30-Second Takeaway
- Prioritize splenic salvage over splenectomy for severe blunt splenic injury in carefully selected polytrauma patients.
- Treat early calcium derangements after major trauma as prognostic red flags for mortality and transfusion demand.
- In adult arrest, prioritize rapid high-quality IV access; IO first-line offers no survival advantage and may reduce sustained ROSC.
- Use rib cage–abdomen motion after spinal trauma to risk-stratify weaning and guide extubation or tracheostomy timing.
- Advanced transport and ECMO strategies offer context-specific benefits without consistent survival gains across settings.
Week ending February 28, 2026
Practice-shaping updates in splenic trauma, early resuscitation physiology, and ECMO/arrest management
Splenic salvage outperforms splenectomy in severe blunt splenic injury with polytrauma
This TQIP cohort included 12,930 adults with severe blunt splenic injury and multiple trauma from 2017–2022. Open splenectomy was used in 26%, splenic angioembolization in 20%, and observation in 54%. Compared with splenectomy, both angioembolization and observation were associated with significantly lower in-hospital mortality on multivariable analysis. Angioembolization and observation also had fewer complications, including ARDS, cardiac arrest, and severe sepsis, plus shorter ICU and hospital stays. These data support prioritizing splenic salvage strategies in severe blunt splenic trauma when hemodynamics and resources permit close monitoring.
Both hypo- and hypercalcemia on ED arrival after major trauma signal worse outcomes
This prospective multicenter cohort enrolled 1,270 highest-activation major trauma patients with immediate ionized calcium measurement at ED arrival. Hypocalcemia occurred in 22% and hypercalcemia in 5% of patients, with 73% eucalcemic. Twenty-four–hour mortality was higher with both hypocalcemia and hypercalcemia than with eucalcemia, forming a U-shaped association. Patients with either calcium derangement required more blood products in the first 24 hours than eucalcemic patients. Arrival calcium outside the normal range should be treated as an early severity marker requiring closer monitoring and tailored resuscitation.
Initial IO access offers no survival benefit over IV in adult out-of-hospital cardiac arrest
This systematic review and meta-analysis included two randomized trials with 7,561 adults in out-of-hospital cardiac arrest. Initial intraosseous versus intravenous access produced similar 30-day survival (OR 0.97; 95% CI 0.80–1.18; moderate-certainty). Favorable neurological outcome at 30 days or discharge did not differ between IO and IV groups, with low-certainty evidence. However, sustained ROSC was less likely with initial IO access (OR 0.89; 95% CI 0.80–0.99; moderate-certainty). These findings support prioritizing rapid high-quality IV access and reserving IO for situations where IV placement is delayed or impossible.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.