The Talks | scanFOAM

Can we use the Sgarbossa Criteria? Below you’ll find what’s most likely (and hopefully) the silliest, catchiest and nerdiest talk on this topic recorded at the ECG masterclass from SWEETS2019. In it, Jonathan Ilicki, Alex Szeps and Elena Sgarbossa delve into how we best assess these patients. Here, first, is a bit more detail.

The Sgarbossa Criteria are three ECG rules that were developed by Dr Sgarbossa in 1996:

3 or more points has been shown to be highly specific (98%) for ACS in patients with LBBB​[1]​. Life on the Fast Lane has a great ECG database with a page about the Sgarbossa criteria.

There is limited research (key articles below​[2–7]​), but what has been published to date indicates the criteria are very specific, but not sensitive for ACS in patients with VPR​[8]​ (open access here).

Amal Mattu has a great ECG resource called ECG Weekly. Here is an episode where he discusses using the Sgarbossa Criteria for Ventricular Paced Rhythm.

Interestingly, the Smith-modified Sgarbossa Criteria have recently been shown to have superior sensitivity and specificity to the original criteria​[9]​. It wasn’t included in the presentation as it’s tricky to fit the phrase “Smith-modified Sgarbossa Criteria” into a song…

Dr Smith is an ECG wizard (and also a really nice guy) and has a great blog entirely focused on how to get better at assessing ECGs. Here are a couple of posts on assessing for ACS/ACO in ECGs with VPR:

This is the talk by Richard Lyon at The Bick Sick in Zermatt, 2018.

Richard goes over initiatives taken to improve what were dismal outcomes in Scotland in the out-of-hospital cardiac arrest population. Tune in to hear about the marginal gains approach applied with attention to every little detail. Learn how to improve your clinical audit data to allow feedback to the clinicians and how to lead the way forward in your own organisations and communities. Finally, some thoughts on how new and upcoming technology can be harnessed to provide even better care for this patient group.

Dr. Lyon is a consultant in emergency medicine and clinical lead for Medic1 at the Royal Infirmary of Edinburgh. He is associate medical director of Kent, Surrey & Sussex Air Ambulance and chair or Pre-hospital Emergency Care at the University of Surrey. Born in Luxembourg, he became a volunteer fireman at the age of 15 and developed an early passion for pre-hospital emergency care. He completed a unique doctorate thesis on out-of-hospital cardiac arrest (OHCA) – the TOPCAT study, which has formed the basis of a successful programme of work to improve outcome from OHCA across Scotland. He is active in resuscitation and trauma research and was proud to be part of the winning BMJ Awards Emergency Medicine Team of the Year. He has won numerous national and international awards for his work and in 2017 was awarded an MBE in Her Majesty The Queen’s Birthday Honours for services to emergency healthcare.

Find him here

This is James DuCanto‘s talk at the airway session of The Bick Sick in Zermatt, 2018.

Jim is well known in the FOAM sphere and beyond for his passion on airway management and is a very dedicated and ingenious inventor of equipment for airway simulation and airway management. Jim is tinkerer of epic proportions and is always great fun to hang out with as there’s bound to be some new crazy contraption he wants to show off. I for one personally feel his beeryngoscope[icon name=”trademark” class=”” unprefixed_class=””] deserves a lot more recognition (no, I don’t think it’s trademarked yet, but it ought to be). Here it is out in the wild at #smaccUS.

On a more serious note, in recent years Jim has focused a lot of energy on the SALAD concept (Suction Assisted Laryngoscopy Airway Decontamination) which essentially is continuous large bore catheter suctioning of the upper airway through the whole intubation process. He has demonstrated it at numerous conferences throughout the world including at iterations of SMACC. The amount of flights cases he drags around the world for his SALAD teaching is quite insane and a testiment to Jim’s no holds barred approach to airways. If you get a chance to try it out do take it as it’ll probably be your one shot at intubating a regurgitating wookie with a laryngoscope blade fitted to an axe.

Follow Jim down the rabbit hole of contaminated airways in this talk.

Mostly from Jim’s slide set

Geir Strandenes’ talk at The Bick Sick in Zermatt, 2018.

Geir does a tour de force on blood transfusion, its history, physiology, the evidence base and ongoing developments in prehospital transfusion practice in both civilian and military settings. He specifically adresses how to apply principles of damage control resuscitation to remote locations and the introduction of fresh whole blood prehospitally from the point of injury onward.

Geir represents the THOR network (Trauma Hemostasis and Oxygenation Research network). You can find a lot more information on their website.

The Big Sick conference in february 2018 was a hugely rewarding, small-format conference that brought resuscitation nerds together in the perfect setting of Zermatt, Switzerland. Top speakers and top talks, but the conference was a total blast not least because the group of delegates was very sociable and interested in learning from each outside the sessions as much as during them.

Other commitments have postponed editing, but the talks are now getting ready to go online and we hope you’ll find the content was worth the wait.

We will release talks intermittently these next few months awaiting the next installment in february 2019.

Here first is a talk by prof. Samuel Tisherman from Baltimore’s shock trauma center on deep hypothermia as a means to buying time in refractory traumatic cardiac arrest. He describes the history of how this therapy was developed from early animal models up until the current human EPR-CAT trial.