New insights in emergency medicine

Emergency medicine represents an umbrella group of disciplines that aims to diagnose and treat acute and life-threatening conditions as well as ensuring that long term outcomes are not adversely affected. Advances in this important field were highlighted recently at the International symposium on Intensive Care and Emergency Medicine (ISICEM), which was attended by BMC Medicine. ISICEM is one of the largest emergency medicine conferences, and, with key opinion leaders discussing cutting edge science, it attracted over 5000 delegates in Brussels where it was held this year.

Topics were diverse and focused on clinical trials, technical advances in life saving equipment, and molecular mechanisms of pathology. Of particular interest were the results and implications of the PROWESS SHOCK study; a randomized controlled trial (RCT) to test the efficacy of Xigris, which had been used licensed to treat sepsis for the past ten years. The trial showed that it had no improvement in outcome, and it was subsequently withdrawn from the market due to lack of efficacy. Prof Derek Angus gave an excellent commentary on the results of this study and its potential implications, including interpretation of clinical trial results, and future therapies for sepsis. Jean-Louis Vincent, who also chaired the conference, provided some reassurance from the negative results with Xigris, with results from a global phase 2b on thromobomodulin, which is another potential therapy for sepsis.

Exciting developments in the field of ventilation in the ICU were also discussed and debated. For example, acute respiratory distress syndrome (ARDS) is a life threatening condition that requires the patient to be immobilized and put on a ventilator for breathing support to oxygenate the blood. However, ventilator induced lung injury (VILI) is a common problem. A relatively novel and increasingly used technique which has been developed to avoid this problem, is the method of extracorporeal membrane oxygenation (ECMO) , and the pros and cons of this were discussed by Ville Pettila and Antonio Pesenti.

Interestingly, this work has implications for ICU recovery in terms of mobilization and length of stay in hospital. Muscle wasting is an important complication to consider, and Eddy Fan discussed how use of techniques such as ECMO, which allows the patient to be mobile, can drastically minimize this. Nick Hart also gave an interesting talk on the molecular mechanisms behind muscle wasting in the ICU with a view to finding additional targets for therapy.

It is hoped that the topics discussed at this conference, which encompassed many aspects of advances in science and technology, will lead to novel insights and a deeper understanding of issues and challenges in this field.

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