Emergency Medicine

IO vs IV access for OHCA: no meaningful difference in 1-year outcomes

This multicenter RCT randomized adults with nontraumatic OHCA to initial intraosseous (IO) or intravenous (IV) vascular access, with up to two attempts allowed. At 1 year, survival was similar between IO and IV groups (11% vs 9%; risk ratio 1.24, 95% CI 0.91–1.67). Favorable neurologic survival (mRS 0–3) was also comparable (10% vs 8%; risk ratio 1.28, 95% CI 0.93–1.77). Among survivors, EQ-5D-5L scores were high in both groups, with modest numeric advantage for IO (mean difference 7; 95% CI 1–13). 1

Assay-specific hs-cTnI-VITROS cutoffs enable safe, efficient MI rule-out

This prospective multicenter cohort derived and validated alternative 0/1- and 0/2-hour algorithms for the hs-cTnI-VITROS assay in ED chest pain patients. Among 2931 adults with suspected MI, 16% had centrally adjudicated myocardial infarction. Using a ≤2 ng/L cutoff at presentation in patients with symptom onset >3 hours allowed direct MI rule-out in a subset. Combining a 0-hour value ≤2 ng/L with a 1-hour absolute change ≤1 ng/L ruled out 51% of patients with 99.1% sensitivity (95% CI 96.9–99.8). 2

Early nonsurgical resuscitation improves outcomes in isolated moderate–severe TBI

This cohort included 507 adults with isolated moderate-to-severe TBI cared for within a resource-limited trauma system in South Africa. Patients receiving grouped nonsurgical critical resuscitation interventions (nsCRIs) ≤1 hour or 1–3 hours were compared with those treated >3 hours or missing nsCRIs. Overall, 7-day mortality was 27.6% and 30-day mortality 31.2%. nsCRIs delivered ≤1 hour were associated with a 26% relative reduction in 7-day mortality (HR 0.74; 95% CI 0.56–0.98) versus delayed or missed care. 3

Nonoperative appendicitis management in elders fails often, especially ≥85 years

This retrospective cohort studied 300 patients ≥65 years with CT-diagnosed acute appendicitis, comparing initial nonoperative management (NOM) versus surgery. Of 83 patients initially managed nonoperatively, 24.1% required surgery within 30 days and 25.3% had recurrence needing surgery within one year. NOM failure rose steeply with age, reaching 54.5% in patients ≥85 years (P < 0.001). High frailty, severe comorbidities, longer symptom duration, and extensive CT inflammatory findings were associated with higher NOM failure risk. 4