PRISM Rounds: Pulmonary Critical Care & Sleep Podcast

How long should comatose patients remain at 33°C after out-of-hospital cardiac arrest?In this episode of PRISM Rounds, we examine the icecap randomized clinical trial, which studied 1,158 comatose OHCA survivors who had already been rapidly cooled to 33°C. Patients were assigned to different cooling durations ranging from 6 to 72 hours.Longer cooling did not improve neurological recovery, mortality, or secondary neurological outcomes. We discuss the adaptive trial design, the separate shockable and nonshockable rhythm cohorts, the meaning of the approximately 50% probability that 6 hours was the shortest optimal duration, and why this does not establish a universal six-hour protocol.The episode places icecap in context with TTM, TTM2, and HYPERION while keeping clear that these trials addressed different temperature-management questions.Read the study:https://jamanetwork.com/journals/jama/fullarticle/2852508Subscribe to PRISM Rounds on Apple Podcasts, Spotify, or YouTube, and visit:https://www.prismrounds.comTags:icecap, cardiac arrest, out-of-hospital cardiac arrest, OHCA, targeted temperature management, therapeutic hypothermia, post-cardiac arrest care, neuroprotection, neurological recovery, TTM, TTM2, HYPERION, critical care, intensive care, emergency medicine, resuscitation, ICU, fever prevention, modified Rankin Scale, PRISM Rounds

In Season 1, Episode 58 of PRISM Rounds, we review the 2025 Society of Critical Care Medicine guideline for the treatment of heat stroke and translate its recommendations into practical bedside decisions for emergency and critical care clinicians. We discuss why active cooling should begin immediately, why cold- or ice-water immersion is preferred when feasible, and why the guideline emphasizes both the speed of cooling and the goal of reaching a core temperature below about 39°C within 30 minutes. We also review what to do when immersion is not practical and how the guideline approaches classic versus exertional heat stroke.The episode also covers therapies that should generally be avoided. Routine acetaminophen, NSAIDs, salicylates, and dantrolene are not recommended for temperature reduction, and prophylactic antibiotics or antiseizure medications should be limited to research settings.An important theme is the strength of the recommendations versus the strength of the evidence. Several recommendations are strong despite very low-certainty evidence, reflecting the practical and ethical difficulty of conducting randomized trials that delay effective cooling in patients with true heat stroke.The bedside message is simple: recognize heat stroke early, start the fastest feasible active cooling strategy, continue simultaneous resuscitation and organ support, and avoid medications that do not address the underlying problem.Read the guideline:https://doi.org/10.1097/CCM.0000000000006551More PRISM Rounds:https://www.prismrounds.comAvailable on Apple Podcasts, Spotify, YouTube, and other major podcast platforms.Tags:PRISM Rounds, S01E58, critical care, ICU, heat stroke, heatstroke, hyperthermia, SCCM, Society of Critical Care Medicine, emergency medicine, cooling, cold water immersion, ice water immersion, exertional heat stroke, classic heat stroke, temperature management, dantrolene, antipyretics, heat illness, resuscitation, evidence based medicine, clinical guidelines, guideline review, medical education, FOAMed, pulmonary critical care

Should we wait for a patient with intermediate-high-risk pulmonary embolism to deteriorate before pursuing reperfusion—or intervene before the right ventricle fails?In this episode of PRISM Rounds, we examine PRAGUE-26, a multicenter randomized trial published in the New England Journal of Medicine comparing conventional catheter-directed thrombolysis with low-dose alteplase plus anticoagulation against anticoagulation alone in patients with intermediate-high-risk acute pulmonary embolism.The headline result is striking: the 7-day composite of death, recurrent pulmonary embolism, or cardiorespiratory decompensation or collapse occurred in 0.7% with catheter-directed thrombolysis versus 6.8% with standard care. But the interpretation requires nuance. The benefit was driven primarily by fewer episodes of cardiorespiratory deterioration, not a demonstrated mortality reduction. Overall major bleeding was not clearly increased, yet two intracranial hemorrhages occurred in the thrombolysis group and none with anticoagulation alone. We break down patient selection, the low-dose alteplase strategy, the composite endpoint, rescue reperfusion, early RV recovery, bleeding risk, and the limitations of an open-label trial conducted in experienced tertiary cardiovascular centers. Most importantly, we ask what prague-26 should change at the bedside: Does this trial support routine early catheter-directed thrombolysis, or does it help us identify the selected patient who should undergo reperfusion before overt hemodynamic collapse?The article was published online in the New England Journal of Medicine on August 31, 2026, DOI 10.1056/NEJMoa2608012. PRISM Trials / PRISM Rounds:Visit PRISM TrialsJournal article:Read “Catheter-Directed Thrombolysis in Intermediate-High-Risk Pulmonary Embolism” in NEJMTags:#PRISMRounds #PRISMTrials #CriticalCare #CriticalCareMedicine #ICU #PulmonaryCriticalCare #PulmonaryMedicine #Pulmonology #PulmonaryEmbolism #PE #IntermediateHighRiskPE #SubmassivePE #CatheterDirectedThrombolysis #CDT #Thrombolysis #Alteplase #Anticoagulation #Reperfusion #PERT #PulmonaryEmbolismResponseTeam #RightVentricle #RVFailure #RightHeartStrain #HemodynamicCollapse #CardiorespiratoryDecompensation #Shock #VTE #VenousThromboembolism #EmergencyMedicine #Cardiology #InterventionalCardiology #IntensiveCare #ClinicalTrials #RandomizedTrial #RCT #EvidenceBasedMedicine #MedicalEducation #JournalClub #NEJM #FOAMed #FOAMcc #MedEd #EvidenceBasedCriticalCare

In this episode of PRISM Rounds, we discuss the SAVE-O2 AI randomized clinical trial, which tested autonomous closed-loop oxygen titration versus usual manual oxygen adjustment in 300 hospitalized adults receiving supplemental oxygen.The autonomous system kept patients in the target SpO2 range much more often, 85% vs 63%, while also reducing time spent in hypoxemia and, even more strikingly, hyperoxemia. We break down what the trial shows, what it does not show, the importance of pulse oximetry accuracy and skin pigmentation, and whether improved oxygen control is enough to justify broader implementation. We also discuss the accompanying editorial by Weingart and Matthay, which explores the potential impact on clinician workload, oxygen stewardship, resource-limited settings, and the next generation of implementation and outcomes studies. SAVE-O2 AI trial, JAMA Internal Medicinehttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2026.4023DOI: https://doi.org/10.1001/jamainternmed.2026.4023Invited Commentary: Potential Transformative Impact of Autonomous Oxygen Delivery in Hospitalized Patientshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2026.4038DOI: https://doi.org/10.1001/jamainternmed.2026.4038Find more episodes at www.prismrounds.com and subscribe on Apple Podcasts or Spotify.Tags#PRISMRounds #SAVE02AI #CriticalCare #ICU #PulmonaryCriticalCare #OxygenTherapy #Hypoxemia #Hyperoxemia #PulseOximetry #ClosedLoopControl #ArtificialIntelligence #DigitalHealth #ClinicalTrials #RandomizedTrial #JAMAInternalMedicine #RespiratoryCare #FOAMcc #MedEd

Does video laryngoscopy improve first pass success for routine tracheal intubation, and does blade geometry matter?In this episode of PRISM Rounds, we discuss the COVALENT randomized clinical trial, which compared direct laryngoscopy, Macintosh style video laryngoscopy, and hyperangulated video laryngoscopy in more than 2,400 perioperative intubations.We review the higher first pass success with video laryngoscopy, why the hyperangulated strategy performed best, the important role of stylet use, and what the accompanying editorial adds to the interpretation.We also discuss how COVALENT builds on the DEVICE trial in critically ill adults and why the airway conversation may now be shifting from simply video versus direct toward which video strategy, blade, and adjunct work best in different clinical settings.Find PRISM Rounds on Apple Podcasts, Spotify, and https://prismrounds.comTags:Critical Care, ICU, Airway Management, Video Laryngoscopy, Direct Laryngoscopy, COVALENT Trial, DEVICE Trial, Tracheal Intubation, First Pass Success, Emergency Airway, Anesthesiology, Pulmonary Critical Care, Evidence Based Medicine, Journal Club, PRISM Rounds, FOAMcc, FOAMed