What did HALT-IT establish about tranexamic acid for gastrointestinal bleeding? This 2020 appraisal examines the lack of a mortality benefit and the increased venous thromboembolism and seizure signals, alongside questions about recruitment, treatment timing and the trial’s primary outcome.
JC: Halt! It’s not time for TXA! Or is it? HALT-IT results at St Emlyn’s Read More
An early June 2020 response to RECOVERY’s announcement that hydroxychloroquine had not shown benefit in hospitalised patients with COVID-19. Simon Carley explains the platform trial design and why the limited information released at that stage still required a full critical appraisal.
The RECOVERY platform trial: No benefit to Hydroxychloroquine in Covid-19. St Emlyn’s Read More
Could arginine vasopressin reduce blood-product requirements after major traumatic haemorrhage? This appraisal reviews a small single-centre randomised trial, examining reduced transfusion use alongside the lack of a demonstrated mortality benefit and the limits of applying its findings to a broader trauma population.
JC: AVP in Haemorrhagic Shock. St Emlyn’s Read More
A review of the January 2020 interim BSPED guidance on diabetic ketoacidosis in children and young people. Chris Gray explains changes to diagnosis, severity assessment, fluids, potassium and insulin, alongside the evidence and practical questions raised by that edition of the guidance.
JC: D-K-hoorAy! New Paeds DKA guidelines Read More
Did adding vitamin C and thiamine to hydrocortisone improve outcomes in septic shock? This 2020 VITAMINS appraisal examines a randomised comparison that found no improvement in its primary vasopressor-free-time outcome, while discussing the contrast with earlier observational claims and remaining questions about timing and patient selection.
A 2020 appraisal of PEPTIC, comparing proton pump inhibitors with H2 receptor blockers for stress-ulcer prophylaxis in intensive care. The review examines mortality and gastrointestinal bleeding outcomes, treatment crossover and competing interpretations of a large pragmatic trial whose clinical implications were debated.
JC: The PEPTIC study PPI vs H2RBs on the ICU. St Emlyn's Read More
A first look at the 65 trial as presented at Critical Care Reviews 2020. The review examines lower blood-pressure targets in older intensive care patients with vasodilatory hypotension, reduced vasopressor exposure and uncertainty around mortality, with a discussion of interpretation beyond statistical significance.
JC: The 65 trial. Targeting MAP in sepsis. St Emlyn's at #CCR20 Read More
A 2019 appraisal of rocuronium versus suxamethonium for prehospital rapid-sequence intubation. The review examines first-pass success, the interpretation of a non-inferiority trial and the limits of detecting rare complications, while considering how airway choices depend on the wider clinical setting and available resources.
JC: Rocuronium or Suxamethoniun for RSI. St Emlyn's Read More
