Emergency Medicine

Video vs direct laryngoscopy during cardiac arrest: safer tube placement without survival gain

This ILCOR-commissioned systematic review included 16 studies (3 RCTs, 13 observational) of intubation during cardiac arrest comparing video with direct laryngoscopy. Across three small RCTs (331 patients), video did not improve first-pass or overall intubation success versus direct laryngoscopy. Large observational cohorts favored video laryngoscopy for first-pass success and overall success, though certainty was very low. Video laryngoscopy consistently reduced esophageal intubation rates compared with direct laryngoscopy in both RCTs and observational data. There was no consistent difference in ROSC, survival, or good neurologic outcome between devices, and overall evidence certainty was very low. 1

Updated pediatric readiness blueprint for every emergency department

This technical report updates the 2018 pediatric readiness guidance for all emergency departments. It emphasizes that most critically ill, injured, or mentally ill children present to community EDs, not pediatric centers. The report details required pediatric-focused medications, equipment, policies, education, and staffing to deliver effective emergency care to children. It is intended as a practical resource for ED clinical and administrative leaders to systematically improve pediatric readiness across diverse systems. 2

Child Opportunity Index and race linked to worse pediatric OHCA neurologic outcomes

This CARES-based cohort included 17,903 pediatric out-of-hospital cardiac arrests to examine neighborhood opportunity, race, and outcomes. Only 9.2% of children achieved survival to discharge with favorable neurologic status. Very low Child Opportunity Index areas had lower odds of favorable outcome versus very high areas (aOR 0.68, 95% CI 0.54-0.84). Black/African American children had lower odds of favorable outcome than White children (aOR 0.81, 95% CI 0.69-0.96). Lower bystander CPR/defibrillation partially mediated worse outcomes for disadvantaged neighborhoods and Black/African American children, highlighting a modifiable system-level target. 3

LMWH outperforms unfractionated heparin for VTE prophylaxis after firearm-related penetrating brain injury

This TQIP analysis studied 2012 adults with isolated firearm-related penetrating brain injury receiving pharmacologic VTE prophylaxis. After adjustment, low-molecular-weight heparin was associated with substantially lower odds of VTE than unfractionated heparin (OR 0.49, 95% CI 0.32-0.77). LMWH similarly reduced VTE risk in patients undergoing early craniotomy/craniectomy and those without neurosurgical intervention. Prophylaxis type was not associated with increased late neurosurgical decompression or in-hospital mortality. These data support LMWH as the preferred VTE prophylaxis agent after penetrating brain injury when not otherwise contraindicated. 4