Alejandro C. Arroliga M.D.

White, H. D., S. Ghamande and A. C. Arroliga (2017). “Therapeutic hypothermia for acute respiratory distress syndrome.” Crit Care Med 45(11): e1202-e1203.

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In a recent issue of Critical Care Medicine, Slack et al (1) published findings of a pilot feasibility study focused on the usage of therapeutic hypothermia (TH) for moderate to severe acute respiratory distress syndrome (ARDS). Patients treated with TH in their study (1) were more likely to survive compared with historic controls with a similar level of severity. We applaud Slack et al (1) for shinning new light on this application of TH. Despite progress in treatment of ARDS, morbidity and mortality of this disease remain substantial, and development of new treatment approaches is necessary (2).

White, H. D., B. A. A. White, S. Ghamande and A. C. Arroliga (2017). “Combining efforts for positive progress in the graduate medical education match process.” Ann Am Thorac Soc 14(8): 1357-1358.

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Candidate selection for any job is a daunting task fraught with subjectivity. To date, an objective, validated application and interview tool with universal applicability does not exist within graduate medical education. However, in a recent issue of the AnnalsATS, Bosslet and colleagues (1) published results of a scoring tool designed to objectively weigh components of the electronic application and attributes displayed during the interview, revealing strong correlations between this tool and traditional fellowship ranking methodology. Also published in that issue of the journal, Tatem and colleagues (2) evaluated the implementation of behavioral-based interviewing within medical education. We applaude Bosslet and Tatem and their colleagues for their contribution in this realm.

Hayek, A. J., H. D. White, S. Ghamande, C. Spradley and A. C. Arroliga (2017). “Is therapeutic hypothermia for acute respiratory distress syndrome the future?” J Intensive Care Med 32(7): 460-464.

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INTRODUCTION: Severe acute respiratory distress syndrome (ARDS) has a high mortality, and there is limited knowledge about management of severe ARDS refractory to standard therapy. Early evidence suggests that therapeutic hypothermia (TH) could be a viable treatment for acute respiratory failure. We present 2 cases where TH was successfully used to manage refractory ARDS on extracorporeal membrane oxygenation (ECMO) and a review of the literature around TH and acute respiratory failure. RESULTS: We present 2 cases of ARDS secondary to H1N1 influenza and human metapneumovirus. Both patients were treated with the current evidence-based therapy for ARDS. Venovenous ECMO was used in both patients for refractory hypoxemia. Therapeutic hypothermia was applied for 24 hours with improved oxygenation. We did a review of the literature summarizing 38 patients in 10 publications where TH was successfully utilized in the treatment of acute respiratory failure. CONCLUSION: Therapeutic hypothermia may be a viable salvage therapy for ARDS refractory to the current evidence-based therapy but needs further evaluation.

Garmon, E. H., E. M. Stock, A. C. Arroliga and J. D. Bean-Lijewski (2017). “Effects of training on resident physician emergency airway management skills.” Can J Anaesth 64(7): 777-779.

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Emergency airway management is necessary when patients develop acute cardiopulmonary failure. Early intubation prevents hypoxemia from a poor bag-mask seal, but multiple intubation attempts increase the risk of complications.1, 2, 3 The Canadian Airway Focus Group summarizes the adverse effects associated with multiple intubation attempts in Table 3 of their 2013 publication on difficult tracheal intubation in the unconscious patient.4 Highly trained residents in supervised intensive care settings have previously been studied. 1, 2, 3

Garmon, E. H., E. M. Stock, A. C. Arroliga and J. D. Bean-Lijewski (2017). “Effects of training on resident physician emergency airway management skills.” Can J Anaesth: 2017 Feb [Epub ahead of print].

Full text of this article.

Emergency airway management is necessary when patients develop acute cardiopulmonary failure. Early intubation prevents hypoxemia from a poor bag-mask seal, but multiple intubation attempts increase the risk of complications.1, 2, 3 The Canadian Airway Focus Group summarizes the adverse effects associated with multiple intubation attempts in Table 3 of their 2013 publication on difficult tracheal intubation in the unconscious patient.4 Highly trained residents in supervised intensive care settings have previously been studied. 1, 2, 3