30-Second Takeaway
- Pediatric OHCA survival during EMS CPR declines steeply, dropping below 1% around 15 minutes of ongoing efforts.
- Initial IO access in adult OHCA offers no survival advantage over IV and may slightly reduce sustained ROSC.
- IV acetaminophen adds modest early analgesic benefit to titrated IV morphine, most notably for nontraumatic pain.
Week ending February 28, 2026
Recalibrating ED resuscitation, trauma, pain, and sepsis care with new data
Pediatric OHCA: survival after EMS CPR drops below 1% by ~15 minutes
In this Resuscitation Outcomes Consortium cohort, 1,313 pediatric EMS-treated OHCAs had 10.4% survival to hospital discharge. Time-dependent survival probability with ongoing EMS CPR was 7.9% at 1 minute and fell below 1% by 14.8 minutes. The upper 95% CI for survival dropped below 1% at 22 minutes of EMS-initiated prehospital CPR. These data provide an objective framework for EMS and ED teams when discussing continuation or termination of pediatric resuscitation efforts.
Initial IO vs IV access in adult OHCA: no survival gain, slightly less sustained ROSC
This systematic review and meta-analysis included two RCTs with 7,561 adults with OHCA randomized to initial IO vs IV vascular access. Initial IO access did not improve 30-day survival versus IV (OR 0.97, 95% CI 0.80-1.18; moderate-certainty). Neurologically favorable survival was similar (OR 1.03, 95% CI 0.81-1.31; low-certainty). Sustained ROSC was slightly less likely with IO (OR 0.89, 95% CI 0.80-0.99; moderate-certainty).
IV acetaminophen adds modest early analgesic benefit to titrated IV morphine
This multicenter ED RCT randomized 430 adults with severe acute pain to titrated IV morphine plus acetaminophen vs morphine plus placebo. Pain reduction at 30 minutes consistently favored the acetaminophen group, and noninferiority of morphine alone was not demonstrated. For nontraumatic pain, between-group differences approached 0.8 NRS points in favor of acetaminophen across analyses. Findings support maintaining multimodal regimens, including IV acetaminophen, when rapid pain control is required despite weight-based morphine titration.
Admission ionized calcium derangements in major trauma predict mortality and blood use
This prospective multicenter trauma cohort enrolled 1,270 highest-activation patients with ionized calcium measured immediately on ED arrival. Hypocalcemia occurred in 22% and hypercalcemia in 5%, with eucalcemia in 73%. Twenty-four–hour mortality was higher with hypocalcemia (11.9%) and hypercalcemia (22.8%) versus eucalcemia (4.3%), demonstrating a U-shaped risk pattern. Any calcium derangement was associated with increased 24-hour blood product use compared with eucalcemia.
References
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Additional Reads
Optional additional studies from this edition.