Clinical Outcomes With and Without Direct Discharge Home ICUs are an important part of an acute care system and provide life-sustaining treatment to critically ill patients. The level and complexity of care delivered in ICUs can vary. For example, some ICUs provide support for multiple organ failure, while others may focus on single-system support or might be a point of transition between the ward and the highest level of care. Patient care pathways, in general, fu...

ORIGINAL ARTICLE Defibrillation Strategies for Refractory Ventricular Fibrillation Sheldon Cheskes, P. Richard Verbeek, Ian R. Drennan, et al N Engl J Med November 6, 2022DOI: 10.1056/NEJMoa2207304 Abstract BACKGROUND Despite advances in defibrillation technology, shock-refractory ventricular fibrillation remains common during out-of-hospital cardiac arrest. Double sequential external defibrillation (DSED; rapid sequential shocks from two defibrillators)...

ORIGINAL ARTICLE Once-Weekly Semaglutide in Adolescents with Obesity Daniel Weghuber, Timothy Barrett, Margarita Barrientos-Pérez, et al N Engl J Med November 2, 2022DOI: 10.1056/NEJMoa2208601 Abstract BACKGROUND A once-weekly, 2.4-mg dose of subcutaneous semaglutide, a glucagon-like peptide-1 receptor agonist, is used to treat obesity in adults, but assessment of the drug in adolescents has been lacking. METHODS In this double-blind, parallel-grou...

ORIGINAL ARTICLE Trial of an Intervention to Improve Acute Heart Failure Outcomes Douglas S. Lee, Sharon E. Straus, Michael E. Farkouh, et al N Engl J Med November 5, 2022DOI: 10.1056/NEJMoa2211680 Abstract BACKGROUND Patients with acute heart failure are frequently or systematically hospitalized, often because the risk of adverse events is uncertain and the options for rapid follow-up are inadequate. Whether the use of a strategy to support clinicians i...

ICU vs High-Dependency Care Unit for Septic Shock Sepsis is a life-threatening disease with high mortality. More than 10,000 people die from sepsis every year in Japan. Septic shock is when sepsis is associated with circulatory and cellular metabolic abnormalities. International guidelines recommend the use of antimicrobial therapy and source control with drainage or surgery, intensive care with fluid resuscitation and vasopressors for septic shock. However, there ...

ORIGINAL ARTICLE Methylprednisolone for Heart Surgery in Infants — A Randomized, Controlled Trial Kevin D. Hill, Prince J. Kannankeril, Jeffrey P. Jacobs, et al N Engl J Med November 6, 2022DOI: 10.1056/NEJMoa2212667 Abstract BACKGROUND Although perioperative prophylactic glucocorticoids have been used for decades, whether they improve outcomes in infants after heart surgery with cardiopulmonary bypass is unknown. METHODS We conducted a multicenter...

ORIGINAL ARTICLE Duration of Device-Based Fever Prevention after Cardiac Arrest Christian Hassager, Henrik Schmidt, Jacob E. Møller, et al N Engl J Med November 6, 2022DOI: 10.1056/NEJMoa2212528 Abstract BACKGROUND Guidelines recommend active fever prevention for 72 hours after cardiac arrest. Data from randomized clinical trials of this intervention have been lacking. METHODS We randomly assigned comatose patients who had been resuscitated after a...

ORIGINAL ARTICLE Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia Alik Farber, Matthew T. Menard, Michael S. Conte, et al N Engl J Med November 7, 2022DOI: 10.1056/NEJMoa2207899 Abstract BACKGROUND Patients with chronic limb-threatening ischemia (CLTI) require revascularization to improve limb perfusion and thereby limit the risk of amputation. It is uncertain whether an initial strategy of endovascular therapy or surgical revascular...

Original Investigation  November 6, 2022 Treatment Time and In-Hospital Mortality Among Patients With ST-Segment Elevation Myocardial Infarction, 2018-2021 James G. Jollis, Christopher B. Granger, Jessica K. Zègre-Hemsey, et al JAMA. Published online November 6, 2022. doi:10.1001/jama.2022.20149 Key Points Question  What were the treatment times and in-hospital mortality among US patients with ST-segment elevation myocardial infa...

Sepsis Awareness - Patient, Public and Healthcare Professionals Sepsis is a preventable cause of death. Early recognition, diagnosis, and appropriate clinical management can prevent sepsis and improve outcomes. However, the condition is not widely recognised by patients and the general public. In addition, knowledge gaps also persist among healthcare professionals.  Increasing knowledge and awareness of sepsis, its risk factors and symptoms among the public...