Corticosteroids significantly reduced sequelae in patients with Bell’s palsy (idiopathic facial paralysis)
SOURCE
Madhok VB, Gagyor I, Daly F et al. (2016) Corticosteroids for bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 18:CD001942.
CONTEXT
Bell’s palsy is a relatively common presentation to emergency departments (incidence of 25/100 000/year). Though the prognosis is generally good, adverse sequelae can have a serious social impact for patients. Theuse of corticosteroids in the treatment of Bell’s palsy is very controversial.
CLINICAL QUESTION
Should I prescribe corticosteroids to patients with Bell’s palsy?
BOTTOM LINE
Corticosteroids should be prescribed in Bell’s palsy. They significantly reduced incomplete recovery of facial motor function at 6 months without adverse effects (high quality evidence). The number of people who need to be treated with corticosteroids to avoid one incomplete recovery was 10. Corticosteroids also reduced the development of motor synkinesis and crocodile tears syndrome (moderate quality evidence).
CAVEAT
The administration of corticosteroids (dosage, route and administration time since the beginning of the symptoms) differed between included studies.
All authors did not use a standardized scale to evaluate recovery of motor facial function.
AUTHOR INFORMATION
Sébastien BEROUD
Hospices Civils de Lyon, CHU Lyon-Sud
Lyon, France
sebastien.beroud@chu-lyon.fr
Kirk MAGEE
Dalhousie University – Halifax Infirmary
Nova Scotia, Canada
Kirk.magee@dal.ca
Bystander chest compression-only cardiopulmonary resuscitation increased survival of non-asphyxial out-of hospital cardiac arrest patients
SOURCE
Zhan L, Yang LJ, Huang Y, et al (2017)Â Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest. Cochrane Database Syst Rev 27;3:CD010134.
CONTEXT
Non-asphyxial out-of-hospital cardiac arrest (OHCA) is a significant cause of death worldwide. Cardiopulmonary resuscitation (CPR) is a well-established treatment for cardiac arrest and must be rapidly initiated by rescuers (bystanders or professional CPR providers).
CLINICAL QUESTION
For non-asphyxial OHCA, should the rescuersperform continuous chest compression CPR (with or without rescue breaths, CCC-CPR) or conventional CPR plus rescue breathing (interrupted chest compression withpauses for breaths)?
BOTTOM LINE
Bystander-administered
Chest compression-only CPR (without rescue breaths), supported by telephone instruction, increased the proportion of people who survive to hospital discharge compared with conventional interrupted chest compression CPR with rescue breaths (high quality of evidence).
Trained professionals
There is no significant difference regarding the return of spontaneous circulation, survival to hospital admission, survival to hospital dischargeand adverse events between CCC-CPR with asynchronous rescue breaths compared to interrupted chest compressions with rescue breaths (moderate quality of evidence).
CAVEAT
Only four articles were selected and contributed to the results: one for trained professionals, and three for bystanders. In one of these articles, children older than one year of age were also included. It did not allow to conclude which CPR to be used.Finally, there is no data available regarding survival at one year or quality of life, and evidence regarding the neurological outcomes of survival was insufficient.
AUTHOR INFORMATION
Daniel MEYRAN
Bataillon de Marins Pompiers de Marseille
Marseille, France
daniel.meyran@me.com
Haldun AKOGLU
Marmara University Faculty of Medicine
Istanbul, Turkey
drhaldun@gmail.com