Saturday, January 14, 2017

Morphine Mortality in APE

Resultado de imagen de emergency medicine news
Runde D. EM News 2016; 38 (11): 31–31
doi: 10.1097/01.EEM.0000508278.78193.16
..."The most compelling and certainly the most cited article on morphine for APE was performed by W. Frank Peacock IV, MD. (Emerg Med J 2008;25[4]:205.) Before looking at the paper, we need to acknowledge how awesome his name is. This was a retrospective analysis of the Acute Decompensated Heart Failure National Registry (ADHERE) that compared the records of 20,782 hospitalizations for APE where the patient received IV morphine with 126,580 hospitalizations where the patient was not given morphine. The quick summary is that the patients who received IV morphine did worse in essentially every way, but I'll summarize the high points here:
  • Need for intubation: 15.4 percent in the morphine group vs. 2.8 percent in the no-morphine group (NNH=8).
  • Need for ICU admission: 38.7 percent in the morphine group vs. 14.4 percent in the no-morphine group (NNH=5).
  • Mortality: 13.0 percent in the morphine group vs. 2.4 percent in the no-morphine group (NNH=10).
... the take-home point should be pretty clear, but just to summarize one more time: Do not give morphine to patients with acute pulmonary edema. Perhaps someday a study will give us cause to revisit this issue, but until then I'll hold the morphine rather than holding my breath."