• Trials
    • Carotid artery surgery
      • European Carotid Surgery Trial (ECST);
        Journal des maladies vasculaires 1993
        Link:www.ncbi.nlm.nih.gov/pubmed/9593407
        • Patients with symptommatic stenosis of 70-99% benefit from CEA.
          • NICE say patients with TIAs or non-disabling strokes should have USS within 1 week and surgery done within 2 weeks.
            Link:www.nice.org.uk/nicemedia/pdf/CG68NICEGuideline.pdf
      • North American Symptommatic Carotid Endarterectomy Trial (NASCET); Stroke 1999
        Link:stroke.ahajournals.org/content/30/9/1751.full.pdf
        • For every 6 patients treated, 1 major stroke was prevented at 2 years for symptomatic patients with 70-99% stenosis
        • Smaller benefit for patients with 50-69% stenosis with NNT of 22 at 5 years
      • General Anaesthetic vs Local Anaesthetic (GALA) trial (Lancet, 2008)
        Link:www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61699-2/fulltext#article_upsell
        • No difference in quality of life, risk of post-op events or length of hospital stay.
    • SAPPHIRE Trial
      Link:www.theheart.org/article/856965.do
      • Compared CEA with carotid angioplasty and stenting. No difference but confers about higher rates of restenosis with stents and the longer term stroke prevention rates unknown
    • BALTI-2 trial
      Link:ac.els-cdn.com/S0140673611616231/1-s2.0-S0140673611616231-main.pdf?_tid=0ee464dc-a2e0-11e2-bca3-00000aab0f6c&acdnat=1365709578_cb21002aa62de508aee73b13f1b86303
      • Used β-agonists in ARDS. They were poorly tolerated and may worsen outcomes
    • MASTER study
      Link:www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)08266-1/fulltext#article_upsell
      • Most adverse outcomes not reduced by combined epidural/GA and post-op epidural analgesia. High risk patients may benefit.
        Link:Epidural benefit
    • Cardiac Arrests
      • HACA study (NEJM 2002)
        Link:www.nejm.org/doi/pdf/10.1056/NEJMoa012689
        • Cooling following OOH VF arrest. NNT for improved neurological outcome following out of hospital VF arrest = 6
        • Criticised as high temperature in ‘normothermia’ group => ? effect of hyperthermia rather than hypothermic protection
      • Targeted temperature management at 33 vs 36 degrees C after cardiac arrest (NEJM 2013)
        Link:www.nejm.org/doi/full10.1056/nejmoa1310519#t=article
        • No difference in outcome between two groups
    • MAGIC trial
      Link:www.nejm.org/doi/pdf/10.1056/NEJMoa055531
      • Perioperative chemotherapy improves survival in patients with gastrooesophageal cancers
    • MAGPIE study
      Link:www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)08778-0/fulltext#article_upsell
      • Compared magnesium with placebo for pre-eclampsia. Reduced the risk of eclampsia.
    • Perioperative β-blockers
      • DECREASE IV trial (Ann Surg)
        Link:www.ncbi.nlm.nih.gov/pubmed/19474688
        • Bisoprolol used for 30 days pre-op
          2x2 factorial design along with fluvastatin
          Reduction shown in 30 day cardiac death and non-fatal MI, with trend for improved outcome with statin.
      • POISE (2008, Lancet)
        Link:www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60601-7/fulltext#article_upsell
        • 8000 patients having non-cardiac surgery. Metoprolol used 2-4 hrs prior to surgery and continued for 1/12.
          Reduction in non-fatal MI but increase in strokes and higher total mortality (3.1% vs 2.3%). Stopping beta blockers causes a 2.6 increase in 1yr mortality
      • VISION (JAMA 2012)
        Link:umexpert.um.edu.my/file/publication/00009976_83556.pdf
        • Age >45, non-cardiac surgery, inpatient surgery
        • 9% had MI
          • 80% clinically silent
          • High 30 day mortality with even small troponin rises
          • Troponin at day 3 linked to mortality
    • Raised ICP
      • DECRA trial
        Link:www.nejm.org/doi/pdf/10.1056/NEJMoa1102077
        • Medically refractory ICP; worse outcomes following decompressive craniotomy that with standard medical therapy
      • The RESCUEicp trial is ongoing looking at similar issues
        Link:www.rescueicp.com
    • ARDS
      Link:ALI and ARDS
      • CESAR trial
        Link:www.ncbi.nlm.nih.gov/pubmed/19762075
        • Benefit from ECMO (NNT 6)
      • Fluid management (FACTT trial)
        Link:www.nejm.org/doi/pdf/10.1056/NEJMoa062200
        • Less ventilation days with conservative fluid management and no increase in ANY adverse events but no mortality benefit
      • OSCILLATE Study (NEJM)
        Link:www.oscillatetrial.com/storage/nejmhighfrequencyoscillation%20in%20early%20ARDS.pdf
        • Halted after higher number of deaths in HFOV group
      • OSCAR Trial (NEJM)
        Link:www.nejm.org/doi/pdf/10.1056/NEJMoa1215716
        • No difference in outcome between HFOV & conventional ventilation
    • PA Catheters
      • PAC-Man trial (Lancet 2005)
        Link:www.ncbi.nlm.nih.gov/sites/entrez/16084255?dopt=Abstract&holding=f1000,f1000m,isrctn
        • No clear evidence of benefit or harm in managing a patient with a PAC on ITU
      • PA vs CVC to guide treatment of ALI (NEJM 2006)
        Link:www.nejm.org/doi/full/10.1056/NEJMoa061895
        • No difference in outcome but more complications in PAC group
    • Trachman study
      Link:www.ncbi.nlm.nih.gov/pmc/articles/PMC558092/pdf/bmj33001243.pdf
      • BMJ 2005; early tracheostomy may reduce ventilation days and length of stay.