Summa’s Emergency Department Collaborates in National Trial to Establish Clinical Best Practice
Summa Health System’s Departments of Emergency Medicine and Internal Medicine participated in a NIH funded study to examine whether current standard of care or protocol based resuscitation strategies were more effective in treating patients in septic shock. This study, recently published in the New England Journal of Medicine, enrolled patients in 31 Emergency Departments across the United States. At Summa Akron City Hospital, Scott Wilber, M.D. , MPH, Interim Chair, Department of Emergency Medicine and Bradley Martin, M.D., Chair, Department of Internal Medicine, collaborated to lead the local effort.
The study compared two protocol based interventions relative to usual care. Both protocols required a standardized regiment for providing fluids and medications; one of the protocols also required placement of a central venous catheter which could monitor oxygen saturation near the heart. The primary outcome was rate of in-hospital death from any cause at 60 days and the study was adequately powered to find a clinically significant difference with a sample size of 1,341 patients divided among the three groups. The collaborative effort between the Department of Emergency Medicine and the Intensive Care Unit resulted in the enrollment of 31 patients at Summa.
As expected, more central lines were placed in patients on the protocol requiring a central line, and more fluid and medications were received by patients in both protocol groups. The two protocol based interventions led to a higher requirement for intensive care and renal-replacement therapy. Despite these differences, there were no significant differences in mortality among the three groups. All three groups of patients promptly received similar amounts of antibiotics and other required medications, indicating the usual care provided was of high quality and not improved by the addition of more procedures and medications. National studies such as these highlight the necessity for conducting rigorous trials to establish best practices.
Click here for article: ED Treatment for Early Septic Shock