EMOttawa - Emergency Medicine Ottawa

Landmark Series
Quant EC, et. al 2009;339:b3354.
Methods: 4/5 
Usefulness: 4/5

Article Link

This high quality meta-analysis
demonstrated that the addition of antivirals to steroids did not result in any additional benefit in achieving at least partial facial muscle recovery for Bell's palsy when compared to steroids alone. JC attendees noted that these conclusions were in contrast to a previously reviewed meta-analysis which came to the opposite conclusion. It was felt that this meta-analysis combined higher quality and more population homogeneous studies that supported the results. It is possible that antivirals may benefit patients with severe facial paralysis but further evidence is required to confirm the trend in this subgroup.

Landmark Series
Mayer SA, Brun NC, Begtrup K, Broderick J, Davis S, Diringer MN, et al. N Engl J Med. 2008 May 15;358(20):21
27–37. 
Article Link

This industry sponsored, international multicentre RCT involved 841 patients with acute ICH and found that Factor VII was associated with a reduced growth in hematoma size but no improvement in survival or function and an increase in arterial serious adverse events. There appears to be no role for Factor VII in acute ICH.

Landmark Series
Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, et al. N Engl J Med. 2008 Jan.10;358(2):111–24.

Article Link

This European multicentre RCT compa
red hydrocortisone to placebo for 499 ICU patients with septic shock and found no difference in mortality despite quicker resolution of shock with hydrocortisone; the hydrocortisone patients had more episodes of superinfection including new sepsis. This landmark trial suggests no advantage and possible harm from routine use of hydrocortisone for septic shock.