Vasopressors and Inotropes in Acute Myocardial Infarction Related Cardiogenic Shock: A Systematic Review and Meta-Analysis
JOURNAL OF CLINICAL MEDICINE
Authors: Karami, Mina; Hemradj, Veemal V.; Ouweneel, Dagmar M.; den Uil, Corstiaan A.; Limpens, Jacqueline; Otterspoor, Luuk C.; Vlaar, Alexander P.; Lagrand, Wim K.; Henriques, Jose P. S.
Abstract
Vasopressors and inotropes are routinely used in acute myocardial infarction (AMI) related cardiogenic shock (CS) to improve hemodynamics. We aimed to investigate the effect of routinely used vasopressor and inotropes on mortality in AMI related CS. A systematic search of MEDLINE, EMBASE and CENTRAL was performed up to 20 February 2019. Randomized and observational studies reporting mortality of AMI related CS patients were included. At least one group should have received the vasopressor/inotrope compared with a control group not exposed to the vasopressor/inotrope. Exclusion criteria were case reports, correspondence and studies including only post-cardiac surgery patients. In total, 19 studies (6 RCTs) were included, comprising 2478 CS patients. The overall quality of evidence was graded low. Treatment with adrenaline, noradrenaline, vasopressin, milrinone, levosimendan, dobutamine or dopamine was not associated with a difference in mortality between therapy and control group. We found a trend toward better outcome with levosimendan, compared with control (RR 0.69, 95% CI 0.47-1.00). In conclusion, we found insufficient evidence that routinely used vasopressors and inotropes are associated with reduced mortality in patients with AMI related CS. Considering the limited evidence, this study emphasizes the need for randomized trials with appropriate endpoints and methodology.
Primary wound care in children
THERAPEUTISCHE UMSCHAU
Authors: Scherer, Cordula; Berger, Steffen
Abstract
Successful wound care of infants and children is facilitated by good preparation and a calm atmosphere.There is not only the child as a patient but also the parents, with their fears and concerns. The physician has to take care of both of them. Parent and child should be informed about the therapeutic intervention appropriately. Reassuring of the child and distraction from the procedure are as important as the treatment itself (e.g. wound stitching or application of wound dressing). Topical anesthesia with LET Get (lidocain, epinephrine, tetracaine), non-stinging methods to clean the wound (NaCl 0,9 %/ Polyhexanid (Prontosan (R)) soaked swabs) and intranasal application of fentanyl/dormicum can be used to avoid fear and pain. Sedation is used deliberately in small children for wound care. Laceration wounds, mainly those affecting the scalp, chin or forehead can be treated in the emergency room without general anesthesia. Extensive wounds, burns and animal bites often require wound care under anesthesia in children.