If one is good, two must be better, right? If it applies to cookies and ice cream, why not defibrillators? That’s the question the DOSED-VF trial set out to answer. We’ve covered this topic in episodes 12 and 27, including going over the pilot trial of DOSED-VF. But now the full meal deal is available. And you may have heard it was stopped early because… well, you’d best listen to find out. 
And, as a special bonus, Dr. Jarvis explains the difference between odds and risk after he fell off into the statistical rabbit hole. 

Remember, this podcast also has a YouTube version complete with graphs and charts (oh, my!): 
https://www.youtube.com/@FlightbridgeedHEMS/playlists

Citation:
1. Cheskes S, Verbeek PR, Drennan IR, et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022;387(21):1947-1956. doi:10.1056/NEJMoa2207304

Other papers discussed in this episode:
2. Mapp JG, Hans AJ, Darrington AM, et al. Prehospital Double Sequential Defibrillation: A Matched Case–Control Study. Braithwaite SA, ed. Academic Emergency Medicine. 2019;26(9):994-1001. doi:10.1111/acem.13672
3. Beck LR, Ostermayer DG, Ponce JN, Srinivasan S, Wang HE. Effectiveness of Prehospital Dual Sequential Defibrillation for Refractory Ventricular Fibrillation and Ventricular Tachycardia Cardiac Arrest. Prehosp Emerg Care. 2019;23(5):597-602. doi:10.1080/10903127.2019.1584256
4.Cabanas JG, Myers JB, Williams JG, De Maio VJ, Bachman MW. Double Sequential External Defibrillation in Out-of-Hospital Refractory Ventricular Fibrillation: A Report of Ten Cases. Prehosp Emerg Care. 2015;19(1):126-130. doi:10.3109/10903127.2014.942476
5. Cheskes S, Dorian P, Feldman M, et al. Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial. Resuscitation. 2020;150:178-184. doi:10.1016/j.resuscitation.2020.02.010
6. Ranganathan P, Aggarwal R, Pramesh C. Common pitfalls in statistical analysis: Odds versus risk. Perspect Clin Res. 2015;6(4):222. doi:10.4103/2229-3485.167092See omnystudio.com/listener for privacy information.

EMS LHP EP67 - DOSED-VF

Dr. Crowe returns to the EMS Lighthouse Project Podcast from our “vacation” in Mexico to discuss the impact of variations between pulse oximetry and blood gas values across races.
 
Citation:

Sudat SEK, Wesson P, Rhoads KF, et al. Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course. Am J Epidemiol. Published online September 2022:kwac164. doi:10.1093/aje/kwac164
Fawzy A, Wu TD, Wang K, et al. Racial and Ethnic Discrepancy in Pulse Oximetry and Delayed Identification of Treatment Eligibility Among Patients With COVID-19. JAMA Intern Med. 2022;182(7):730. doi:10.1001/jamainternmed.2022.1906

 
 See omnystudio.com/listener for privacy information.

EMS LHP Episode 65: SpO2 vs SaO2 Variations Between Races

National guidelines for the management of seizures recommend midazolam 10 mg IM as first line therapy. The big question is how often EMS follows this guideline or how well that guideline matches up to real world use. Dr. Jarvis makes a road trip to ESO headquarters to discuss this paper using the ESO research dataset with newly minted Texan Mike Verkest and special guest Dr Remle Crowe. We go deep on the very interesting methodology used in this paper as we get our nerd on!
Citation:
Guterman EL, Sporer KA, Newman TB, et al. Real-World Midazolam Use and Outcomes With Out-of-Hospital Treatment of Status Epilepticus in the United States. Annals of Emergency Medicine. Published online August 2022.  

doi:10.1016/j.annemergmed.2022.05.024See omnystudio.com/listener for privacy information.

Real World Midazolam Use In Seizures

First, there was Episode 31: TXA for Epistaxis (the Zahed RCT from Tehran), then there was Episode 40: TXA for Epistaxis, Part Deux (the NoPAC trial), now there's Episode 64: TXA for Epistaxis, Part Trois, another Iranian RCT.
So... we have conflicted evidence, all from RCTs, about whether TXA works for epistaxis. Dr. Jarvis goes through the prior trials and then gives a more detailed look at the new evidence. He closes by talking about how he handles conflicting evidence.

Citation:
Hosseinialhashemi M, Jahangiri R, Faramarzi A, et al. Intranasal Topical Application of Tranexamic Acid in Atraumatic Anterior Epistaxis: A Double-Blind Randomized Clinical Trial. Annals of Emergency Medicine. 2022;80(3):182-188. doi:10.1016/j.annemergmed.2022.04.010See omnystudio.com/listener for privacy information.

EMS LHP Episode 64: TXA for Epistaxis, Part Trois

Description: COVID sucks, no doubt about it. Vaccination has been a game changer for how we live through the pandemic, but we still need therapeutics for those breakthrough cases and the unvaccinated amongst us. Paxlovid is a novel anti-viral agent that showed promise in an initial industry-sponsored trial among unvaccinated patients with the delta strain. But does it hold up in the real world where vaccination is common, and omicron has pushed delta to the wayside? Dr. Jarvis reviews the initial RCT and a recent Israeli observational trial where more than 75% of patients were vaccinated. He also covers the contraindications for its use. Finally, he’ll no doubt massacre the almost impossible-to pronounce generic names for the drugs in Paxlovid.
Citations.

1. Najjar-Debbiny R, Gronich N, Weber G, et al. Effectiveness of Paxlovid in Reducing Severe Coronavirus Disease 2019 and Mortality in High-Risk Patients. Clinical Infectious Diseases. Published online June 2, 2022:ciac443. doi:10.1093/cid/ciac443
2.Hammond J, Leister-Tebbe H, Gardner A, et al. Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19. N Engl J Med. 2022;386(15):1397-1408. doi:10.1056/NEJMoa2118542See omnystudio.com/listener for privacy information.

EMS LHP - E63 - Unpacking Paxlovid

Our good friends at Montgomery County Hospital District EMS in suburban Houston brings us a nice feasibility study about the use of esmolol for refractory v-fib. Dr. Jarvis discusses why this is a helpful study. If you like the show, please give us a 5-star rating wherever you get your podcasts. Did you know our podcast is on YouTube, too? Check us out and subscribe on the FlightBridgeED channel. Drop us questions/comments/suggestion for future pods at: Jeff.jarvis@flightbridgeed.com @DrJeffJarvisSee omnystudio.com/listener for privacy information.

EMS LHP - E62 - Esmolol in cardiac Arrest?

Dr. Jarvis interviews several EMS industry leaders discussing why we should use Red Lights & Sirens as a clinical intervention and only as indicated. This podcast is part of the first-ever national EMS quality improvement effort led by NEMSQA (https://www.nemsqa.org/lights-and-siren)Join us for interviews with Drs. Doug Kupas, Lawrence Brown, Michael Redlenner, and Mike Taigman to hear about The Case Against Lights & Sirens. Did you know all of our podcasts are also available as in video versions? Check them out on the FlightbridgeED YouTube channel.See omnystudio.com/listener for privacy information.

EMS LHP Episode 61: Red Lights & Sirens Collaborative

I got a great question during my FAST22 talk about what to make of two different papers, seemingly on the same topic, that give different results. In this case, it was about the Prague study Mike and I spoke about on the last episode (E59) and the one from Minneapolis (The ARREST trial). It was a great question that’ll I’ll discuss in this episode. I’ll also talk more about the ARREST trial.
If you like the show, please give us a 5-star rating wherever you get your podcasts. 

Did you know our podcast is on YouTube, too? Check us out and subscribe on the Flightbridgeed channel.

Drop us questions/comments/suggestion for future pods at:
Jeff.jarvis@flightbridgeed.com
@DrJeffJarvisSee omnystudio.com/listener for privacy information.

EMS LHP – Episode 60 – Dueling ECMO Papers

Mikey V and Dr. Jarvis get together again, “live” from Planet Hollywood at Las Vegas for FAST22! We took the opportunity to sit down and discuss two papers on cardiac arrest. Should we stay and play or should we load and go? In other words, should we work our arrests to conclusion where we find them or rapidly transport them? In a paper from Prague, we discuss whether early transport with LUCAS direct to cath lab for ECMO and PCI improves survival.As a foretaste of a pod to come, we’ll discuss the apparent contrasting results between the Prague ECMO study and one from Minneapolis (The ARREST trial) in a future episode. If you like the show, please give us a 5-star rating wherever you get your podcasts. Did you know our podcast is on YouTube, too? Check us out and subscribe on the FlightBridgeED channel. Drop us questions/comments/suggestion for future pods at: Jeff.jarvis@flightbridgeed.com @DrJeffJarvisSee omnystudio.com/listener for privacy information.

LHP E59 - Cardiac Arrest Transport & ECMO

Y’all have had lots of questions about using sodium bicarbonate in cardiac arrest after we ran an interview with Dr. Menegazzi talking about an abstract he presented showing benefit with bicarb. You wanted more so here it is! Dr. Jarvis reviews a paper from British Columbia from 2017 that looks at just this thing!
If you like the show, please give us a 5-star rating wherever you get your podcasts.Did you know our podcast is on YouTube, too? Check us out and subscribe on theFlightbridgeed channel.
Drop us questions/comments/suggestion for future pods at:Jeff.jarvis@flightbridgeed.com@DrJeffJarvis
Citations:1. Kawano T, Grunau B, Scheuermeyer FX, et al. Prehospital sodium bicarbonate use could worsen long term survival with favorable neurological recovery among patients with out-ofhospital cardiac arrest. Resuscitation. 2017;119:63-69. doi:10.1016/j.resuscitation.2017.08.008See omnystudio.com/listener for privacy information.

EMS LHP – Episode 57 – Bicarb Use In Cardiac Arrest?

Join us for a joint release of the first episode of The Pediatric EMS Podcast. We collaborate with the great folks from the PEC podcast, and MedicMindset to introduce this new podcast. We discuss assessment and management of pediatric pain.See omnystudio.com/listener for privacy information.

LHP - E58 - Pediatric Pain

Do y'all treat a-fib? Have you wondered what the best method of rate control is? Should you use diltiazem or metoprolol? How about the best pad placement for electrical Cardioversion? Should you go anterior posterior or anterior lateral? Great questions! Dr. Jarvis reviews two recent papers to help shed the bright light of science on these two questions.See omnystudio.com/listener for privacy information.

EMS LHP – Episode 56 – Atrial Fibrillation Treatment

We’re back with the second part of our interviews with researchers from NAEMSP 2022 conference in San Diego. In this episode, Dr. Jarvis interviews Dr. Brian Miller from Fort Worth, Texas about his work on “MCD Walk”, ie the case of the migratory Lucas device, Dr. Sarah Frances McClure from UT San Antonio about the impact of EMS leadership engagement on a medic’s decision to get vaccinated against COVID-19, and finally Dr. Jim Menegazzi from Pitt about sodium bicarb in EMS Witnessed cardiac arrest.
Abstracts:
“MCD Walk” – Mechanical Compression Device Migration Leading to Inadequate Compression Depth.
Kerby Johnson, BS, NRP
William Gleason, BS, LP
Brian Miller, MD, FACEP, FAEMS
Veer Vithalani, MD, FACEP, FAEMS
Office of the Medical Director, Metropolitan Area EMS Authority, Fort Worth, Texas
 
EMS Leadership Presence Positively Influences EMS Provider’s Decision to Receive the COVID-19 Vaccine
Sarah Frances McClure, DO, FAWM, NRP
Bryan Everitt, MD, NRP
Mark Sparkman, MD
David Wampler, PhD, LP
Courtney Wenzell, EMT-P
University of Texas Health Science Center at San Antonio, Dept of Emergency Medicine & San Antonio FD
 
Sodium Bicarbonate Use in EMS-Witnessed Out-of-Hospital Cardiac Arrest
Sara M. Niederberger
Remle Crowe, PhD, EMT
David D. Salcido, PhD
James J. Menegazzi, PhD
University of Pittsburgh School of Medicine, Dept of Emergency Medicine, & ESO
 
If you like the show, please give us a 5-star rating wherever you get your podcasts.
 
Did you know our podcast is on YouTube, too? Check us out and subscribe on the Flightbridgeed channel.
 
Drop us questions/comments/suggestion for future pods at:
Jeff.jarvis@flightbridgeed.com
@DrJeffJarvisSee omnystudio.com/listener for privacy information.

EMS LHP – Episode 55 – Research from NAEMSP 2022 – Part 2

NAEMSP in Sunny San Diego… Just. SO. MUCH. GREAT. RESEARCH. Dr. Jarvis interviewed a small sample of the great work presented. There was so much we broke it into two parts. This episode features interviews with Dr. Amber Rice from Tucson, Arizona discussing a secondary analysis of the EPIC trial looking further into the impact of hypotension on TBI, Dr. Veer Vithalani from MedStar in Fort Worth, TX discussing how he used his CAD and ePCR data to determine which calls could safely get a BLS response, Dr. Erin Lincoln from Austin discussing her work on disparities in analgesia, and Dr. Henry Wang on his latest secondary analysis of the PART trial, this one looking at the impact of airway type (LT or ET) on ventilatory rates.See omnystudio.com/listener for privacy information.

Episode 54 – NAEMSP Research Part I

Are you still giving Calcium in undifferentiated cardiac arrests? Not those with hyperkalemia or hypocalcemia… you know, when it’s actually indicated. Be honest, now… Nobody’s looking. If you are, join us for this episode where we review a randomized, double-blind, placebo-controlled clinical trial of calcium vs placebo in out-of-hospital cardiac arrest.See omnystudio.com/listener for privacy information.

EMS Lighthouse Project Podcast: Episode 53 - Calcium in Out of Hospital Cardiac Arrest

Do you even bougie, bro? Do you use the bougie on every intubation? If so, why? Do you think it improves first pass success? Well, I certainly did. At least before this trial was released. Join me to discuss this randomized controlled trial of bougie vs no bougie for intubation. I suspect the results will surprise you!See omnystudio.com/listener for privacy information.

Episode 52 – The BOUGIE Trial

Dr. Jarvis and Mike Verkest return for part 2 of our interviews with some of the great researchers at the Prehospital Care Research Forum at EMS Expo in Atlanta. In this episode, we interview: Kevin Collopy on his RCT comparing ketamine and etomidate for RSI, Sean McAllister on Sepsis using the ESO dataset, and  David Page about PCRF and his work on comparing Mexican and American EMT training. If you like the show, please give us a like on YouTube and a 5-star rating wherever you get your podcasts.See omnystudio.com/listener for privacy information.

Episode 51 – Abstracts from PCRF at EMS Expo 2021 - Part 2

Dr. Jarvis and Mike Verkest were at EMS Expo in Atlanta. We recorded some interviews from the FlightbridgeED booth on the exhibit floor and then discussed them when Mike stopped by the Casa Jarvis in Austin a bit later. There was so much goodness, we broke it up into two different episodes to keep these at a reasonable length.See omnystudio.com/listener for privacy information.

Episode 50 – PCRF Research Abstracts from EMS Expo – Part I

Ketamine has been getting a lot of attention recently in the media. Its probably safe to say it’s had a bad year. We like ketamine. We felt bad it’s been having a rough year so we wanted to do something that would lift its spirits. Fortunately, Dr. David Barbic and his colleagues from Vancouver, BC published a wonderful, randomized trial comparing ketamine to a combination of haloperidol plus midazolam for undifferentiated agitation in the ED. This was the amazingly titled RACKED trial (Rapid Agitation Control with Ketamine in the ED). It has direct and important implications for EMS and is something all emergency providers should know about. Dr. Jarvis reviews the trial and then invites Dr. Barbic himself on the show to discuss this study. If you like the show, please give us a like on YouTube and a 5-star rating wherever you get your podcasts.See omnystudio.com/listener for privacy information.

Episode 49 – The RACKED Trial, with Dr. Barbic

Mike and Jeff get together to discuss some airway papers from the National Emergency Airway Registry (NEAR) and float an idea for some merch. If you like the show, please give us a like on YouTube and a 5-star rating wherever you get your podcasts. Drop us questions/comments/suggestion for future pods at: Jeff.jarvis@flightbridgeed.com, @DrJeffJarvis, or Mike.Verkest@flightbridgeed.com, @MikeVerkestSee omnystudio.com/listener for privacy information.

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