October 8, 2020

Background: Prior to the discovery of thrombolytics, clinicians could only observe their patients completing their myocardial infarctions and then classify them according to whether their subsequent ECGs developed Q waves. When trials showed a clear survival benefit with thrombolytics (especially in STE) this shifted the paradigm from “Q-wave/ non Q-wave MI” to “STEMI / non-STEMI”. Eventually STEMI became synonymous with acute coronary occlusion (ACO) requiring reperfusion, except this connection was never studied in trials. Unfortunately, the STEMI criteria have limited diagnostic criteria for ACO, leading to false cath lab activation. And worse, missing ⅓ of ACO (NSTEMI), depriving them of emergent reperfusion therapy. This led many authors to shift from STEMI/ NSTEMI to ACO-MI/ non- ACO-MI. 

June 29, 2020

Background: In patients with acute respiratory distress syndrome (ARDS) the National Heart, Lung, and Blood Institute ARDS clinical trials network recommends a target partial pressure of arterial oxygen (Pao2) between 55 and 80 mmHg. Goals of arterial oxygenation are not based on robust experimental data and prior evidence has shown the feasibility of targeting a lower partial pressure of arterial oxygen in patients with ARDS. The authors of this trial, aptly named the study, LOCO2 (Liberal Oxygenation vs Conservative Oxygenation). They sought to determine whether a lower oxygen strategy was safe in patients with ARDS.