Clinical Q, Primary Outcome, Bottom Lines: 1)ACS, 2)AKI

Question 1

IABP-SHOCK II Clinical Question

Answer 1

In patients with acute MI complicated by cardiogenic shock, does an intraaortic balloon pump (IABP) reduce mortality?

Question 2

IABP-SHOCK II Bottom Line

Answer 2

In patients with acute MI complicated by cardiogenic shock, there was no difference in 30-day mortality with IABP placement.

Question 3

IABP-SHOCK II Primary End Point

Answer 3

30-day mortality

Question 4

SHOCK Clinical Question

Answer 4

Among patients who developed cardiogenic shock during acute MI, what are the benefits of early revascularization compared to initial medical stabilization on mortality?

Question 5

SHOCK Bottom Line

Answer 5

• Compared to initial medical stabilization, early revascularization was associated with a nonsignificant trend towards improved survival at 30 days among patients who developed cardiogenic shock during acute MI. However, early revascularization did confer a significant benefit by 6 months.
• SHOCK trial cohort demonstrated the benefit or revascularization at 1 and 6 years, suggesting that the benefit of revascularization persisted for years.

Question 6

SHOCK Primary outcome

Answer 6

30-day mortality

Question 7

AKIKI clinical question

Answer 7

Among ICU patients with AKI, does early renal replacement therapy (RRT) reduce mortality as compared to delayed RRT

Question 8

AKIKI bottom line

Answer 8

Among ICU patients with AKI, there is no mortality difference between early or delayed RRT.

Question 9

AKIKI primary outcome

Answer 9

overall survival at day 60.

Question 10

ATN Clinical Question

Answer 10

In critically ill patients with acute tubular necrosis, does more intensive renal replacement therapy decrease the risk of death at 60 days compared to conventional less-intensive renal replacement therapy?

Question 11

ATN bottom line

Answer 11

In critically ill patients with acute tubular necrosis, more intensive renal replacement therapy does not improve all-cause mortality at 60 days compared to conventional less-intensive therapy. In the ATN study, intensive RRT did not improve renal function or nonrenal organ dysfunction, although it was associated with more frequent hypotensive episodes

Question 12

ATN primary outcome

Answer 12

All-cause mortality at 60 days

Question 13

IDEAL-ICU Clinical Question

Answer 13

Among ICU with septic shock and AKI without urgent need for dialysis, does an initiation of renal replacement therapy (RRT) using an early-initiation strategy reduce all-cause mortality at 90 days when compared to a delayed-initiation strategy?

Question 14

IDEAL-ICU Bottom Line

Answer 14

Among ICU with septic shock and AKI without urgent need for dialysis, there was no difference in 90-day all cause mortality when comparing early-initiation vs. delayed-initiation RRT strategies. Overall use of RRT was lower in the delayed-initiation strategy group.

Question 15

IDEAL-ICU Primary outcome

Answer 15

Death from any cause at 90 days after randomization

Question 16

SALT-ED Clinical Q

Answer 16

Among noncritically ill adult patients in the ED, does fluid management with balanced crystalloid result in earlier hospital discharge compared to isotonic crystalloids

Question 17

SALT-ED Bottom Line

Answer 17

Among non-critically ill ED patients, initial fluid resuscitation with balanced crystalloids (Lactated Ringer’s or Plasma-Lyte) does not reduce duration of hospitalization when compared to the isotonic crystalloid, normal saline. However, balanced crystalloid use is associated with a reduction in major kidney-related events.

Question 18

SALT-ED Primary Outcome

Answer 18

Hospital-free days to day 28 (Composite)