EM Quick Hits 27 Colchicine for COVID, Bicarb in Cardiac Arrest, Troponin in CKD, GHB Withdrawal, Iloprost for Frostbite, Patient Complaints

Topics in this EM Quick Hits podcast Justin Morgenstern on colchicine for COVID pneumonia (0:52) Victoria Myers on sodium bicarbonate in cardiac arrest (6:25) Brit Long on troponin in chronic kidney disease (14:06) Michelle Klaiman on GHB withdrawal management (21:00) Ian Walker on iloprost for frostbite (26:46 ) Sarah Reid on tips on preventing patient and parent complaints (33:54) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Brit Long, Michelle Klaiman, Ian Walker and Anton Helman Cite this podcast as: Helman, A. Klaiman, M. Long, B. Walker, I. Myers, V. Reid, S. Morgenstern, J. EM Quick Hits 27 - Colchicine for COVID, Bicarb in Cardiac Arrest, Troponin in CKD, GHB Withdrawal, Iloprost for Frostbite, Patient Complaints. Emergency Medicine Cases. March, 2021. https://emergencymedicinecases.com/em-quick-hits-march-2021/. Accessed [date]. Colchicine for COVID - COLCORONA RCT * Design - COLCORONA is an RCT that enrolled 4488 patients age > 40, with either PCR confirmed or clinical criteria for COVID pneumonia and one of the following high-risk criteria: age >70, obesity, diabetes, uncontrolled hypertension, known respiratory disease, known heart failure, known coronary disease, fever of at least 38.4°C within the last 48 hours, dyspnea at the time of presentation, bicytopenia, pancytopenia, or the combination of high neutrophil and low lymphocyte counts; patients were randomized to either colchicine 0.5mg bid x 3 days, then once daily x 27 days or placebo * Outcome was a composite of death OR hospitalization due to COVID * Results - no significant difference in death; no significant difference in hospitalization, no significant difference in mechanical ventilation; however, intention to treat analysis: Odds ratio of protection from death OR hospitalization: , 0.79 (95% CI 0.61 to 1.03); Prespecified subgroup analysis: PCR confirmed cases only: Odds ratio of protection from death from hospitalization, 0.75 (95% CI, 0.57 to 0.99), mostly driven by prevention of hospitalization; patients on colchicine had significant side effects (eg., GI bleed) and increased rates of pneumonia and PE * Problems with this trial * Trial stopped early (not because of major harm or significant benefit), because of difficulty recruiting patients, and may be underpowered * The odds ratio crosses 1 therefore there is no clear protective benefit from colchicine * Conclusion - There is presently no role for colchicine for COVID-19 in ambulatory patients with high risk factors Expand to view reference list * Tardif J-C, Bouabdallaoui N, L’Allier PL., et al. Efficacy of Colchicine in Non-Hospitalized Patients with COVID-19. Infectious Diseases (except HIV/AIDS); 2021. IV Sodium Bicarbonate in Cardiac Arrest * Administration of sodium bicarbonate in cardiac arrest is likely to increase serum pH (which is generally lower the longer a patient is in cardiac arrest), however it does not lower serum potassium as is commonly believed, and it adds a potentially detrimental sodium and volume load as well as shifts the oxygen-Hb curve and decrease serum calcium; it ...