Emergency Medicine

Sixth-generation hs-cTnT <13 ng/L safely expands single-presentation MI rule-out in ED chest pain

This multicenter ED cohort derived and externally validated a sixth-generation hs-cTnT threshold for single-sample MI rule-out. An hs-cTnT <13 ng/L at presentation classified 61% of derivation patients with an NPV of 99.9% and sensitivity 99.4% for 30-day MI or cardiac death. In the external cohort, 45.4% were <13 ng/L, with NPV 99.0% and sensitivity 97.5% for 30-day MI or cardiac death. Compared with the fifth-generation assay, the sixth-generation assay identified a much larger low-risk group at presentation without compromising safety. 1

Serious-game training modestly improves trauma triage of severely injured older adults

This randomized trial assigned 800 emergency physicians at non–trauma centers to serious-game–based trauma triage training vs usual education. Physicians in the game group undertriaged 49% of severely injured older adults vs 57% in controls, a model-adjusted difference of -7%. Overtriage and the composite of 30-day mortality or readmission did not differ between groups. Intervention adherence was high, with nearly all physicians completing at least one two-hour tablet-based session. 2

ED-initiated, video-enhanced ACP improves documentation and goal-concordant care

This multicenter ED randomized trial tested video-enhanced ACP plus structured conversation and EHR notification vs usual care in older or seriously ill adults. At 3 months, ACP documentation was higher with the intervention (45.6% vs 31.3%; rate difference 14.3%), and benefits persisted at 6 months. Intervention patients had higher ACP knowledge and engagement scores, without changes in expressed goals-of-care preferences. Among 94 decedents, median goal-concordance scores were substantially higher in the intervention group (10 vs 7). 3

Mobile ECMO truck ECPR for refractory VF/VT OHCA appears feasible with outcomes comparable to in-hospital ECPR

This single-center registry evaluated a fluoroscopy-enabled ECMO truck delivering scene-based ECPR for refractory VF/VT OHCA within a regional arrest system. Eight ECMO truck patients were matched to eight in-hospital ECPR patients based on low-flow time. Total low-flow times and needle-stick–to–ECMO flow intervals were similar between groups. Neurologically favorable survival to discharge was 25% in both ECMO truck and in-hospital cohorts. 4