Unexplained syncope: 14-day ambulatory ECG monitoring did not reduce repeat faints at one year

The edition in brief

ASPIRED randomised 2,234 adults at 45 UK hospitals whose syncope stayed unexplained after emergency department evaluation to immediate 14-day ambulatory ECG monitoring or usual care. Patient-reported syncope episodes at one year did not differ (mean 1.37 vs 1.58; rate ratio 0.89, 0.68 to 1.18), and adverse events were more frequent with monitoring (49 vs 8, one serious in each group). A meta-analysis of 19 observational studies of older adults presenting to the ED after a fall found cumulative ED revisits of 8.8% at 7 days, 15.0% at 30 days and 41.3% at one year, and hospital readmission of 10.4% at 30 days. A meta-analysis of 163 studies (78,053 adults) put one-year mortality after ECMO at 37.2% for venovenous, 55.2% for venoarterial and 74.4% for extracorporeal CPR, with functional outcomes reported in fewer than a quarter of studies. The X-COPD trial of extracorporeal CO₂ removal to allow early extubation in ventilated COPD exacerbations stopped at 18 of 192 planned patients; ventilation was shorter with the device (mean 7.1 vs 24.3 days), but the trial is too small to guide practice.