms.

Reference: McQuown CM, Frey JA, Amireh A, Chaudhary A. Transfer of do not resuscitate orders to the emergency department from extended care facilities. Am J Emerg Med. Published on 4 Feb 2017. doi: 10.1016/j.ajem.2017.02.007.

A quasi-experimental, before-after trial examining the impact of an emergency department mechanical ventilator protocol on clinical outcomes and lung-protective ventilation in acute respiratory distress syndrome

By William James Frederick III, MD, PhD

A single center, quasi-experimental, before-after trial shows a lung-protective mechanical ventilation protocol for emergency department and intensive care patients with Acute Respiratory Distress Syndrome reduced mortality and increased ventilator-free days.

Reference: Fuller BM, Ferguson IT, Mohr NM, et al. A Quasi-Experimental, Before-After Trial Examining the Impact of an Emergency Department Mechanical Ventilator Protocol on Clinical Outcomes and Lung-Protective Ventilation in Acute Respiratory Distress Syndrome. Crit Care Med. 2017;45(4);645-52.