In patients with well-controlled DM (HbA1c < Anticoagulation in AF: Stopping warfarin in AF

8), Aspirin use was associated ↓ serious BRIDGE for a short duration ↓ minor bleeding and
vascular events, but ↑ increase in major ASCEND (2018) does not ↑ VTE
bleeding. Not associated with any change in

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the incidence of GI or orther cancers.
Apixaban vs Warfarin in AF: In patients with
nonvalvular AF and at ≥1 risk factor, apixaban

summaries / abstracts In patients with stable ischemic heart disease, ARISTOTLE is associated with a greater reduction in rates
CABG did not improve survival as compared to of stroke or systemic embolism while having a
medical therapy. However, the 10-year follow-up CASS (1983) lower rate of lower bleeding than warfarin.
results showed a significant long term mortality AF
benefit of CABG in patients with initial LVEF<0.5
Rivaroxaban vs Warfarin in AF: Among
patients with nonvalvular AF, rivaroxaban is
ROCKET AF (2011)
No benefit of pre-operative coronary noninferior to warfarin in preventing stroke and
revascularization over medical therapy before DECREASE-V systemic TE.
vascular surgery
Dabigatran vs Warfarin in AF: Compared to
PCI does not reduce mortality in stable CAD CARP (2004) warfarin, high-dose dabigatran reduces stroke
RE-LY
risk without increasing the risk of major
bleeding among patients with atrial fibrillation.
The higher the peak TnT in the first 3 POD,
VISION (2011) Cardiac
the shorter the median time to death
In patients with type 2 diabetes without
hypercholestrolemia, atorvastatin is safe and
CARDS Adult patients with acute lung injury or acute
effectively reduced the risk of cardiovascular
HACA trial [2002]: Hypothermia improved survival respiratory distress syndrome should be
events, as compared to placebo. In patients with septic shock, mortality and ARDSNet (2000)
(NNT 7) and neurological outcomes (NNT 6) ventilated with tidal volumes of 6 ml/kg,
rates of ischaemic events were similar in those
TTM post Cardiac Arrest TRISS (2014) limiting plateau pressures to 30 cm water. Use of 4% albumin or 0.9% sodium chloride
Among patients with severe trauma and major assigned to a blood transfusion at a higher vs.
TTM trial [2013]: No difference in neurological ↑ mortality, stroke and hypotension in bleeding, early administration of plasma, platelets, lower threshold SAFE (2004) for fluid resuscitation results in
metoprolol and red blood cells in a 1:1:1 ratio compared with a PROPPR (2015) similar outcomes at 28 days
outcome (nearly 1000 patients) Patients with severe ARDS have improved
1:1:2 ratio did not result in significant differences in PROSEVA
mortality at 24 hours or at 30 days. The transfusion threshold in critically ill patients mortality with early and long proning sessions

To determine if TXA is superior to placebo for ↓ CV deaths, AMIs, post-op AF and need for Blood Transfusion
can be between 7-9g/dl without adverse effects. ARDS Among ICU patients with hypovolemic shock,
POISE-1 (β-Blockers) TRICC (1999) Compared with the previously higher (>9g/dl) CRISTAL (2013) there was no mortality benefit at 28 days with
the occurrence of life-threatening, major, and revascularisation.
The restrictive transfusion strategy (Hb 7.5) is threshold, this results in less blood transfusion and The early use of a neuromuscular blocking colloids over crystalloids for fluid resuscitation.
critical organ bleeding, and non-inferior to ACURAsys
non-inferior to the liberal transfusion strategy (Hb its associated costs and potential complications. agent in severe ARDS may improve outcomes
placebo for the occurrence of major arterial
and venous thrombotic event ∴ Continue, but don’t start / wait 2 weeks if 9.5) in cardiac surgery patients with a moderate- TRICS-3 (2017)
starting to-high risk of death with regards to a composite In an African setting, febrile children with
outcome of death and major disability A restrictive transfusion strategy (Hb 7.5) did In adults with moderate-severe ARDS, the impaired perfusion, had an increased mortality
POISE-3 (2022) early application of HFOV as compared to FEAST
TITRe2 (2015) not demonstrate clinical or financial superiority OSCILLATE if they were treated with a fluid bolus
To determine the impact of a hypotension- standard ventilation does not reduce mortality
over a liberal transfusion (Hb 9) strategy compared with no fluid bolus
avoidance strategy versus a hypertension- Clonidine arm: No ↓ MI/death; ↑ hypotension/arrest and may be harmful
avoidance strategy on the risk of vascular
death and major vascular events in patients POISE-2
who are followed for 30 days after noncardiac No evidence that resuscitation with 6% HES
Aspirin arm: No ↓ MI/death; ↑ major Showed improved survival @ 6 months (63% vs 47%) (130/0.4) as compared with saline, in the ICU
surgery
bleeding in adults with severe acute respiratory failure CHEST (2012) provides any clinical benefit to the patient.
Supports ECMO as a valid treatment option for the Indeed the use of HES resulted in an
CESAR
management of patients with severe respiratory increased rate of renal replacement therapy
failure, but does not show that ECMO is better than
conventional ventilation
"goal-directed therapy provided at the earliest
stages of severe sepsis and septic shock…
ECMO
ANZ ECMO Influenza investigators showed a has significant short-term and long-term
ICU →FLUIDS...
mortality rate of 21% (lower than previous published benefits."
studies) Rivers (2001)

Until ProCESS, ARISE and ProMISe, Rivers’

NAP4 (Major Complications of Airway trial represented the best evidence for EGDT
Systematic review on ECMO in H1N1 pandemic (Crit Care Med,
Management in the UK) and demonstrated a strong benefit.
2010) found insufficient evidence for ECMO use among patients with
H1N1

Prolongs the safe apnoea time in healthy In critically ill patients presenting to the
children but has no effect to improve CO2 THRIVE in Children (2017) In ICUs that target moderate depths of sedation emergency department with early septic shock,
Airway ARISE
EGDT did not reduce all-cause mortality at 90
clearance with continuous infusions or drugs, daily sedative
KRESS EGDT days
interruptions will probably reduce the period of
mechanical ventilation and ICU length of stay
THRIVE combines the benefits of 'classical'
apnoeic oxygenation with continuous positive In patients with septic shock who were identified
THRIVE (2014) No clear benefit or harm from the use of PAC early and received intravenous antibiotics and
airway pressure and gaseous exchange PAC-MAN
through flow-dependent deadspace flushing in critically ill patients PROMISE adequate fluid resuscitation, hemodynamic
management according to a strict EGDT protocol
did not lead to an improvement in outcome
A blood glucose target of less than 10.0 mmol/
L (180 mg/dL) resulted in lower mortality than
a target of 4.5 to 6.0 mmol/L (81 to 108 mg/ NICE SUGAR Adults with sepsis in the ED have ~20% 60-
dL), and the authors do not recommend use of day mortality and providing care by a
the lower target in critically ill adults PROCESS (2014) dedicated team following either a strict
(EGDT) or relaxed protocol makes no
difference to this
No difference in 90-day mortality when comparing
permissive hypotensive to usual care in septic 65 Trial (2020)
shock patients. Aiming for a MAP 60-65 in age>65

Despite the possibility of a modest reduction in

the risk of massive bleeding, the strong and
consistent negative mortality trend associated
with aprotinin, as compared with the lysine BART (2008)
analogues (TXA), precludes its use in high-risk
cardiac surgery (to ↓ postop bleeding)

Platelet transfusions cannot be recommended for the Trauma

PATCH
treatment of acute ICH in people taking antiplatelets therapy

TXA safely reduced the risk of death in Avoidance of nitrous oxide and the
bleeding trauma patients in this study. On the concomitant increase in inspired O2
basis of these results, TXA should be CRASH 2 (2010) ENIGMA 1 concentration decreases the incidence of
considered for use in bleeding trauma complications after major surgery but does not
patients. influence length of stay
N₂O
No evidence that nitrous oxide increases the
NAP5 (AAGA) risk of death and cardiovascular complications
ENIGMA 2 after major non-cardiac surgery, nor that
nitrous oxide increases the risk of surgical site
infection

No clinical benefit in targeting a lighter-plane of

anaesthesia (BIS 50) compared to a deeper-plane
AWARENESS BALANCE (2019) of anaesthesia (BIS 35) in patients over 60 years
of age at risk of complications after surgery (ASA 3
0.16% awareness in the BIS-guided group vs or 4)
0.89% in the routine care group 82% reduction BE-AWARE (2004)
with BIS Anaesthesia
Ondansetron, Dexamethasone and Droperidol
equally and independently reduce the
Awareness 0.6% (BIS) vs 0.3% (EtAC) B-UNAWARE (2008) incidence of PONV with no synergistic effect

Reported for the first time the number of CNB Awareness 0.24% (BIS) vs 0.07% (EtAC) BAG RECALL (2011) No benefit of BIS Using Propofol rather than volatile
performed annually in the UK (≈700 000) and IMPACT (2004) anaesthetics and the avoidance of nitrous
the distribution by type (spinal 46%, epidural oxide also reduce the incidence of PONV but
41%) and indication (obstetric 45%, Awareness 0.12% (BIS) vs 0.08% (EtAC) MACS (2012) to a lesser extent
perioperative 44%)

In patients at increased risk for complications while Remifentanil offers no beneficial effect over
It estimated the risk of permanent injury undergoing elective major abdominal surgery, a fentanyl for PONV prevention
following CNB as pessimistically 1 in 24 000 restrictive fluid regimen was not associated with a
and optimistically 1 in 51 000 and of higher rate of disability-free survival than a liberal RELIEF (2018)
paraplegia or death as pessimistically 1 in 55 fluid regimen 1 year after surgery. However, the NAP 6 (Perioperative Anaphylaxis)
000 and optimistically 1 in 142 000. restrictive regimen was associated with a higher rate
of acute kidney injury
NAP 7 (Perioperative Cardiac Arrest) -
It identified perioperative epidurals as the underway
indication/procedure of highest risk (comprising 1
NAP 3 (Major Complications of Central Neuraxial Block in the UK)
in 7 CNBs but accounting for half of all major
complications, risk of permanent harm
pessimistically 1 in 6 000, optimistically 1 in 12
000).

Pain & Regional

It focused on vertebral canal haematoma,
vertebral canal abscess and vertebral ischaemia
as the prime causes of permanent CNB-related
harm.

It identified delays (organisational and

individual) in identifying and acting on signs of
neurological compromise as a contributory
factor in cases of avoidable patient harm.

There is no overall difference in mortality or

major morbidity in high-risk patients undergoing
major abdominal surgery with the addition of
epidural anaesthesia to general anaesthesia Magnesium sulphate significantly decreases the
MASTERS (2002) MAGPIE (2002) risk of eclampsia in pregnant women with
preeclampsia
On subgroup analysis, there was a small
reduction in respiratory failure in the epidural
group In patients with HFrEF (EF ≤35%) and NYHA
COMET II-IV symptoms, Carvedilol reduced all-cause
mortality compared to metoprolol tartrate.
Obstetrics

Tranexamic acid may be beneficial in reducing

the risk of death due to post-partum
haemorrhage.
WOMAN

Early resuscitation, management of coagulopathy and surgical

assistance with source control, are the most important interventions.

No definite difference in outcomes between

The EVAR II trial compared endovascular GALA (2009) general and local anaesthesia for carotid
abdominal aortic aneurysm repair with no surgery.
intervention in patients unsuitable for the open
procedure.
Among both symptomatic and asymptomatic Less than 1h of sevoflurane anesthesia in early infancy
patients with carotid stenosis, stenting and does not result in an increased risk of adverse
There were significantly fewer aneurysm- EVAR II (2010) endarterectomy (CEA) were associated with GAS
neurodevelopmental outcome at 2 years of age (Part 1) or 5
related deaths in the endovascular group, CREST (2010) similar rates of stroke, MI, and death, although years (part 2) compared with awake-regional anesthesia.
compared to no intervention. stenting was associated with fewer
periprocedural MIs and endarterectomy with
fewer periprocedural strokes
Only multiple anesthesia exposures, but not single
The rates of complication and reintervention
Vascular anesthesia exposure, are associated with a pattern of
were similar to the rates observed in EVAR I. MASK changes in specific neuropsychological domains that
The EVAR I trial compared the safety and
are associated with behavioral and learning
efficacy of endovascular and open abdominal High dose methylprednisolone within 8 hours of difficulties.
CEA reduces the 5-year risk of death or stroke aortic aneurysm repair
NASCIS-2 Spinal Cord injury was beneficial → mild
by 29% among patients with symptomatic NASCET
improvement in motor and sensory scores @ 6
high-moderate (50-69%) carotid stenosis Among healthy children with a single
TXA administration in TBI appears safe, months and 1 year
2. There were no significant differences in anesthesia exposure before age 36 months,
EVAR 1 however by conventional statistics it does not
all-cause mortality between the two groups. CRASH-3 (2019) compared with healthy siblings with no
appear to reduce in hospital TBI associated PANDA
Among patients with symptomatic carotid Steroids Treatment with corticosteroids following head anesthesia exposure, there are no statistically
death at 28 days when administered < 3 hours
artery stenosis, carotid endarterectomy (CEA) injury affords no material benefit Paeds significant differences in IQ scores in later
ECST
reduces the risk of major stroke or death in 3. The endovascular group experienced childhood.
those whose carotid stenosis is ≥80%. significantly higher rates of graft-related MRC CRASH (2004)
In patients with a ruptured intracranial aneurysm, the
complications and reinterventions.
outcome in terms of survival free of disability at 1 ISAT Corticosteroids should not be given to patients with head
year is significantly better with endovascular coiling injuries, unless other specific indications exist that outweigh High rate of severe critical events during the
the increased risk of death demonstrated by this trial anaesthesia management of children for surgical or
diagnostic procedures in Europe, and a large
SIESTA, AnSTROKE, GOLIATH trials showed no variability in the practice of paediatric anaesthesia
difference in short-term clinical outcome between EUROTHERM3235 RCT: Stopped early due to
Endovascular Thrombectomy ↑ mortality in hypo group
EVT patients treated with GA versus conscious
sedation Neurosurgery Age, medical history, and physical condition
TBI APRICOT
were the major risk factors for a serious critical
POLAR RCT: No difference at 6m, ↑ event
Decompressive craniectomy in severe TBI complications in hypo group
patients with intracranial hypertension
refractory to medical management improves DECRA (2016) Beneficial effect of years of experience of the
mortality (by 22%) and functional outcomes ICTuS-2 trial: Stopped early. No difference in most senior anaesthesia team member, rather
compared to continued medical management mortality, functional outcome or AE's. Trend than the type of health institution or providers
Hypothermia
Decompressive Craniectomy towards ↑ pneumonia in hypo group.

Decompressive craniectomy in patients with AIS

TBI and persistently raised intracranial EuroHYP-1 RCT: No difference in 1° outcome.
pressure, after stage 1 and 2 management, RESCUEicp (2016) Only 31% achieved the predefines cooling © 2020 M Ameen Ally
was associated with lower mortality than target! AmeenAlly@gmail.com
medical management.

I-HAST trial: No difference in neurological outcome at

SAH
90d