🔥 Prothrombin Complex Concentrate vs Frozen Plasma for Coagulopathic Bleeding in Cardiac Surgery: The FARES-II Multicenter Randomized Clinical Trial | Bleeding and Transfusion | @JAMA | ⁦@JAMANetwork⁩ | #ACC25 🫀 jamanetwork.com/journals/jam…

I am a big fan of S’ for RV rather than estimates of sizes 🤔#peoplesventricle #RV 🫀 @siddharth_dugar @msiuba @Jose_Diaz_Gomez @saikatmitra05 @OKiamanesh @iamritu @ICUltrasonica @ArcherKMartin Future is strain imaging !! ? @strain_rate @pmgjones @pandompatam @nathanhwaldron

Responding to a tweet I’ll offer this VIDEOLARYNGOSCOPY PROBLEMS….and rebuttals ‘Unavailable’ -yes if you haven’t got it you can’t use it (resource constrained settings) -but in a high income setting unavailability of VL is an OPERATIONAL CHOICE ‘Failure’ -In the recent DEVICE study DL failed more often than VL ‘DL succeeds when VL fails’ -there are large case series of VL rescuing failed DL but none of the opposite -it uncommon at best (and dare I say it) when it occurs often due to poor VL technique ‘VL reduces DL skills’ -if this is true (and I’m not sure it is) I’m not sure it bothers me much, it is a very clinician focussed rather than patient-centred view (cf the LMA reduces FM skills, DL reduces blind nasal skills) -and VL of course is the best way to teach DL skills ‘Capnography more important’ -capnography is vital in determining correct/incorrect tube positioning but has nothing to do with the act of intubation ‘The burden of proof lies with those who want change’ -ok, that proof is widely published, it just needs to be implemented -if VL existed and DL was invented there is about zero chance anyone would adopt it DL is ‘tried and true’ -tell it to the families of patients who have died unnecessarily of oesophageal intubation (One more in NZ media last week, another in UK about to go to inquest) To counter the quote at the top of the slide (which once again is clinician-centred and hints at “heroic healthcare”) ‘Intubation is a potentially dangerous service we provide for our patients, which we should perform in the most effective, reliable and safe way we can. The evidence for each of those three goals lies with VL’ (happy to add refs if requested)