Determining Brain Death The Uniform Law Commission (ULC) created the Uniform Determination of Death Act (UDDA) in the United States in 1980, which was adopted by all 50 states. The UDDA defines death as either the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain, including the brainstem. While the loss of cardiorespiratory function has always been recognised as death, some view the de...

Drones Delivering Automated External Defibrillators Out-of-Hospital Cardiac Arrest (OHCA) is a dangerous condition with high mortality and poor health outcomes. According to the International Liaison Committee for Resuscitation (ILCOR), the global incidence of OHCA treated by emergency medical services (EMS) is 30.0-97.1 per 100,000 population, with discharge/30-day survival rates of 3.1-20.4% and good neurological outcomes of 2.8±18.2%. OHCA incidence in Europe is...

Medical News & Perspectives  April 5, 2023 It Takes an Average of 17 Years for Evidence to Change Practice—the Burgeoning Field of Implementation Science Seeks to Speed Things Up Rita Rubin JAMA. Published online April 5, 2023. doi:10.1001/jama.2023.4387 Colorectal cancer screening with an at-home stool test is more convenient than with a colonoscopy, but an abnormal result on the former still requires a follow-up with the latter. ...

Remote Ischaemic Conditioning in Septic Shock Septic shock is one of the most severe complications of any infection. It affects millions of people each year. Studies show that in the U.S. and Europe, nearly 10% of patients admitted to the ICU have septic shock. Significant efforts have been made to recognise and treat septic shock early. Still, over 50% of patients die of septic shock within days or weeks after diagnosis. Thus, there is a need for new therapeutic a...

Editorial  April 11, 2023 Lack of Benefit of Renin-Angiotensin System Inhibitors in COVID-19 Matthew M. Y. Lee, John J. V. McMurray JAMA. 2023;329(14):1155-1156. doi:10.1001/jama.2023.4405 There has been considerable interest in the potential role of renin-angiotensin system (RAS) inhibitors in patients with COVID-19 given that angiotensin-converting enzyme 2 (ACE2) is the functional receptor for SARS-CoV-2.1 Because ACE inhibitors and angiot...

ECMO for COVID-19 ARDS There is increasing evidence supporting the use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) in patients that do not respond to maximal medical therapy. ARDS can occur in some COVID-19 patients who are hospitalised, and ECMO can be utilised as a treatment option in some cases. Using ECMO can help avoid ventilator-induced lung injury and give the lungs time to rest while waiting for recove...

Prone Positioning for Acute Hypoxaemic Respiratory Failure Prone positioning is a medical intervention that was initially proposed over 50 years ago as a way to improve gas exchange. Multiple clinical trials have been conducted on its effectiveness, with the Proning Severe ARDS Patients landmark trial demonstrating a mortality benefit in patients with severe ARDS. As a result, expert consensus and societal guidelines now recommend using prone positioning for severe...

Invited Commentary  May 1, 2023 Xuebijing Injection for the Treatment of Sepsis: What Would a Path to FDA Approval Look Like? Ellis F. Unger, David B. Clissold JAMA Intern Med. Published online May 1, 2023. doi:10.1001/jamainternmed.2023.0788 Sepsis is a serious condition with high morbidity and mortality for which treatment advancements are desperately needed. In this issue of JAMA Internal Medicine, Liu et al1 describe the results...

Sequential Extracorporeal Therapy in Sepsis Sepsis and septic shock are significant causes of morbidity and mortality in critical care, with a complex and rapidly evolving clinical presentation. This involves microbial invasion, infection focus, immune response, circulating pathogen and pathogen products, immunodysregulation, organ damage, and multiple organ dysfunction. Extracorporeal therapies may be used to target specific molecules at different stages, includin...

Invited Commentary  March 27, 2023 Should We Add Fludrocortisone to Hydrocortisone for Treatment of Septic Shock? Michael A. Matthay, Issa J. Dahabreh, B. Taylor Thompson JAMA Intern Med. 2023;183(5):460-461. doi:10.1001/jamainternmed.2023.0257 Mortality for patients with septic shock is greater than 30% in most studies. The mechanisms that contribute to poor survival are primarily explained by the development of multiorgan failure from activ...