Fourteen days of ECG monitoring after unexplained syncope in the ED did not reduce further faints

The edition in brief

In ASPIRED, 2,234 adults whose syncope remained unexplained after emergency department assessment were randomised to immediate 14-day ambulatory ECG monitoring or usual care; syncope episodes at a year did not differ (IRR 0.89, 0.68-1.18), and monitoring brought more minor adverse events. A meta-analysis of 163 studies found one-year mortality of 37% after venovenous ECMO, 55% after venoarterial ECMO and 74% after extracorporeal CPR, with functional outcomes reported in fewer than a quarter of studies. An Intensive Care Medicine review concludes beta-blockers have established roles in myocardial infarction, tachyarrhythmias, hypertensive emergencies, thyroid storm and variceal bleeding prevention, but limited or conflicting evidence in septic shock, traumatic brain injury, acute heart failure and burns. A scoping review of medical screening for adult psychiatric presentations found mostly retrospective evidence, and most society statements discouraged routine laboratory testing. In US data covering 5.4 million paediatric mental health ED visits, half were to high-volume paediatric EDs, and presentation patterns differed by ethnicity and diagnosis.