General Critical Care

Management of patients on antithrombotic therapy with severe infections: a joint clinical consensus statement of the ESC Working Group on Thrombosis, the ESC Working Group on Atherosclerosis and Vascular Biology, and the International Society on Thrombosis and Haemostasis

ESC guidelines for management of antithrombotic therapy with severe infection and coagulopathy

Individuals on single or combined antithrombotic therapy with high or very high cardiovascular risk have an elevated susceptibility to severe infections and related complications, both in the short and long term. When infection and sepsis is associated with coagulopathy, adjustments to antithrombotic therapy is often necessary based on underlying cardiovascular conditions, treatment indications, clinical status, and patient prognosis:

• If the platelet count falls below 100 × 10^9/L in patients already on oral anticoagulation (OAC), heparins should be utilized; heparins should be discontinued if the platelet count drops below 30 × 10^9/L.

Epinephrine in Out-of-Hospital Cardiac Arrest

A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms

Standard-dose epinephrine, high-dose epinephrine, and the combination of epinephrine with vasopressin are associated with increased ROSC and survival to hospital admission post-OHCA compared to placebo or no treatment. However, these agents don't necessarily enhance survival to discharge or ensure a good functional outcome. Notably, standard-dose epinephrine does improve survival to discharge for patients with a nonshockable rhythm but not for those with a shockable rhythm.

Effects of Hypothermia vs Normothermia on Societal Participation and Cognitive Function at 6 Months in Survivors After Out-of-Hospital Cardiac Arrest

The "TTM2" trial compared the effects of cooling (hypothermia) and maintaining normal temperature (normothermia) in people who survived out-of-hospital cardiac arrest (OHCA). The study aimed to see if these approaches had different impacts on functional outcomes and cognitive function after six months.

Conservative versus Liberal Oxygenation Targets in Intensive Care Unit Patients (ICONIC)

In this study, the effectiveness of different oxygenation strategies in intensive care unit (ICU) patients was investigated. The aim was to determine if a low-oxygenation strategy, targeting lower levels of oxygen in the blood, would lead to lower 28-day mortality compared to a high-oxygenation strategy, where higher oxygen levels were maintained.

The study involved a randomized multicenter trial with mechanically ventilated ICU patients who were expected to require ventilation for at least 24 hours. Patients were divided into two groups: the low-oxygenation group (targeting a PaO2 of 55-80 mmHg or SpO2 of 91-94%) and the high-oxygenation group (targeting a PaO2 of 110-150 mmHg or SpO2 of 96-100%). The primary outcome assessed was 28-day mortality.

Safety and efficacy of artesunate treatment in severely injured patients with traumatic hemorrhage. The TOP-ART randomized clinical trial

The TOP-ART trial aimed to determine the safety and efficacy of intravenous artesunate in reducing multiple organ dysfunction syndrome (MODS) in trauma patients with major hemorrhage. The trial, however, was terminated early due to safety concerns after enrolling 90 out of the targeted 105 patients. In the 83 patients who received either artesunate (n=54) or placebo (n=29), it was found that serious adverse events (SAEs) were more common in the artesunate group, with 31% (n=17) of patients experiencing SAEs compared to 17% (n=5) in the placebo group.

Furthermore, 17% of the artesunate group experienced venous thromboembolic events (VTE) compared to just 3% in the placebo group. There was no statistical evidence supporting the superiority of artesunate in improving organ dysfunction as measured by the 48-hour SOFA score. The median score was 5.5…