Emergency & Critical Care Guidelines

American Heart Association

LANDMARK GUIDELINES: Comprehensive update to resuscitation science including new recommendations on compression quality, early defibrillation, and post-cardiac arrest care

New England Journal of Medicine / European Multicenter RCT

LANDMARK TRIAL (n=1,900): Hypothermia at 33°C did NOT improve outcomes vs targeted normothermia at 37.5°C in comatose post-cardiac arrest patients. Changed practice from routine hypothermia.

New England Journal of Medicine / Resuscitation Outcomes Consortium

LANDMARK TRIAL (n=3,026): First head-to-head comparison of amiodarone vs lidocaine for shock-refractory VF/pVT cardiac arrest. Amiodarone showed trend toward better survival to discharge.

Resuscitation Journal / International Evidence Review

Comprehensive systematic review establishing ETCO₂ as the most reliable real-time CPR quality indicator and prognostic tool during cardiac arrest resuscitation.

American Heart Association

Updated PALS guidelines emphasizing high-quality CPR, early recognition of respiratory failure, and age-appropriate interventions based on comprehensive evidence review

American College of Cardiology / American Heart Association

Comprehensive guideline on evaluation and diagnosis of chest pain including STEMI, NSTEMI, and risk stratification strategies

New England Journal of Medicine / Swedish Multicenter RCT

LANDMARK TRIAL (n=6,629): Routine oxygen therapy in normoxemic acute MI patients provided NO benefit and may cause harm. Ended decades of routine oxygen use.

New England Journal of Medicine / Canadian Multicenter RCT

LANDMARK TRIAL (n=4,745): Low-dose colchicine 0.5mg daily reduced cardiovascular events post-MI (5.5% vs 7.1%). First anti-inflammatory therapy proven effective in MI.

New England Journal of Medicine / Landmark Heart Failure Trial

LANDMARK TRIAL (n=8,442): Sacubitril/valsartan (Entresto) superior to enalapril for HFrEF - reduced CV death and HF hospitalization by 20%. First major advance in HF therapy in decades.

American Heart Association / American Stroke Association

Guideline for early management of acute ischemic stroke including IV thrombolysis and mechanical thrombectomy based on major RCTs

New England Journal of Medicine / Landmark Stroke Trial

LANDMARK TRIAL (n=182): Mechanical thrombectomy 6-16 hours after stroke last known well resulted in better functional outcomes vs medical therapy in patients with perfusion mismatch. Extended treatment window dramatically.

New England Journal of Medicine / Chinese Multicenter RCT

LANDMARK TRIAL (n=656): Thrombectomy alone non-inferior to tPA followed by thrombectomy for large vessel occlusion stroke. Simplified treatment, potentially safer.

Society of Critical Care Medicine / European Society of Intensive Care Medicine

International guidelines for management of sepsis and septic shock with evidence-based recommendations on fluid resuscitation, vasopressors, and antibiotic timing

New England Journal of Medicine / NIH-funded Multicenter RCT

LANDMARK TRIAL (n=1,563): Restrictive fluid strategy non-inferior to liberal fluid strategy in sepsis-induced hypotension. Changed practice toward more judicious fluid administration.

New England Journal of Medicine / European Multicenter RCT

LANDMARK TRIAL (n=1,679): Norepinephrine superior to dopamine as first-line vasopressor in shock. Dopamine associated with more arrhythmias and higher mortality in cardiogenic shock subgroup.

American College of Surgeons

Updated trauma management emphasizing damage control resuscitation, permissive hypotension, and balanced blood product ratios

JAMA / Multicenter Trauma RCT

Landmark trial (n=680) comparing balanced resuscitation protocols (1:1:1 vs 1:1:2 ratios) for trauma patients requiring massive transfusion

The Lancet / Landmark International Mega-Trial

LANDMARK TRIAL (n=20,211): Tranexamic acid (TXA) reduces death due to bleeding in trauma patients when given within 3 hours of injury. Changed worldwide trauma practice.

New England Journal of Medicine / Military-Civilian Trauma Trial

LANDMARK TRIAL (n=580): Whole blood resuscitation showed trend toward lower 24-hour mortality vs balanced blood components (6% vs 10%, p=0.06). Simpler, potentially better.

New England Journal of Medicine / Pragmatic ICU Trial

LANDMARK TRIAL (n=15,802): Balanced crystalloids (Lactated Ringer's, PlasmaLyte) associated with lower mortality and less AKI vs normal saline in critically ill patients.

New England Journal of Medicine / French Multicenter RCT

LANDMARK TRIAL (n=310): High-flow nasal oxygen reduced intubation rate and 90-day mortality vs standard oxygen and NIV in acute hypoxemic respiratory failure. Changed respiratory support practice.

New England Journal of Medicine / French Multicenter RCT

LANDMARK TRIAL (n=466): Early prone positioning in severe ARDS (PaO₂/FiO₂ <150) reduced 28-day mortality from 32.8% to 16% (NNT=6). Stopped early for overwhelming benefit.

New England Journal of Medicine / International Multicenter RCT

LANDMARK TRIAL (n=1,417): Video laryngoscopy increased first-pass intubation success (85% vs 71%) and reduced severe complications vs direct laryngoscopy in critically ill patients.