The edition · Emergency & Critical Care
Neither prone positioning nor oscillation helped children with early ARDS, and four in ten paramedic STEMIs were something else
PROSpect, stopped for futility at 424 children, found no gain in ventilator-free days from prone positioning or HFOV, but more airway and pressure complications. In a statewide ambulance registry, 60% of suspected STEMIs were confirmed.
The edition in brief
The PROSpect factorial trial in 75 paediatric ICUs randomised 424 children with early moderate-to-severe ARDS; neither prone positioning nor high-frequency oscillatory ventilation increased ventilator-free days to day 28, and prone positioning brought more airway obstruction (rate ratio 4.83) and pressure injury, while HFOV brought more haemodynamic instability. The authors advise against routine first-line use of either. In 7,205 paramedic-suspected STEMIs with a discharge diagnosis in Victoria, Australia, 60% were confirmed STEMI; those with a non-cardiac final diagnosis had higher long-term mortality than confirmed STEMI (HR 1.75). A single-centre programme raised outpatient management of low-risk pulmonary embolism from 5% to 33% of eligible patients with no 30-day recurrence or deaths after ED discharge. A meta-analysis of 105 studies found cancer associated with roughly doubled hospital mortality in sepsis, most consistently for haematological malignancy; estimates were unadjusted. The pearl: think of aortic dissection before giving antithrombotics for suspected STEMI.
Four in ten paramedic-suspected STEMIs had another final diagnosis
A suspected STEMI that turns out not to be STEMI is still a high-risk patient; look actively for the serious alternative diagnosis.
A structured programme raised outpatient care of low-risk PE from 5% to 33%, with no 30-day deaths
Combine PESI and Hestia to identify low-risk PE patients who can go home, with anticoagulation and follow-up arranged.
Cancer was linked to roughly double the odds of hospital death in sepsis
Sepsis in a patient with cancer carries about twice the odds of hospital death; treat fully while discussing goals early.
Before antithrombotics for STEMI, spare a thought for dissection
In suspected STEMI with atypical features, exclude aortic dissection before giving antithrombotics.
Prone positioning and HFOV did not increase ventilator-free days in early paediatric ARDS
In early moderate-to-severe paediatric ARDS, do not use prone positioning or HFOV routinely; they added harms without more ventilator-free days.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for emergency & critical care, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free