TTM and ECMO – How low should you go?

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TTM and ECMO – How low should you go?

In 2002, two landmark clinical trials published back-to-back in the New England Journal of Medicine (Bernard and HACA), building upon animal models that showed a neuroprotective benefit to hypothermia after cardiac arrest, set the bar for post-cardiac arrest care in the new millennium. Practice patterns changed rapidly as intensivists and hospital systems attempted to replicate their results, with greater than 50% of their patients in the 33C hypothermia arm of each trial achieving a good neurological outcome.

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CVC Confirmation using POCUS

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CVC Confirmation using POCUS

Central venous catheters (CVCs) are widely used in the resuscitation and treatment of critically ill and injured patients. Standard practice necessitates verification of line placement when inserted above the diaphragm. This has traditionally been accomplished in most institutions by use of post-insertion chest radiography, which will both identify the tip of the catheter at the cavoatrial junction and rule out pneumothorax ipsilateral to the insertion site.

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Retained Hemothorax: An Unusual Case

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Retained Hemothorax: An Unusual Case

Traumatic hemothorax occurs frequently, with up to 300,000 cases occurring yearly in the United States.1  In cases of polytrauma, head and chest injuries frequently occur together,2 and thus it is important for all neurointensivists who see TBI to understand management of common traumatic chest injuries, including hemothorax.  While some small hemothoraces (<300cc’s) can be monitored clinically,3 standard of care for most large traumatic hemothoraces is rapid tube thoracostomy. 

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