Themes & search

The Western Trauma Association issued a new critical-decisions algorithm for traumatic hemothorax, offering a bedside pathway that weighs patient physiology, hemothorax size, adequacy of pleural drainage, and evidence of ongoing hemorrhage to guide the choice between observation, tube thoracostomy, and operative intervention.

In 590 trauma and burn patients across three regional centers, higher early fibrinolytic activation predicted death: admission plasmin-antiplasmin >=1645.6 ng/mL carried ~7x and D-dimer >=6.5 ug/mL ~5x higher adjusted odds of mortality. Trauma patients showed higher fibrinolytic markers than burn patients but similar trajectories, suggesting shared resuscitative adjuncts could target early fibrinolytic dysfunction in both.

Pooling 1,249 patients from two prehospital TXA trials and stratifying by TEG LY30, trauma patients in fibrinolytic shutdown who were randomized to TXA had a markedly lower risk of death (HR 0.32), while hyperfibrinolysis independently tripled mortality risk. Supports fibrinolysis profiling to target who benefits most from early TXA.

Pooled analysis of studies comparing spinal deformity surgery with versus without intraoperative cell salvage, assessing whether cell salvage cuts allogeneic transfusion exposure in the era of routine antifibrinolytics and restrictive transfusion thresholds.

Across 15 studies (183,253 patients), evidence is still insufficient to say whether early/prehospital plasma helps or harms TBI patients — one cluster-RCT secondary analysis suggested lower 24-h and 30-day mortality with prehospital plasma among direct-scene transports at risk of hemorrhagic shock, but two small in-hospital trials showed no benefit (one signaling possible harm), all at very low certainty.

In 9 studies (10,785 patients with nonvariceal upper GI bleeding), ultra-early endoscopy (<=6 h) did not reduce mortality, rebleeding, transfusion, surgery, or length of stay versus early endoscopy (>6 h), but was linked to more ICU admissions — supporting adequate resuscitation and endoscopy within the standard 24-h window rather than rushing to <=6 h.

National consensus recommendations for avoiding allogeneic transfusion after surgery — minimize iatrogenic (lab-draw) anemia, give targeted IV iron, use erythropoiesis-stimulating agents selectively, individualize hemostatic therapy, and recognize/control bleeding early. Oncologic focus, but the patient-blood-management principles carry over to acute-care transfusion practice.

In a propensity-matched single-center comparison (321 blast vs 1,481 matched blunt patients), blast trauma imposed a far higher institutional resource burden — about 3.4x the composite of prolonged stay, ICU admission, or urgent surgery — with markedly higher odds of shock-room triage (OR 10.6), ≥3 operations (OR 12.4), massive-transfusion activation (OR 11.7), and ICU admission (OR 5.5), persisting across all injury-severity strata; relevant to mass-casualty and blast-event resource planning.

Pooling 6 studies (3 RCTs, 3 cohorts; 4,040 patients), prehospital whole blood did not improve 24-hour (RR 1.00) or 28/30-day mortality (RR 1.09) versus standard care; an apparent reduction in 24-hour RBC requirements lost significance on sensitivity analysis and was driven by observational cohorts at serious risk of bias — tempering expectations of a survival benefit from prehospital whole blood.

Exploratory REMAP-CAP analysis testing whether plasma ferritin or suPAR can flag the critically ill COVID-19 patients most likely to benefit from the IL-1 inhibitor anakinra — a treatable-traits / precision-ICU approach to immune modulation.

Pooling 10 RCTs (1,077 patients), pre-endoscopic prokinetics — mostly erythromycin — improved adequate gastric emptying/endoscopic visualization (OR 3.68) and reduced repeat endoscopy (OR 0.54), but showed no clear benefit for mortality, rebleeding, or transfusion; the gains are procedural rather than hard-outcome, and the evidence for metoclopramide is weaker.

In a bench comparison of six portable blood warmers using cold-stored whole blood, the MWarmer gave the most consistent warming (outlet 40–41°C across pressures) while the LifeWarmer Quantum was fastest but warmed poorly under pressure — supporting the MWarmer for far-forward/austere trauma resuscitation.

Across 9 studies (10,785 adults with nonvariceal upper GI bleeding), ultra-early endoscopy (≤6 h) did not reduce mortality (OR 0.88) or rebleeding versus early endoscopy (>6 h), and did not change transfusion, surgery, or length of stay — but was associated with more ICU admissions (OR 1.41). Supports adequate resuscitation and timely endoscopy within the standard 24-h window rather than rushing to ≤6 h.

In a PRISMA systematic review (8 studies) of adults with sickle cell acute chest syndrome requiring ICU or mechanical ventilation, mechanical ventilation was the strongest mortality marker (OR up to 67.5 for MV <96 h in the largest cohort), alongside pulmonary hypertension/cor pulmonale and comorbidity burden; documented bacterial infection was uncommon and procalcitonin-guided antibiotic discontinuation was safe — favoring early recognition, severity-based respiratory support, and antimicrobial stewardship.

Digital Stop the Bleed training was non-inferior to instructor-led training for knowledge, but laypersons performed wound packing (80% vs 100%) and tourniquet application (52% vs 86%) worse than the in-person group — supporting digital training as a supplement to, not replacement for, hands-on instruction.

A curriculum-based deep-learning pipeline detected active pelvic bleeding on contrast-enhanced CT in ~2 seconds with a test AUC of 0.90, outperforming residents and matching board-certified specialists. A plausible triage aid to speed hemorrhage detection in blunt pelvic trauma, pending prospective clinical validation.

Physiology-first, segment-specific playbook for traumatic IVC injury — prioritize hemodynamics over imaging, use damage-control resuscitation and primary venorrhaphy when feasible, and reserve endovascular/hybrid or nonoperative approaches for stable patients with contained bleeding and immediate open-conversion capability.

A machine-learning triage tool (FAIT) using only early EMS/ED vitals and field-visible injuries predicted trauma transfusion need with high accuracy — AUC 0.91 for ruling out any transfusion, and 0.91-0.95 for transfusion, massive (>4 U/4h) and ultra-massive thresholds (0.87-0.91 on EMS vitals alone) — supporting prehospital forecasting of blood-product demand across blunt, penetrating and burn injury, pending prospective validation.

Across 8 studies (8,173 patients, 7 RCTs), balanced crystalloids reduced mortality vs saline (RR 0.92, 95% CI 0.86–0.98; moderate certainty) plus less AKI, hyperchloremia, and RRT, and more ICU/ventilator/vasopressor-free days. Supports preferring balanced crystalloids over saline in sepsis resuscitation.

In the TBI subgroup of the TRAIN trial, a liberal transfusion threshold (Hb <9 g/dL) was associated with fewer unfavorable neurological outcomes at 180 days than a restrictive threshold (Hb <7 g/dL): 58.5% vs 67.4% (RR 0.86, 95% CI 0.75–1.00; P=.047), with no excess infection or cerebral ischemia. Signal is fragile (fragility index 1) but pushes toward a higher transfusion trigger in anemic TBI patients.

In trauma patients aged 40–60 (ISS ≥9), pre-injury antithrombotic therapy raised coagulopathy rates (especially VKA/DOAC) but, after matching, showed no clinically relevant difference in mortality (6.5% vs 6.2%). Unlike in the elderly, anticoagulation may not independently worsen survival in middle-aged trauma.

A 20-expert modified Delphi produced 35 consensus criteria for pediatric prehospital blood transfusion: eligibility = known/suspected severe hemorrhage PLUS ≥1 shock indicator after first-line hemorrhage control PLUS EMS clinical judgment; aims to standardize highly variable pediatric PHT protocols (no consensus reached on EtCO2).

In a multicenter Paris-region cohort, ~1 in 5 severe trauma patients (ABC ≥2 and >20 min prehospital time) would have qualified for prehospital blood transfusion — arguing that PHT should be a routine capability, not a rarity, in advanced trauma systems.

Across 8,577 Impella-treated cardiogenic shock patients, in-hospital cardiac arrest before implantation marked a distinct high-risk phenotype (30-day mortality 48% vs 29% no-arrest; adjusted HR 1.54) with more bleeding, limb ischemia, stroke and sepsis; lactate >4, creatinine >1.5, longer arrest time and VA-ECMO predicted death, supporting early risk stratification.

Digital Stop the Bleed training was non-inferior to instructor-led training for knowledge, but laypeople performed hands-on skills worse (wound packing 80% vs 100%; tourniquet 52% vs 86%). Digital training should supplement, not replace, in-person psychomotor demonstration; learner self-efficacy correlated poorly with actual skill.

In 716 injured adults not on antiplatelet drugs, increasing age was independently associated with lower platelet count and aggregation alongside hypercoagulable clot dynamics; in patients ≥55, low count and reduced aggregation at admission suggested higher mortality — flagging age-related platelet dysfunction as a potential target in resuscitation of older trauma patients.

Scoping review that informed a 5-center New Zealand consensus VTE-prophylaxis guideline. Bottom line for trauma/TBI: mechanical prophylaxis (intermittent pneumatic compression) for essentially all patients, with LMWH started 24–72 h postoperatively — or after confirmed stable neuroimaging in TBI — consistently reducing VTE without a rise in major bleeding; timing and duration individualized by subgroup.

Among 84 hemorrhagic-shock patients who received both blood and intubation within 30 min, a circulation-first approach (CAB — blood before the tube) showed no difference in mortality or hospital length of stay versus airway-first (ABC), challenging the long-standing convention of intubating before transfusing. LITES centers favored CAB for penetrating trauma. Small sample limits generalizability and the authors call for prospective multicenter trials.

Among 25,473 trauma patients, prehospital vitals of SBP <90 mmHg plus HR ≥110 bpm gave the highest positive predictive value (56%) for needing transfusion within 4 h of ED arrival; other criteria (SBP <70, EMS-witnessed arrest) ranged 51–53%. Supports simple physiologic triggers to select patients for prehospital blood.

Pooling 8 studies (8,173 patients; 7 RCTs), balanced crystalloids reduced mortality versus normal saline (RR 0.92, 95% CI 0.86-0.98) with fewer episodes of acute kidney injury, hyperchloremia, and renal replacement therapy, plus more ICU-, ventilator-, and vasopressor-free days — supporting preferential use of balanced solutions over saline for fluid resuscitation in sepsis (moderate certainty).

Among 152 hemodynamically unstable major pelvic-ring injuries, in-hospital mortality was 7.2% and haemorrhage-related mortality just 2% (MTP activated in 45%, angioembolisation in only 5.9%) — reinforcing that mature trauma systems can achieve very low pelvic-haemorrhage mortality.

EAST's annual roundup distills 13 practice-shaping 2025 studies (RCTs + large multicenter cohorts) spanning early resuscitation, timing of lifesaving interventions, analgesia/sedation, ventilator management, infection prevention, transfusion timing, perioperative antibiotics, imaging in older adults, and pediatric trauma pathways — a ready-made map of what changed this year.

PHBTC (aligned with AABB) formally defines the scope and duties of EMS Blood Program Coordinators/Managers — storage and transport validation, continuous component monitoring, standardized education, regulatory compliance, and interagency coordination — to make civilian prehospital whole-blood programs safe and reproducible across diverse EMS systems.

State-of-the-art review frames trauma-related ARDS as a "multi-hit" process (initial injury + dysregulated inflammation + secondary insults like transfusion, infection, fat embolism); management stays largely supportive with lung-protective ventilation, multimodal imaging (CXR, lung ultrasound, CT) for risk stratification, pain control, hemodynamic optimization and timely surgery, with individualized approaches for TBI and hypothermia.

Delphi consensus of 24 ICU experts sets lab/blood-count thresholds for safe early mobilization (hemoglobin, platelets, lactate, INR, pH, potassium), recommends deferring mobilization during transfusion, and flags Hb drop ≥2 g/dL/24h or platelet fall ≥20%/24h as contraindications.

In the subset with supratherapeutic INR >6 (n=23) needing urgent surgery, high-dose 4F-PCC (50 IU/kg) achieved effective hemostasis in 100% with no thromboembolic events, supporting the maximum-dose strategy for severe VKA-associated coagulopathy.

FAST sensitivity is strongly volume-dependent — only 14% at 250 mL, 37% at 500 mL, but 74% at 1000 mL and 91% at 1500 mL — so a negative FAST does not exclude significant intra-abdominal bleeding in an unstable patient. Longitudinal (vs transverse) views of the Douglas pouch boosted sensitivity by >20%; Morison's pouch had the highest yield.

Modeling the real-world cohort of 957 females of childbearing potential given prehospital RhD-positive products puts the future HDFN risk at only ~0.2-0.3% per year (one case per ~2.4-80.7 years by region), largely because most were of advanced maternal age and likely RhD-positive. Supports using RhD-positive blood in prehospital hemorrhagic shock when RhD-negative units are scarce.

Across 7 RCTs (>12,000 adults with TBI, spontaneous ICH, or SAH), TXA did not reduce short-term (RR 0.93, 0.86–1.00) or long-term mortality (RR 1.02) and did not improve neurological outcomes; its effect on rebleeding was inconclusive and thromboembolic events were not increased. Does not support routine TXA for intracranial hemorrhagic brain injury.

SR-MA quantifying the gap between blood supply and demand across low- and middle-income countries — directly relevant to trauma/hemorrhage resuscitation capacity and transfusion access in resource-limited settings. (PubMed abstract not yet available; based on title/metadata.)

Meta-analysis examining how patient sex and injury mechanism modify outcomes after massive transfusion in trauma — relevant to risk stratification and interpreting MT/whole-blood resuscitation trials.

In 955 anaemic elective cardiac surgery patients, preoperative IV iron modestly reduced red cell transfusion (61% vs 68%) and marginally improved days alive and at home at 90 days — supporting IV iron as part of patient blood management.

In 187 cancer patients with septic shock, a liberal (Hb 9 g/dL) vs restrictive (7 g/dL) transfusion strategy gave no difference in 12-h lactate clearance or 28-day mortality, but more thrombotic events with liberal — no support for routinely preferring either strategy.

Post hoc analysis of the ULTRA trial (812 aneurysmal SAH patients) found ultra-early, short-term TXA was associated with worse 6-month functional outcome in males (aOR 1.94, 95% CI 1.20–3.14) but not in females; reinforces that routine TXA cannot be recommended in aneurysmal SAH.

Meta-analysis (16 studies, 16,702 patients) found a pooled VAP incidence of 31.6% in ventilated patients with acute cerebrovascular disease; older age (≥65) and COPD were the most consistent risk factors — flagging targets for prevention in this understudied neurocritical population.

In 47,730 Australian/NZ major-trauma patients, defining traumatic shock as SBP ≤90 mmHg or shock index >1 flagged a subgroup with ~4x higher in-hospital mortality (30.9% vs 7.4%), giving a simple, reproducible bedside definition for a condition that still lacks consensus.

In 292 highest-tier trauma activations sampled within 1 h of injury (pre-transfusion), male and female patients showed distinct early plasma proteomic signatures (e.g., FCN3, SHBG, CERU, PZP, APOD) that persisted after adjustment for age, ISS, base deficit and lactate — suggesting sex-informed "endotyping" could refine precision trauma resuscitation.

Pooling TBI, spontaneous ICH, and SAH trials, TXA showed no benefit on short- or long-term mortality (RR 0.93 / 1.02), functional independence (RR 0.97), or dependence-or-death, and its effect on rebleeding remained inconclusive with no excess thromboembolism — arguing against routine TXA for intracranial hemorrhagic injury despite its extracranial hemorrhage-control role.

Prehospital NEWS discriminated short-term trauma mortality far better than shock index (AUROC 0.87–0.96 vs 0.48–0.79) and reliably predicted transfusion and resource needs; SI still flags patients needing urgent intervention (elevated >0.9) but performs poorly in geriatric and isolated-TBI patients — supporting NEWS for EMS trauma triage.

Pooling 5 RCTs (423 patients), ERAS components cut hospital stay by ~2.6 days and reduced postoperative pain in orthopedic trauma, but with low-to-moderate certainty and unresolved safety signals (numerically higher infection, unstable DVT estimate) — larger standardized trials still needed.

A practical review of angioembolization for trauma hemorrhage — now a cornerstone minimally invasive therapy — cataloguing complications from mild/self-limiting to endovascular failure requiring open surgery, to inform patient-selection and management decisions.

RBC transfusion reasons vary by intensity: hypotension and tachycardia were the top physiological triggers in non-major/major transfusions, but hypotension was cited far less in massive transfusion — arguing that transfusion intensity and clinical context, not hemoglobin alone, should frame transfusion-practice evaluation.

Practical framework for five GI oncologic emergencies (malignant obstruction, hemorrhage, perforation, cholangitis, neutropenic enterocolitis): resuscitation/sepsis control precede oncologic concerns, favor endoscopic/nonoperative options when feasible, and lower the threshold for diversion over primary anastomosis with recent antiangiogenic therapy, neutropenia, or heavy contamination.

A bedside whole-blood coagulometer (ClotChek) distinguished meaningfully anticoagulated apixaban/rivaroxaban patients from normals with high accuracy (AUC 0.91–0.96) — a potential rapid point-of-care test to guide reversal decisions in bleeding/trauma patients on DOACs, though it still needs clinical outcome validation.

In trauma patients receiving only 1–3 units of RBCs, early empiric calcium supplementation in hypocalcemic patients was independently associated with more AKI, ARDS, DVT, and PE — challenging the growing practice of giving calcium with the first unit of blood, at least in low-volume transfusion. Hypothesis-generating; single-center, retrospective.

In selected patients, non-operative management of penetrating liver injuries was associated with lower mortality (RR 0.40) and fewer complications (RR 0.83) than operative management, with no significant difference in transfusion or length of stay — supporting NOM as a viable option in appropriately selected, hemodynamically stable patients. Based on observational data only.

Bayesian reanalysis of MINT finds high probability (89–99%) that a liberal transfusion strategy (Hb >10 g/dL) lowers 30-day death/MI in anemic MI patients, modestly outweighing a small increase in heart failure risk — supports liberal transfusion in this population.

In matched cohorts (1,868 MRSA+ vs controls), preoperative MRSA colonization roughly doubled-to-tripled odds of sepsis, pneumonia, VTE, wound dehiscence, and transfusion after lower-extremity ortho trauma surgery — supports preop MRSA screening for risk stratification and possible decolonization.

Bayesian reanalysis of the "negative" cold-stored platelet trauma RCT (24h mortality 5.9% vs 10.2%, frequentist p=0.28) found an ~89% posterior probability that early cold-stored platelet transfusion reduces 24-hour mortality in patients at risk of hemorrhagic shock — suggesting a likely benefit that a definitive phase III trial should confirm.

Systematic review found platelet quality (pH, aggregation, metabolism) is preserved in DEHP-free plasticizer systems while DEHP leaches far more than alternatives, raising modeled recipient exposure especially in neonates/pediatrics — supports the ongoing transition to phthalate-free blood collection and storage without compromising transfusion performance.

A practical framework for anticoagulated hip-fracture patients that decouples the (looser) haemostatic threshold for surgery from the (stricter) threshold for neuraxial anaesthesia, and uses active reversal plus patient blood management to keep surgery within 24-48 h rather than passively waiting out drug clearance.

A Bayesian-network ML model risk-stratifies trauma-induced coagulopathy early after injury; in this national cohort 75% of patients at medium-or-higher TIC risk did NOT receive TXA within 1 h — suggesting ML triage could direct earlier, more targeted TXA to those most likely to benefit.

Synthesis of prehospital/transport REBOA use shows mixed mid- to long-term survival and no firm consensus on indications; underscores that field REBOA remains investigational in traumatic arrest.

In isolated mild TBI after ground-level falls, DOAC use was not associated with worse radiographic progression or outcomes, and pharmacologic reversal (4F-PCC or andexanet alfa) conferred no measurable benefit — supporting selective rather than routine reversal.

Among blunt pelvic-fracture patients (prehospital binder used in only 1.8%), binder use was not associated with lower 24-hour RBC transfusion volume or in-hospital mortality, but was associated with more pelvic angioembolization (33.0% vs 21.2%, OR 1.82) — suggesting binders shape or reflect downstream hemorrhage-control strategy rather than directly cutting transfusion needs.

Pediatric trauma-induced coagulopathy protocol: limit crystalloid to ≤20 mL/kg then switch to blood components, transfuse on clinical signs rather than labs alone, use thromboelastography to guide products, run an MTP at 1:1–1:2 plasma:RBC (whole blood preferred when available), give TXA for severe hemorrhage, and add enoxaparin VTE prophylaxis after stabilization in selected older/pubertal low-bleeding-risk patients.

In 1,013 transfused trauma patients (785 whole-blood-first), a WB-first strategy was associated with ~29% lower total 24-hour blood volume (ratio 0.71, 95% CI 0.55–0.90) with no significant effect modification by injury mechanism; the 30-day mortality estimate was non-significant and unstable (~30% missing labs).

RhD-positive whole blood/RBCs should not be withheld from RhD-negative females of childbearing potential when RhD-negative units are unavailable and transfusion is clinically indicated — immediate survival outweighs future reproductive risk (modeled perinatal-death risk ~0.04%; any HDFN-complicated future pregnancy ~0.6–6.5%). Recommends selective Rh immunoglobulin prophylaxis for low-volume exposures, structured antibody surveillance, counseling, multidisciplinary follow-up, and institutional protocols; also flags an equity gap — women are ~40% less likely than comparable men to receive whole blood.

Cochrane review of RBC volume per transfusion event — an area with minimal prior evidence despite "single-unit" Choosing Wisely guidance. Highlights that per-event transfusion volume practice (including in pediatrics/neonates) rests on sparse, low-certainty data, with no firm signal that a particular volume strategy improves mortality.

Retrospective multicenter cohort (IMADIS teleradiology workflow, 103 French EDs, 2020–2022) characterizing acute-on-chronic SDH vs isolated acute SDH in mild TBI and their association with radiological mass-effect markers — aimed at sharpening imaging-based risk stratification in complicated mTBI.

SR-MA of RCTs comparing balanced crystalloids vs normal saline for pediatric DKA resuscitation (primary outcomes: time to DKA resolution, new AKI) — adds to the broader critical-care debate on avoiding hyperchloremic acidosis with balanced fluids.

In isolated mild TBI after ground-level falls, DOAC use was not associated with worse radiographic progression or outcomes, and pharmacologic reversal (4F-PCC or andexanet) offered no measurable benefit — supporting selective rather than routine reversal.

Evidence for how to organize acute GI bleeding services is very thin — multidisciplinary and transfusion-free (bloodless) programs showed promise, but hub-and-spoke network affiliation alone did not improve risk-adjusted mortality.

This systematic review and Bayesian meta-analysis found no clear advantage of mechanical over manual bag-valve ventilation during CPR for return of spontaneous circulation, survival, or good neurological outcome, supporting current guidelines that do not recommend mechanical ventilation over manual ventilation during resuscitation.

In a 200-patient RCT of decompressive craniectomy for TBI, omitting watertight duraplasty gave similar complication rates, mortality (28% vs 24%), 6-month functional outcomes (GOS), and cranioplasty results, while significantly shortening operative time and reducing intraoperative blood loss — suggesting the watertight closure step can often be safely skipped.

This PRISMA systematic review (3 studies, 1,111 polytrauma patients with lumbar spine fractures) found early fixation (<72 h) was associated with fewer ventilator days (4.9 vs 7.8) and shorter ICU stay (10.9 vs 13.7 d) than late fixation, but with only three moderate-quality studies these effects remain uncertain, hospital length of stay was similar, and injury severity (ISS) was the dominant driver of outcomes.

Pooling 11 RCTs (4,136 adults ventilated after ROSC), restrictive/conservative oxygen targets showed no significant difference in all-cause mortality (RR 0.96) or unfavorable neurological outcome (RR 0.96) versus higher-oxygen targets; restrictive targets modestly increased ventilator-free days but raised hypoxemia risk (RR 1.65). Under current normothermia protocols the accumulated evidence trends toward futility for a restrictive approach.

Pooling 33 RCTs (2,864 patients), oxiracetam raised post-treatment MMSE by ~4.7 points after acute TBI when background therapy was balanced; evidence is limited to Chinese trials and overall certainty remains uncertain.

In 3,686 propensity-matched OHCA patients whose rhythm converted from non-shockable to shockable, amiodarone during resuscitation was associated with higher ROSC-on-admission (26.7% vs 23.0%), 24-hour survival (21.4% vs 14.7%), and survival to discharge (6.5% vs 4.2%); the gain in favourable neurological outcome was not statistically significant. Suggests a group currently outside the "after three shocks" guideline may still benefit from amiodarone.

Pooling 10 observational studies (5,183 ECPR patients), rhythm improvement (non-shockable to shockable) during CPR roughly tripled the odds of good neurological recovery (RR 3.12), while decay toward asystole strongly predicted failure (RR 0.20). Argues the rhythm trend during resuscitation, not just the initial rhythm, should inform ECPR candidacy.

Across six heterogeneous observational reports, ward-level AED capability before the code team arrives did not consistently improve survival or neurological outcomes in in-hospital cardiac arrest (largest multicentre cohort adjusted RR 1.01). Evidence is insufficient to recommend routine ward AEDs; earlier defibrillation must be weighed against compression interruptions.

In 108 acute brain-injury patients (7,089 paired readings), the two commercial pupillometry indices NPi and QPi correlated and both predicted poor 6-month outcome, but QPi was far more sensitive to propofol/sufentanil. The indices are not interchangeable in sedated ICU patients, and QPi's apparent link to raised ICP is likely confounded by sedation.

In 2,583 Danish bystander-witnessed OHCA patients surviving at least 30 days, a longer time from emergency call to ROSC was associated with worse long-term outcomes — more anoxic brain damage, more nursing-home admission, and lower return-to-work — reinforcing that minimizing time-to-ROSC matters not only for immediate survival but for functional recovery.

Using the Japanese JAAM-OHCA registry, the R-EDByUS score — derived from prehospital variables alone — was externally validated for predicting poor 1-month neurological outcome (CPC 3-5) in OHCA patients transported to tertiary centers, supporting its use for early risk stratification in both the prehospital-ROSC and ongoing-CPR groups.

Pooling 1,249 patients from two prehospital TXA trials and stratifying by TEG LY30, trauma patients in fibrinolytic shutdown who were randomized to TXA had a markedly lower risk of death (HR 0.32), while hyperfibrinolysis independently tripled mortality risk. Supports fibrinolysis profiling to target who benefits most from early TXA.

Using the international ADAPT pediatric severe-TBI dataset, this analysis tested whether decompressive craniectomy improves long-term functional independence in children — addressing a question with little high-quality evidence and informing how aggressively to pursue surgical decompression in pediatric TBI.

Latent class analysis of routine labs within 6 hours of ROSC in Singapore's national OHCA cohort identified three reproducible phenotypes — multi-organ dysfunction, homeostatic, and immune-dysregulated — that independently stratified neurological recovery and mortality out to 3 years. A step toward lab-based, phenotype-guided post-arrest care, pending external validation.

In the British Columbia registry, opioid-associated OHCA (13% of cases, median age 40) showed no overall difference in favourable neurological survival versus undifferentiated arrest, but the relationship between Utstein predictors and outcomes differed by sex, initial rhythm, and witnessed status — a caution that mixing opioid cases into observational OHCA analyses can distort findings.

In this 200-patient RCT, performing decompressive craniectomy for TBI without watertight duraplasty produced similar postoperative complications (CSF leak, infection, hydrocephalus, hygroma), mortality (28% vs 24%), 6-month GOS, and cranioplasty outcomes compared with watertight duraplasty — but with significantly shorter operative time and less intraoperative blood loss, arguing the dura need not be closed watertight during DC.

Across 15 studies (183,253 patients), evidence is still insufficient to say whether early/prehospital plasma helps or harms TBI patients — one cluster-RCT secondary analysis suggested lower 24-h and 30-day mortality with prehospital plasma among direct-scene transports at risk of hemorrhagic shock, but two small in-hospital trials showed no benefit (one signaling possible harm), all at very low certainty.

In 86 comatose severe-TBI patients, combining rTMS with median nerve electrical stimulation for 4 weeks produced higher awakening efficacy (93%) than either therapy alone (~62-66%), with better GCS/MoCA and cerebral blood-flow measures — an early signal that dual neuromodulation may aid arousal, though the trial is small and single-center.

A 2-site pilot RCT showed it is feasible to randomize ventilated subacute cervical SCI patients to moderate-low (8-10 mL/kg) vs moderate-high (14-16 mL/kg) tidal volumes, generating exploratory data on pneumonia, ventilator-free days, and inflammation — groundwork for a definitive trial rather than a practice change yet.

Across 16 guidelines/consensus documents, initial adult TBI care agrees on the fundamentals — early neurological assessment, airway protection, avoiding hypotension and hypoxemia, and timely CT — but still diverges on blood-pressure and cerebral-perfusion-pressure targets, repeat imaging, definitions of neurological deterioration, escalation/observation protocols, and seizure and VTE prophylaxis; the authors call for harmonizing definitions and pathways.

Across 19 studies (N=1113) in children with mild-to-severe TBI, cognitive behavioral therapy for insomnia was the most consistently effective treatment for post-injury sleep-wake disturbances and persistent post-concussion symptoms, while melatonin showed mixed, non-significant pooled effects.

In a multicenter registry analysis (31,055 patients; 16,922 propensity-matched), prehospital cervical spine immobilization was not associated with lower hospital mortality or better neurological outcome (GOS) — even in the subgroup with confirmed cervical spine injury — arguing against routine, undifferentiated immobilization.

In a propensity-matched TQIP analysis (174 pairs), starting hyperosmolar therapy (hypertonic saline or mannitol) within 3 h of admission in severe TBI did not change operative interventions or mortality versus a later start, but was associated with fewer ICU days and ventilator days.

Across 154,137 Japanese non-cardiac OHCA cases, bystander rescue-breathing CPR was associated with modestly lower 30-day mortality and unfavorable neurological outcomes versus compression-only CPR — the benefit concentrated in children and in drowning/asphyxial arrests, supporting rescue breaths when the arrest is non-cardiac.

In the All-Japan Utstein Registry (554,923 witnessed OHCA, 2005–2023), family-member-witnessed arrests had the lowest 1-month neurologically favorable survival (4.2% vs 10.1% for passersby vs 15.3% for friends/colleagues); the association reversed in the young (family-witnessed better at ages 20–40) but held for worse outcomes in the elderly — pointing to targeted CPR training for family members of high-risk older adults.

Across 27 EMS agencies in Connecticut (1,917 non-traumatic OHCA), a structured pit-crew CPR training program was associated with an immediate rise in ROSC (aOR 1.41) and a gradual increase in neurologically intact survival (aOR 1.20 per 4-month interval) after implementation, though overall survival to discharge did not change — supporting team-based resuscitation training within existing EMS systems.

Across 22 studies, AI models on non-contrast brain CT achieved strong diagnostic accuracy (many AUCs ≥0.90) for TBI findings but more variable prognostic performance; only 9 had external validation and prognostic models were all high risk of bias, so prospective multicenter validation is needed before clinical use.

Of 68,663 US TBI-related deaths in 2023, suicide (36%) was the leading cause ahead of unintentional falls (32%); rates were highest among adults ≥75, males, and American Indian/Alaska Native individuals. Directs prevention toward falls, firearm-suicide, and the highest-risk populations.

Of nine Australasian guidelines for moderate-to-severe paediatric TBI, only the PREDICT guideline rated high quality; hospital-based guidelines were methodologically weak, exposing a regional consensus gap for severe paediatric TBI.

In 970 adult ED patients with suspected TBI (GCS 13-15), a 15-minute whole-blood POC GFAP/UCH-L1 test predicted CT intracranial injury with 96.5% sensitivity and 96.5% NPV; the FDA-cleared platform supports rapid triage and CT sparing at the bedside.

Pooled VTE frequency in severe pediatric TBI was 7% (rising to 20% with central venous lines), driven by injury severity and multimodality treatment — arguing that VTE is an under-recognized risk warranting standardized surveillance and prophylaxis consideration in children.

New multidisciplinary consensus (42 recommendations) for managing TBI specifically in resource-constrained mass casualty incidents — covers on-site triage, tiered decision-making by injury severity, transport, in-hospital priority management, ICP monitoring, and early rehab. Fills a gap left by routine-practice TBI guidelines.

Decompressive craniectomy yields higher QALY gains than medical management but is costlier at 12 months; cost-effectiveness falls as injury severity rises and disappears at the extreme end. DC decisions should weigh both expected clinical benefit and cost, and favor patients at lower risk of unfavorable outcome.

In the TBI subgroup of the TRAIN trial, a liberal transfusion threshold (Hb <9 g/dL) was associated with fewer unfavorable neurological outcomes at 180 days than a restrictive threshold (Hb <7 g/dL): 58.5% vs 67.4% (RR 0.86, 95% CI 0.75–1.00; P=.047), with no excess infection or cerebral ischemia. Signal is fragile (fragility index 1) but pushes toward a higher transfusion trigger in anemic TBI patients.

In trauma patients aged 40–60 (ISS ≥9), pre-injury antithrombotic therapy raised coagulopathy rates (especially VKA/DOAC) but, after matching, showed no clinically relevant difference in mortality (6.5% vs 6.2%). Unlike in the elderly, anticoagulation may not independently worsen survival in middle-aged trauma.

Multimodal MRI synthesis finds pediatric mild TBI is associated with widespread white-matter microstructural disruption, prefrontal/parietal cortical thinning and hippocampal atrophy persisting up to a year, and network reorganization — evidence that "mild" pediatric TBI carries measurable, sometimes chronic, neurobiological changes. Mechanistic/imaging, not yet a management change.

Only 8.7% of RCTs underpinning critical care guidelines had no exclusion criteria; pregnancy, moribund status, renal/liver dysfunction and TBI were commonly excluded — a reminder to weigh external validity before applying guideline recommendations to complex ICU patients.

In patients with >=3 rib fractures and concomitant TBI, surgical stabilization of rib fractures (SSRF) was associated with markedly lower in-hospital mortality in focal TBI (OR 0.26) and diffuse TBI, with TBI phenotype modifying the benefit. Suggests concomitant TBI should not automatically exclude patients from SSRF.

National TQIP analysis (8,728 patients, 2017–2023) shows sharply rising e-scooter trauma; injuries were mostly mild-moderate but head/neck trauma caused 96% of the (low, 0.9%) deaths, helmet use was rare (12%) and alcohol present in 16.5% — reinforcing the case for helmet and prevention policy.

IPD meta-analysis of 2 RCTs (7,561 OHCA patients) found no significant difference between intraosseous-first and intravenous-first vascular access for 30-day survival (OR 1.01) or favorable neurologic outcome (OR 1.08); the ROSC point estimate slightly favored IV but was not significant.

Systematic review of 22 studies: AI on non-contrast head CT reaches high diagnostic accuracy (AUC often >0.90) for TBI findings and moderate-to-high prognostic discrimination, but nearly all studies are retrospective, only 9 had external validation, and all prognostic models were high risk of bias — not ready for routine clinical use without prospective multicenter validation.

In the Japanese pediatric OHCA registry, first post-ROSC PaCO2 category (hypo-, normo-, hypercapnia) showed no clear independent association with 30-day favorable neurologic outcome or survival, though estimates were imprecise — no strong signal to support a specific early CO2 target in children.

First resource-stratified guideline for blast/penetrating TBI in low-resource and conflict settings. Core message: aggressively avoid hypotension and hypoxia, use non-contrast head CT (add CTA for penetrating injury), hyperosmolar therapy first-line for raised ICP, noninvasive multimodal neuromonitoring when invasive ICP monitoring is unavailable, and prioritize early transfer to neurosurgical care.

Of 221 surgically treated cervical spinal cord injuries extubated without planned airway management, 23% needed emergency airway intervention. Neurogenic shock, complete motor impairment, and vertebral artery injury stratified risk (100% / 70% / 24% / 3% with all / two / one / no factors) — a practical way to flag who warrants prophylactic airway management or closer monitoring.

Scoping review that informed a 5-center New Zealand consensus VTE-prophylaxis guideline. Bottom line for trauma/TBI: mechanical prophylaxis (intermittent pneumatic compression) for essentially all patients, with LMWH started 24–72 h postoperatively — or after confirmed stable neuroimaging in TBI — consistently reducing VTE without a rise in major bleeding; timing and duration individualized by subgroup.

Umbrella review of 10 systematic reviews (42 primary studies) found no consistent evidence that non-invasive brain stimulation (rTMS or tDCS) improves cognition after TBI, and all underlying reviews were low or critically low quality by AMSTAR-2. Routine clinical use for post-TBI cognitive rehabilitation is not supported outside research or carefully selected cases.

Relatives of severely injured patients (mostly TBI cohorts) show high early rates of depression, anxiety and stress (28-56%) and reduced quality of life that persists long-term; ~50% report unmet information/emotional needs. Argues for standardizing significant-other outcome measures alongside patient PROMs in trauma care.

Across 70 studies, extremity injuries (including amputations) are the leading blast-injury pattern; body-region distribution differs between military and civilians (more head injuries in military, more thorax/abdomen in civilians), likely reflecting protective-equipment availability — useful for preparedness and resource planning.

A derived/internally-validated risk score classified ~45% of isolated-TBI patients as low risk, in whom early (<24 h) pharmacologic prophylaxis was associated with lower mortality, DVT, and PE. Associative and hypothesis-generating — prospective validation with serial imaging needed before use, but it reframes the "wait 72 h" default.

2.8% of acute SDH patients were readmitted with chronic SDH within 180 days, carrying substantial morbidity (26% functional decline, 34% needing evacuation). The validated PERSIST score stratifies risk (highest decile 7.1% vs lowest 0.7%) to flag patients who may warrant closer surveillance.

In pediatric trauma, hypothermia on arrival tracked with air-EMS transport (OR 1.74), firearm injury (OR 1.97), and TBI severity (up to OR 2.40); 8.2% had missing/invalid temperatures, more often in severely injured and Black/Hispanic children — pointing to concrete targets for prehospital warming and documentation QI.

State-of-the-art review frames trauma-related ARDS as a "multi-hit" process (initial injury + dysregulated inflammation + secondary insults like transfusion, infection, fat embolism); management stays largely supportive with lung-protective ventilation, multimodal imaging (CXR, lung ultrasound, CT) for risk stratification, pain control, hemodynamic optimization and timely surgery, with individualized approaches for TBI and hypothermia.

Beta-blockade in the ICU remains context-dependent: established benefit in acute MI, tachyarrhythmias, hypertensive emergencies, thyroid storm and variceal-bleed prevention, but evidence is limited/conflicting in septic shock, TBI, acute heart failure and burns. Safety depends on agent/dose, patient phenotype, timing, and whether it is continuation vs de novo initiation — argues for a phenotype-driven, physiology-guided approach.

In a 3,088-patient cohort of mild TBI, patients ≥75 years (55% of the cohort) were scanned 98% of the time; a multivariable risk model had only moderate discrimination (AUC 0.69) and could safely cut CT use by just 1.5% at 100% sensitivity — rule-out strategies offer little practical benefit for reducing head CT in the very elderly.

ARDS complicates up to a third of acute brain injury patients and forces a real trade-off — lung-protective low-tidal-volume/higher-PEEP ventilation raises PaCO2 and can worsen intracranial pressure, while tight CO2 control deviates from ARDS strategy. Argues for physiology-driven, patient-specific ventilation guided by multimodal neuromonitoring (ICP, brain tissue oxygenation) rather than protocolised care.

Across 7 RCTs (>12,000 adults with TBI, spontaneous ICH, or SAH), TXA did not reduce short-term (RR 0.93, 0.86–1.00) or long-term mortality (RR 1.02) and did not improve neurological outcomes; its effect on rebleeding was inconclusive and thromboembolic events were not increased. Does not support routine TXA for intracranial hemorrhagic brain injury.

In children with blunt trauma, cervical spine CT was highly sensitive for clinically significant injury (98.7% after accounting for retrospectively identifiable injuries) with a negative predictive value of ~100%, supporting definitive pediatric c-spine clearance based on a normal CT.

Evidence on flying after decompressive craniectomy for severe TBI is heterogeneous; secondary physiological insults in transit — not elapsed postop time or a fixed intracranial-air threshold — drive risk, supporting a structured defer/conditional/ready fitness-to-fly pathway.

In ventilated acute brain injury patients, higher tidal volume helped only when respiratory system elastance was low; optimal tidal volume falls and optimal rate rises as elastance increases, with ~1 cmH2O driving pressure ≈ 3 breaths/min in prognostic weight — argues for elastance/driving-pressure-guided settings.

Meta-analysis (16 studies, 16,702 patients) found a pooled VAP incidence of 31.6% in ventilated patients with acute cerebrovascular disease; older age (≥65) and COPD were the most consistent risk factors — flagging targets for prevention in this understudied neurocritical population.

Across 467 resuscitative thoracotomy patients, EAST (signs of life) and WTA (prehospital arrest time) guidelines identified similar survivor subsets (survival ~6–7%, neurologically intact ~5–6%); both signs of life and arrest duration matter, supporting development of a unified RT guideline.

SSRF showed no mortality benefit over non-operative management in isolated flail chest, but in flail-chest patients with severe TBI it was linked to lower in-hospital mortality (OR 0.28) — though at the cost of longer ICU stay and more VAP/tracheostomy across both groups.

Pooling TBI, spontaneous ICH, and SAH trials, TXA showed no benefit on short- or long-term mortality (RR 0.93 / 1.02), functional independence (RR 0.97), or dependence-or-death, and its effect on rebleeding remained inconclusive with no excess thromboembolism — arguing against routine TXA for intracranial hemorrhagic injury despite its extracranial hemorrhage-control role.

Prehospital NEWS discriminated short-term trauma mortality far better than shock index (AUROC 0.87–0.96 vs 0.48–0.79) and reliably predicted transfusion and resource needs; SI still flags patients needing urgent intervention (elevated >0.9) but performs poorly in geriatric and isolated-TBI patients — supporting NEWS for EMS trauma triage.

Intra-arrest TEE is highly feasible (80–100% insertion, few complications), shifts chest-compression position in 19–76% of cases and alters management in 31–48%, and links compressions over the LVOT/aortic valve to worse ROSC — yet the two existing RCTs show no improvement in survival or neurological outcome, so its patient-centred benefit remains unproven.

Adding early (6-hour) processed EEG metrics (suppression ratio, BIS) to routine clinical/lab data significantly improved ML prediction of poor neurological outcome after cardiac arrest (AUC 0.88 long-term, 0.86 at discharge) versus either data source alone — a promising early risk-stratification aid pending external validation.

Across 56 studies (1,248 patients), covert consciousness (CMD) was more often detected after traumatic brain injury than anoxic or cerebrovascular injury and was independent of time since injury, task, or modality — reinforcing standardized neurodiagnostic protocols in unresponsive brain-injured patients.

Across 101 studies, secondary personality disorder affected ~29% of TBI survivors and broad personality change ~68%; changes (irritability, emotional instability, aggression, withdrawal) persist long-term, yet evidence on treatment is almost absent — a major unmet management gap.

Early enteral nutrition (<48h) in TBI trended toward lower short-term mortality (significant in the RCT-only sensitivity analysis, RR 0.58) and reduced ventilation time, ICU/hospital stay, sepsis, VAP, and stress ulcers versus delayed feeding, with only more diarrhea — but high bias and heterogeneity mean larger RCTs are still needed.

Pooling 6 studies (926 patients), no significant link between time-to-surgery and mortality or function in acute subdural hematoma — the classic "4-hour rule" is confounded by indication (sicker patients get operated faster), not evidence that speed lacks benefit.

New consensus guideline for early treatment and evacuation of TBI at sea, where imaging, monitoring, and evacuation windows are severely constrained; centers on reducing secondary brain injury via on-scene triage, tiered decision-making under limited imaging, platform-capability classification, minimum en-route monitoring, and maritime-specific risk management.

Trauma kills 4.5M people/year with 84% of deaths in low/middle-income countries; over 1M deaths could be averted annually if LMIC case-fatality matched high-income levels. Long-term priorities are more blood availability, better TBI care, and improved prehospital care; immediate opportunities include trauma short courses, QI programs, an international trauma registry for benchmarking, and IATSIC-based needs assessments.

In comatose post-arrest patients in whom life support was NOT withdrawn (minimizing self-fulfilling-prophecy bias), having >=2 unfavorable guideline-recommended markers within 14 days predicted poor 12-month outcome with zero false positives (adjusted OR 34.7); adding the Coma Recovery Scale-Revised improved discrimination — supports repeated, multimodal prognostication.

Pooled diagnostic accuracy for primary blast TBI was high (sensitivity 0.93, specificity 0.90, AUC 0.96), but biomarker and neuroimaging tools are impractical in acute battlefield settings; VOMS-based vestibular/ocular screening and the structured BATL-2 instrument are better suited for front-line use.

US emergency-department spine injuries from e-scooters, e-bikes, and hoverboards rose ~8.4-fold over a decade (mostly fractures, predominantly in adult males) — a fast-growing trauma burden that warrants clinical anticipation and prevention/counseling efforts.

Withdrawal of life-sustaining treatment occurs earlier in moderate-to-severe TBI than in other trauma and is driven by distinct neuro-specific factors (diffuse axonal injury, decompressive surgery, ICP monitoring); accumulating complications — the first four mattering most — may serve as practical triggers for goals-of-care discussions.

ML/DL models (including transformers and gradient boosting) can outperform GCS-based tools for detecting injury and predicting outcomes in pediatric TBI, but heterogeneity and limited external validation keep them pre-clinical.

Authoritative ICM review argues for moving beyond fixed ICP thresholds toward individualized, multimodal-guided management in TBI and other acute brain injury—reframing how ICP data should drive bedside decisions.

In alert patients with neck pain but normal exam and normal static CT, delayed flexion-extension films identified no surgically relevant unstable injury—arguing against routine use and for CT-based clearance instead.

Over a decade, moderate-plus (MAIS2+) mobility-scooter injuries rose 38% (91% in ages 70-79), with rollover the commonest mechanism and traumatic brain injuries more than doubling (+103%); ~30% required admission — a growing elderly trauma burden warranting targeted prevention.

Synthesis of 32 studies identifies the main unmet needs of caregivers of people with moderate-to-severe TBI — information, mental-health support, hope, financial assistance, education of the social network, and peer support — to guide targeted caregiver-support interventions.

IPD meta-analysis of 56 studies (1,248 patients) found covert consciousness (volitional brain responses without behavioral output) is common but varies by etiology — less detectable after anoxic or cerebrovascular injury than after TBI, and more common in minimally conscious state minus. Detection was independent of time since injury, task paradigm, and modality, arguing for standardized protocols in neuro-ICU prognostication.

Portuguese national consensus proposes a decision algorithm combining the Canadian CT Head Rule with serum GFAP/UCH-L1 to safely avoid head CT in GCS 14–15 patients within 12 hours of injury; negative biomarkers in moderate-risk patients permit discharge without CT, and patients ≥75 need repeat CT rather than repeat biomarkers because baseline levels are elevated.

In isolated mild TBI after ground-level falls, DOAC use was not associated with worse radiographic progression or outcomes, and pharmacologic reversal (4F-PCC or andexanet alfa) conferred no measurable benefit — supporting selective rather than routine reversal.

Pooling 4–5 observational studies (~350–380 adults), abnormal quantitative pupillometry (NPi <3 or absent reflex) within 72 h of TBI was associated with higher in-hospital mortality (OR 1.84) and ~3.6× odds of poor 3–6 month functional outcome; supports the Neurological Pupil Index as a bedside prognostic tool, though heterogeneity is high and controlled validation is still needed.

Retrospective multicenter cohort (IMADIS teleradiology workflow, 103 French EDs, 2020–2022) characterizing acute-on-chronic SDH vs isolated acute SDH in mild TBI and their association with radiological mass-effect markers — aimed at sharpening imaging-based risk stratification in complicated mTBI.

Review arguing that fixed cerebral perfusion pressure thresholds miss individual autoregulation; noninvasive bedside transcranial Doppler can help personalize perfusion-pressure targets in acute brain injury.

Giving hormone replacement therapy to catastrophic-brain-injury patients before brain death was associated with significantly higher odds of organ donation; the methylprednisolone + levothyroxine combination had the greatest effect, supporting a standardized HRT protocol across trauma centers.

In isolated mild TBI after ground-level falls, DOAC use was not associated with worse radiographic progression or outcomes, and pharmacologic reversal (4F-PCC or andexanet) offered no measurable benefit — supporting selective rather than routine reversal.

A decision-tree CDS tool (BATDOK + TBI module) did not increase overall completion of critical actions in simulated en-route TBI care, but improved guideline-concordant tiered sequencing of ICP interventions and rated well on usability — early feasibility signal for en-route decision support.

Prehospital physician attendance was associated with better 30-day neurological outcome (aOR 1.49), with the strongest signal in unwitnessed arrests and no benefit detected in patients who received ECPR — hypothesis-generating for how physician-staffed units should be dispatched.

In 158 neurologically intact thoracolumbar trauma patients, adding emergency MRI to CT changed management in 12% — almost entirely by revealing posterior ligamentous complex injuries CT missed (48 vs 16 PLC injuries). Supports indication-driven, not routine, MRI.

This systematic review and Bayesian meta-analysis found no clear advantage of mechanical over manual bag-valve ventilation during CPR for return of spontaneous circulation, survival, or good neurological outcome, supporting current guidelines that do not recommend mechanical ventilation over manual ventilation during resuscitation.

Pooling 11 RCTs (4,136 adults ventilated after ROSC), restrictive/conservative oxygen targets showed no significant difference in all-cause mortality (RR 0.96) or unfavorable neurological outcome (RR 0.96) versus higher-oxygen targets; restrictive targets modestly increased ventilator-free days but raised hypoxemia risk (RR 1.65). Under current normothermia protocols the accumulated evidence trends toward futility for a restrictive approach.

In 590 trauma and burn patients across three regional centers, higher early fibrinolytic activation predicted death: admission plasmin-antiplasmin >=1645.6 ng/mL carried ~7x and D-dimer >=6.5 ug/mL ~5x higher adjusted odds of mortality. Trauma patients showed higher fibrinolytic markers than burn patients but similar trajectories, suggesting shared resuscitative adjuncts could target early fibrinolytic dysfunction in both.

In this 79-patient phase II RCT, starting angiotensin II, vasopressin, and norepinephrine together early in septic shock sped the fall in renin and lactate, lowered 72-h SOFA, and sharply cut tachyarrhythmias (15.6% vs 68.6%) versus stepwise escalation — promising physiology that was not powered to show a mortality benefit.

In 3,686 propensity-matched OHCA patients whose rhythm converted from non-shockable to shockable, amiodarone during resuscitation was associated with higher ROSC-on-admission (26.7% vs 23.0%), 24-hour survival (21.4% vs 14.7%), and survival to discharge (6.5% vs 4.2%); the gain in favourable neurological outcome was not statistically significant. Suggests a group currently outside the "after three shocks" guideline may still benefit from amiodarone.

Pooling 10 observational studies (5,183 ECPR patients), rhythm improvement (non-shockable to shockable) during CPR roughly tripled the odds of good neurological recovery (RR 3.12), while decay toward asystole strongly predicted failure (RR 0.20). Argues the rhythm trend during resuscitation, not just the initial rhythm, should inform ECPR candidacy.

Across six heterogeneous observational reports, ward-level AED capability before the code team arrives did not consistently improve survival or neurological outcomes in in-hospital cardiac arrest (largest multicentre cohort adjusted RR 1.01). Evidence is insufficient to recommend routine ward AEDs; earlier defibrillation must be weighed against compression interruptions.

In 2,583 Danish bystander-witnessed OHCA patients surviving at least 30 days, a longer time from emergency call to ROSC was associated with worse long-term outcomes — more anoxic brain damage, more nursing-home admission, and lower return-to-work — reinforcing that minimizing time-to-ROSC matters not only for immediate survival but for functional recovery.

Using the Japanese JAAM-OHCA registry, the R-EDByUS score — derived from prehospital variables alone — was externally validated for predicting poor 1-month neurological outcome (CPC 3-5) in OHCA patients transported to tertiary centers, supporting its use for early risk stratification in both the prehospital-ROSC and ongoing-CPR groups.

Pooled systematic review and meta-analysis comparing two bedside physiologic triage scores — the Shock Index Pediatric Age-adjusted (SIPA) and the reverse Shock Index multiplied by GCS (rSIG/rSIM) — for predicting mortality in injured children. Informs which score better flags high-risk pediatric trauma patients for early intervention.

Large nationally representative cohort assessing whether impedance threshold device (ITD) use during non-traumatic out-of-hospital cardiac arrest is associated with better prehospital and longer-term outcomes, where prior evidence has been equivocal.

Across 12 studies (234,129 patients), RTS and ISS performed similarly for predicting trauma mortality (AUC ~0.85) and did not differ in a formal paired comparison, while the simpler Shock Index was weaker (AUC 0.75); none reliably rules death in or out alone. The authors argue SI/RTS (acute triage) and ISS (later anatomical benchmark) are complementary roles, not competing scores to rank.

Latent class analysis of routine labs within 6 hours of ROSC in Singapore's national OHCA cohort identified three reproducible phenotypes — multi-organ dysfunction, homeostatic, and immune-dysregulated — that independently stratified neurological recovery and mortality out to 3 years. A step toward lab-based, phenotype-guided post-arrest care, pending external validation.

In the first binational pediatric OHCA registry report (2017-2023), survival to 30 days/discharge among EMS-treated children was 10% (lowest in infants at 7.9%), with a bimodal incidence peaking in infants and adolescents. Bystander-witnessed arrest, initial shockable rhythm, etiology, older age, and EMS response time predicted survival — arguing for age- and context-specific prevention and resuscitation strategies.

In the British Columbia registry, opioid-associated OHCA (13% of cases, median age 40) showed no overall difference in favourable neurological survival versus undifferentiated arrest, but the relationship between Utstein predictors and outcomes differed by sex, initial rhythm, and witnessed status — a caution that mixing opioid cases into observational OHCA analyses can distort findings.

Across 15 studies (183,253 patients), evidence is still insufficient to say whether early/prehospital plasma helps or harms TBI patients — one cluster-RCT secondary analysis suggested lower 24-h and 30-day mortality with prehospital plasma among direct-scene transports at risk of hemorrhagic shock, but two small in-hospital trials showed no benefit (one signaling possible harm), all at very low certainty.

In 9 studies (10,785 patients with nonvariceal upper GI bleeding), ultra-early endoscopy (<=6 h) did not reduce mortality, rebleeding, transfusion, surgery, or length of stay versus early endoscopy (>6 h), but was linked to more ICU admissions — supporting adequate resuscitation and endoscopy within the standard 24-h window rather than rushing to <=6 h.

Systematic review of economic evaluations of prehospital OHCA care found the evidence base limited and inconsistently reported, with health-equity dimensions (PROGRESS framework) largely neglected — a call for standardized economic and equity reporting in resuscitation research.

Across 16 guidelines/consensus documents, initial adult TBI care agrees on the fundamentals — early neurological assessment, airway protection, avoiding hypotension and hypoxemia, and timely CT — but still diverges on blood-pressure and cerebral-perfusion-pressure targets, repeat imaging, definitions of neurological deterioration, escalation/observation protocols, and seizure and VTE prophylaxis; the authors call for harmonizing definitions and pathways.

In a propensity-matched single-center comparison (321 blast vs 1,481 matched blunt patients), blast trauma imposed a far higher institutional resource burden — about 3.4x the composite of prolonged stay, ICU admission, or urgent surgery — with markedly higher odds of shock-room triage (OR 10.6), ≥3 operations (OR 12.4), massive-transfusion activation (OR 11.7), and ICU admission (OR 5.5), persisting across all injury-severity strata; relevant to mass-casualty and blast-event resource planning.

Pooling 6 studies (3 RCTs, 3 cohorts; 4,040 patients), prehospital whole blood did not improve 24-hour (RR 1.00) or 28/30-day mortality (RR 1.09) versus standard care; an apparent reduction in 24-hour RBC requirements lost significance on sensitivity analysis and was driven by observational cohorts at serious risk of bias — tempering expectations of a survival benefit from prehospital whole blood.

In 79 septic shock patients on >=0.15 ug/kg/min norepinephrine, starting angiotensin II + vasopressin + norepinephrine together (vs classic stepwise) sped renin and lactate clearance, cut 72-h SOFA by 3 points vs 0, and sharply reduced tachyarrhythmias (15.6% vs 68.6%); ICU and 28-day mortality were not significantly different in this phase II trial, so it is hypothesis-generating for a larger study.

In a bench comparison of six portable blood warmers using cold-stored whole blood, the MWarmer gave the most consistent warming (outlet 40–41°C across pressures) while the LifeWarmer Quantum was fastest but warmed poorly under pressure — supporting the MWarmer for far-forward/austere trauma resuscitation.

Older trauma patients fare worse because of reduced physiologic reserve, preinjury comorbidities, and geriatric-specific syndromes; a proactive, multidisciplinary approach — early team activation, prompt resuscitation, comorbidity and syndrome management, and a focus on functional recovery — improves outcomes.

In 6,082 adults with OHCA, an intraosseous-first vascular-access strategy was more likely harmful than beneficial versus intravenous-first (81.6% posterior probability of inferiority for 30-day survival; 98% for ROSC), though any effect is likely modest — reinforcing IV-first access as the default in adult OHCA.

Across 154,137 Japanese non-cardiac OHCA cases, bystander rescue-breathing CPR was associated with modestly lower 30-day mortality and unfavorable neurological outcomes versus compression-only CPR — the benefit concentrated in children and in drowning/asphyxial arrests, supporting rescue breaths when the arrest is non-cardiac.

Across 560,240 non-traumatic OHCA encounters in the ESO Data Collaborative (2018–2024), EMS agencies varied widely in non-initiation of resuscitation (MOR 2.30) and in applying termination-of-resuscitation for TOR-eligible patients (MOR 4.13) even after case-mix adjustment — flagging substantial unwarranted variation in prehospital resuscitation decision-making.

Across 9 studies (10,785 adults with nonvariceal upper GI bleeding), ultra-early endoscopy (≤6 h) did not reduce mortality (OR 0.88) or rebleeding versus early endoscopy (>6 h), and did not change transfusion, surgery, or length of stay — but was associated with more ICU admissions (OR 1.41). Supports adequate resuscitation and timely endoscopy within the standard 24-h window rather than rushing to ≤6 h.

In the All-Japan Utstein Registry (554,923 witnessed OHCA, 2005–2023), family-member-witnessed arrests had the lowest 1-month neurologically favorable survival (4.2% vs 10.1% for passersby vs 15.3% for friends/colleagues); the association reversed in the young (family-witnessed better at ages 20–40) but held for worse outcomes in the elderly — pointing to targeted CPR training for family members of high-risk older adults.

In the prospective multicenter BASIC-OHCA cohort (33,650 EMS-treated OHCA in China), women had higher adjusted odds of prehospital ROSC (OR 1.21) and survival to admission (OR 1.33) but no advantage by discharge or 30 days, and fared worse than men in key subgroups (age ≥50, shockable rhythm, no prehospital epinephrine) — an early female advantage lost during hospital care, flagging a disparity to target.

Across 27 EMS agencies in Connecticut (1,917 non-traumatic OHCA), a structured pit-crew CPR training program was associated with an immediate rise in ROSC (aOR 1.41) and a gradual increase in neurologically intact survival (aOR 1.20 per 4-month interval) after implementation, though overall survival to discharge did not change — supporting team-based resuscitation training within existing EMS systems.

A European expert panel endorsed the ultra-short-acting β1-blocker landiolol for rate control in selected septic-shock patients with new-onset AF — correct reversible triggers first, assess hemodynamics before rate control, start without a bolus at low doses titrated to an initial HR target <110 bpm under echo/hemodynamic monitoring. No consensus was reached on optimal duration or use with severe LV dysfunction.

In a 4-year Victorian OHCA registry, 0.8% of arrests were caused by foreign-body airway obstruction. Magill's forceps and intubation were the most effective interventions for restoring ventilation (73% each), whereas laryngeal mask airways were commonly used but rarely effective (7%). Survival was dismal (3.6% overall; zero survivors among patients >65), reinforcing the primacy of prompt bystander relief and the need to assess futility.

Trauma-informed care practices (introductions, verbal/physical reassurance, complete exam) were delivered inconsistently during acute resuscitation, and Spanish-speaking patients received markedly less trauma-informed communication and fewer complete exams than English speakers — flagging an equity gap now that TIC is in ATLS recommendations.

In aortic dissection/aneurysm transports, esmolol, labetalol, or nicardipine as single agents achieved similar odds of hitting HR/SBP targets versus combinations; labetalol alone had the least hypotension and esmolol the most — suggesting single-agent therapy is a reasonable option when combination beta+CCB isn't feasible en route.

Physiology-first, segment-specific playbook for traumatic IVC injury — prioritize hemodynamics over imaging, use damage-control resuscitation and primary venorrhaphy when feasible, and reserve endovascular/hybrid or nonoperative approaches for stable patients with contained bleeding and immediate open-conversion capability.

Across 8 studies (8,173 patients, 7 RCTs), balanced crystalloids reduced mortality vs saline (RR 0.92, 95% CI 0.86–0.98; moderate certainty) plus less AKI, hyperchloremia, and RRT, and more ICU/ventilator/vasopressor-free days. Supports preferring balanced crystalloids over saline in sepsis resuscitation.

In ICU patients on CRRT or sustained low-efficiency dialysis (many also on ECMO), actual body weight plus RRT intensity and duration were the main determinants of vancomycin exposure. Monte Carlo simulation produced an optimised dosing nomogram to hit the MRSA efficacy target (AUC/MIC ≥400) while staying below the toxicity threshold (AUC ≥700).

Updated WTA critical-decisions algorithm for the mangled extremity — structured guidance on assessment, resuscitation, revascularization sequencing, and limb salvage versus early amputation decision-making after severe extremity trauma.

A 20-expert modified Delphi produced 35 consensus criteria for pediatric prehospital blood transfusion: eligibility = known/suspected severe hemorrhage PLUS ≥1 shock indicator after first-line hemorrhage control PLUS EMS clinical judgment; aims to standardize highly variable pediatric PHT protocols (no consensus reached on EtCO2).

IPD meta-analysis of 2 RCTs (7,561 OHCA patients) found no significant difference between intraosseous-first and intravenous-first vascular access for 30-day survival (OR 1.01) or favorable neurologic outcome (OR 1.08); the ROSC point estimate slightly favored IV but was not significant.

In 3,263 confirmed OHCA calls, ≥1 barrier to dispatcher-assisted CPR occurred after arrest recognition in 44% (most often inability to move the patient). Barrier-present calls had lower bystander-CPR initiation, lower ROSC (aRR 0.89) and markedly lower 30-day survival (aRR 0.57) — a concrete target for improving dispatch call handling.

Across 8,577 Impella-treated cardiogenic shock patients, in-hospital cardiac arrest before implantation marked a distinct high-risk phenotype (30-day mortality 48% vs 29% no-arrest; adjusted HR 1.54) with more bleeding, limb ischemia, stroke and sepsis; lactate >4, creatinine >1.5, longer arrest time and VA-ECMO predicted death, supporting early risk stratification.

In the Japanese pediatric OHCA registry, first post-ROSC PaCO2 category (hypo-, normo-, hypercapnia) showed no clear independent association with 30-day favorable neurologic outcome or survival, though estimates were imprecise — no strong signal to support a specific early CO2 target in children.

First resource-stratified guideline for blast/penetrating TBI in low-resource and conflict settings. Core message: aggressively avoid hypotension and hypoxia, use non-contrast head CT (add CTA for penetrating injury), hyperosmolar therapy first-line for raised ICP, noninvasive multimodal neuromonitoring when invasive ICP monitoring is unavailable, and prioritize early transfer to neurosurgical care.

Pooling 19 RCTs (11,982 patients), LMA gave faster airway placement and higher first-pass and CPR success than endotracheal intubation, with no difference in survival or mortality — supporting LMA as a reasonable, individualized alternative, especially where intubation expertise is limited or chest-compression interruptions must be minimized.

In 716 injured adults not on antiplatelet drugs, increasing age was independently associated with lower platelet count and aggregation alongside hypercoagulable clot dynamics; in patients ≥55, low count and reduced aggregation at admission suggested higher mortality — flagging age-related platelet dysfunction as a potential target in resuscitation of older trauma patients.

Of 221 surgically treated cervical spinal cord injuries extubated without planned airway management, 23% needed emergency airway intervention. Neurogenic shock, complete motor impairment, and vertebral artery injury stratified risk (100% / 70% / 24% / 3% with all / two / one / no factors) — a practical way to flag who warrants prophylactic airway management or closer monitoring.

Among 84 hemorrhagic-shock patients who received both blood and intubation within 30 min, a circulation-first approach (CAB — blood before the tube) showed no difference in mortality or hospital length of stay versus airway-first (ABC), challenging the long-standing convention of intubating before transfusing. LITES centers favored CAB for penetrating trauma. Small sample limits generalizability and the authors call for prospective multicenter trials.

Across 9,423 pediatric in-hospital cardiac arrests (2000–2023), asystole carried lower odds of ROSC and restoration of circulation than PEA, but the survival-to-discharge difference was driven almost entirely by neonates/NICU events — in older children survival did not differ. Challenges lumping PEA and asystole together as one "non-shockable" category.

CPR-induced consciousness occurred in 3.3% of OHCA and rose over 16 years; it was independently associated with markedly better survival to discharge (OR 2.71), so signs of consciousness during CPR may flag favourable physiology rather than a reason to interrupt resuscitation.

Hantavirus cardiopulmonary syndrome remains highly lethal (20.5% in-hospital mortality; ~30-33% among those needing mechanical ventilation or ECMO) and demands heavy respiratory support; mortality rose during the COVID-19 pandemic, underscoring ICU surge vulnerability.

Pooling 8 studies (8,173 patients; 7 RCTs), balanced crystalloids reduced mortality versus normal saline (RR 0.92, 95% CI 0.86-0.98) with fewer episodes of acute kidney injury, hyperchloremia, and renal replacement therapy, plus more ICU-, ventilator-, and vasopressor-free days — supporting preferential use of balanced solutions over saline for fluid resuscitation in sepsis (moderate certainty).

Across all of Denmark, prehospital surgical cricothyroidotomy is exceedingly rare (71 cases in 8 years) but had high procedural success (87%) in a physician-staffed EMS system; survival was low, reflecting the extremis of patients needing it. Benchmarks the "can't intubate, can't oxygenate" rescue airway.

Among 152 hemodynamically unstable major pelvic-ring injuries, in-hospital mortality was 7.2% and haemorrhage-related mortality just 2% (MTP activated in 45%, angioembolisation in only 5.9%) — reinforcing that mature trauma systems can achieve very low pelvic-haemorrhage mortality.

EAST's annual roundup distills 13 practice-shaping 2025 studies (RCTs + large multicenter cohorts) spanning early resuscitation, timing of lifesaving interventions, analgesia/sedation, ventilator management, infection prevention, transfusion timing, perioperative antibiotics, imaging in older adults, and pediatric trauma pathways — a ready-made map of what changed this year.

PHBTC (aligned with AABB) formally defines the scope and duties of EMS Blood Program Coordinators/Managers — storage and transport validation, continuous component monitoring, standardized education, regulatory compliance, and interagency coordination — to make civilian prehospital whole-blood programs safe and reproducible across diverse EMS systems.

New AAST/ACS-COT protocol standardizes nutrition in adult trauma: screen all for malnutrition, use indirect calorimetry in the critically ill, start early enteral feeds once resuscitation is complete (continuous gastric, post-pyloric if high aspiration risk), reserve parenteral nutrition for enteral contraindications, and individualize enteral timing in shock/vasopressors given mesenteric ischemia risk; immunonutrition, glutamine, and pro/prebiotics are not recommended.

Beta-blockade in the ICU remains context-dependent: established benefit in acute MI, tachyarrhythmias, hypertensive emergencies, thyroid storm and variceal-bleed prevention, but evidence is limited/conflicting in septic shock, TBI, acute heart failure and burns. Safety depends on agent/dose, patient phenotype, timing, and whether it is continuation vs de novo initiation — argues for a phenotype-driven, physiology-guided approach.

Austrian multi-society consensus offers guidance on when resuscitative thoracotomy for traumatic cardiac arrest is justified in predominantly blunt-trauma systems, where the evidence and expected benefit differ from penetrating-trauma-heavy settings.

UK Faculty of Pre-Hospital Care consensus de-emphasizes aggressive fluid loading and reframes hyperkalaemia concerns in prehospital crush injury/crush syndrome, giving practicable recommendations for developed-system EMS.

Delphi consensus of 24 ICU experts sets lab/blood-count thresholds for safe early mobilization (hemoglobin, platelets, lactate, INR, pH, potassium), recommends deferring mobilization during transfusion, and flags Hb drop ≥2 g/dL/24h or platelet fall ≥20%/24h as contraindications.

Across 264 VA-ECMO patients at two high-volume centers, LV unloading (Impella or IABP) was not associated with lower 60-day mortality and carried more device-related complications, arguing for phenotype-driven rather than routine unloading.

FAST sensitivity is strongly volume-dependent — only 14% at 250 mL, 37% at 500 mL, but 74% at 1000 mL and 91% at 1500 mL — so a negative FAST does not exclude significant intra-abdominal bleeding in an unstable patient. Longitudinal (vs transverse) views of the Douglas pouch boosted sensitivity by >20%; Morison's pouch had the highest yield.

Modeling the real-world cohort of 957 females of childbearing potential given prehospital RhD-positive products puts the future HDFN risk at only ~0.2-0.3% per year (one case per ~2.4-80.7 years by region), largely because most were of advanced maternal age and likely RhD-positive. Supports using RhD-positive blood in prehospital hemorrhagic shock when RhD-negative units are scarce.

SR-MA quantifying the gap between blood supply and demand across low- and middle-income countries — directly relevant to trauma/hemorrhage resuscitation capacity and transfusion access in resource-limited settings. (PubMed abstract not yet available; based on title/metadata.)

Meta-analysis examining how patient sex and injury mechanism modify outcomes after massive transfusion in trauma — relevant to risk stratification and interpreting MT/whole-blood resuscitation trials.

In 187 cancer patients with septic shock, a liberal (Hb 9 g/dL) vs restrictive (7 g/dL) transfusion strategy gave no difference in 12-h lactate clearance or 28-day mortality, but more thrombotic events with liberal — no support for routinely preferring either strategy.

In 256 circulatory shock patients, 48-hour mean cerebral tissue oxygen saturation (NIRS) did not predict delirium, but lower values were associated with higher 90-day mortality — suggesting cerebral NIRS may flag mortality risk rather than delirium.

Across 467 resuscitative thoracotomy patients, EAST (signs of life) and WTA (prehospital arrest time) guidelines identified similar survivor subsets (survival ~6–7%, neurologically intact ~5–6%); both signs of life and arrest duration matter, supporting development of a unified RT guideline.

In 47,730 Australian/NZ major-trauma patients, defining traumatic shock as SBP ≤90 mmHg or shock index >1 flagged a subgroup with ~4x higher in-hospital mortality (30.9% vs 7.4%), giving a simple, reproducible bedside definition for a condition that still lacks consensus.

In 292 highest-tier trauma activations sampled within 1 h of injury (pre-transfusion), male and female patients showed distinct early plasma proteomic signatures (e.g., FCN3, SHBG, CERU, PZP, APOD) that persisted after adjustment for age, ISS, base deficit and lactate — suggesting sex-informed "endotyping" could refine precision trauma resuscitation.

k-means clustering of nine routine ED variables in the Korean Sepsis Alliance registry identified six reproducible sepsis phenotypes (7-day mortality 6.7%–31.8%) that behave as a continuous severity spectrum; decomposing bundle non-compliance separates appropriate withholding from urgency-related delay — a distinction one-dimensional severity scores miss, relevant to phenotype-stratified resuscitation.

Prehospital NEWS discriminated short-term trauma mortality far better than shock index (AUROC 0.87–0.96 vs 0.48–0.79) and reliably predicted transfusion and resource needs; SI still flags patients needing urgent intervention (elevated >0.9) but performs poorly in geriatric and isolated-TBI patients — supporting NEWS for EMS trauma triage.

Intra-arrest TEE is highly feasible (80–100% insertion, few complications), shifts chest-compression position in 19–76% of cases and alters management in 31–48%, and links compressions over the LVOT/aortic valve to worse ROSC — yet the two existing RCTs show no improvement in survival or neurological outcome, so its patient-centred benefit remains unproven.

Among experienced clinicians, the 'CPR Leader' app did not improve guideline adherence, team performance, non-technical skills, or workload versus standard practice (and slightly delayed compressions in VF) — cognitive aids may help novices or mixed teams but add little for skilled providers.

A year-long county-wide hands-only CPR training program showed no significant overall effect on bystander CPR rates or survival versus control counties, but was associated with an 8.6-percentage-point rise in bystander CPR for public-location arrests — community training may move the needle mainly in public settings, not homes.

EMS-witnessed paediatric arrests had nearly double the adjusted odds of survival to discharge (AOR 1.91) and prehospital ROSC (AOR 1.83) versus bystander-witnessed events, while unwitnessed arrests fared far worse — underscoring early professional recognition/response and the need for paediatric-specific strategies.

Adding early (6-hour) processed EEG metrics (suppression ratio, BIS) to routine clinical/lab data significantly improved ML prediction of poor neurological outcome after cardiac arrest (AUC 0.88 long-term, 0.86 at discharge) versus either data source alone — a promising early risk-stratification aid pending external validation.

Higher intra-arrest PaO2 at 10 minutes was independently associated with sustained ROSC (aOR 1.02), with exploratory cut-offs of PaO2 >60 and PaCO2 <70 mmHg, while pH and lactate were not — suggesting arterial-line placement during ED resuscitation may add physiologic prognostic information beyond hemodynamics.

RBC transfusion reasons vary by intensity: hypotension and tachycardia were the top physiological triggers in non-major/major transfusions, but hypotension was cited far less in massive transfusion — arguing that transfusion intensity and clinical context, not hemoglobin alone, should frame transfusion-practice evaluation.

Practical framework for five GI oncologic emergencies (malignant obstruction, hemorrhage, perforation, cholangitis, neutropenic enterocolitis): resuscitation/sepsis control precede oncologic concerns, favor endoscopic/nonoperative options when feasible, and lower the threshold for diversion over primary anastomosis with recent antiangiogenic therapy, neutropenia, or heavy contamination.

Clustering nine routine ED variables identified six reproducible sepsis phenotypes spanning a continuous severity spectrum (7-day mortality 6.7%–31.8%); decomposing bundle "non-compliance" showed it mixes appropriate withholding vs urgency-related delay in phenotype-specific proportions — a distinction one-dimensional severity scores miss, supporting phenotype-stratified resuscitation.

Updated national first-aid standards adding guidance on pulse oximeters, bronchodilators, supplementary oxygen, repeat adrenaline in anaphylaxis, hypoglycemia correction, counterpressure maneuvers for presyncope, handling of amputated parts, exertional dehydration, and jellyfish stings.

The 2026 AHA/ACC PE guideline introduces "normotensive shock" — tissue hypoperfusion despite preserved blood pressure — as a pre-arrest state; bedside recognition should combine lactate, capillary refill, mottling, and critical-care echo of RV overload to flag patients for early treatment escalation.

Bayesian reanalysis of the "negative" cold-stored platelet trauma RCT (24h mortality 5.9% vs 10.2%, frequentist p=0.28) found an ~89% posterior probability that early cold-stored platelet transfusion reduces 24-hour mortality in patients at risk of hemorrhagic shock — suggesting a likely benefit that a definitive phase III trial should confirm.

In comatose post-arrest patients in whom life support was NOT withdrawn (minimizing self-fulfilling-prophecy bias), having >=2 unfavorable guideline-recommended markers within 14 days predicted poor 12-month outcome with zero false positives (adjusted OR 34.7); adding the Coma Recovery Scale-Revised improved discrimination — supports repeated, multimodal prognostication.

Over 12 years of Japanese national data, pediatric in-hospital cardiac arrest incidence fell (1.03 to 0.86 per 1,000 admissions) while survival to discharge rose to ~30%; most hospitals manage only 1-2 cases/year, supporting arguments for regionalization and a dedicated national resuscitation registry.

No trials directly compared vascular access methods during neonatal resuscitation; very-low-certainty evidence indicates umbilical venous and intraosseous access are both feasible, with most complications reported for intraosseous devices — highlights a major evidence gap rather than establishing a preferred route.

US emergency-department spine injuries from e-scooters, e-bikes, and hoverboards rose ~8.4-fold over a decade (mostly fractures, predominantly in adult males) — a fast-growing trauma burden that warrants clinical anticipation and prevention/counseling efforts.

First tri-society Spanish consensus on accidental hypothermia — 37 Delphi-based recommendations across the whole rescue chain (prehospital prevention, initial assessment, transport, polytrauma care, hospital rewarming, cardiac arrest and ECMO resuscitation), giving a standardized protocol backbone.

Synthesis of prehospital/transport REBOA use shows mixed mid- to long-term survival and no firm consensus on indications; underscores that field REBOA remains investigational in traumatic arrest.

Danish registry linkage of >22,000 OHCA cases finds preexisting ECG abnormalities are associated with the initial arrest rhythm, hinting at identifiable pre-arrest risk signatures relevant to shockable-rhythm likelihood.

Severe cardiac complications after isolated sternal fracture were rare, challenging blanket telemetry/rhythm-monitoring protocols for blunt cardiac injury and supporting a more selective monitoring approach.

In a large global-network cohort, burn patients who developed shock within 7 days had markedly higher acute kidney injury (RR 1.65), renal replacement therapy (RR 4.42) and mortality (RR 2.60 at 3 months) than matched non-shock burn patients, with elevated 1-year RRT and death persisting — supports intensified renal surveillance and kidney-protective strategies after burn shock.

Adding hemoperfusion to ECMO did not reduce all-cause mortality, and within the three RCTs it was associated with higher mortality (OR 4.96) — current evidence does not support routine cytokine adsorption on ECMO.

Passive leg raise loses accuracy in intra-abdominal hypertension (AUROC 0.71 vs 0.96), producing 16 false negatives tied to a persistently negative CVP–IAP gradient; end-expiratory occlusion and the 100 mL mini-fluid challenge remained reliable and should be preferred when IAP ≥12 mmHg.

Before labelling septic shock refractory, run a parallel bedside sweep for reversible contributors — antimicrobial adequacy and source control first, then fluid responsiveness/tolerance, acidemia and sedation burden, and cardiac mechanisms including ventriculo-arterial uncoupling and dynamic LVOT obstruction.

Practical trauma/acute-care review of rhabdomyolysis; there is still no universal definition or agreed CK threshold and management remains debated — emphasizes timely resuscitation, monitoring for evolving AKI, compartment syndrome and DIC, and recognizing patients who need urgent surgical intervention.

Synthesis of 25 years of trials argues fixed, isolated hemodynamic/metabolic targets (e.g., early goal-directed therapy) have repeatedly failed to reproduce outcome benefits; the field is shifting toward physiology-guided, phenotype-driven resuscitation using reversible tests in short decision cycles and rapidly responsive signals such as capillary refill time (ANDROMEDA-SHOCK-1/2).

In 1,013 transfused trauma patients (785 whole-blood-first), a WB-first strategy was associated with ~29% lower total 24-hour blood volume (ratio 0.71, 95% CI 0.55–0.90) with no significant effect modification by injury mechanism; the 30-day mortality estimate was non-significant and unstable (~30% missing labs).

RhD-positive whole blood/RBCs should not be withheld from RhD-negative females of childbearing potential when RhD-negative units are unavailable and transfusion is clinically indicated — immediate survival outweighs future reproductive risk (modeled perinatal-death risk ~0.04%; any HDFN-complicated future pregnancy ~0.6–6.5%). Recommends selective Rh immunoglobulin prophylaxis for low-volume exposures, structured antibody surveillance, counseling, multidisciplinary follow-up, and institutional protocols; also flags an equity gap — women are ~40% less likely than comparable men to receive whole blood.

SR-MA of RCTs comparing balanced crystalloids vs normal saline for pediatric DKA resuscitation (primary outcomes: time to DKA resolution, new AKI) — adds to the broader critical-care debate on avoiding hyperchloremic acidosis with balanced fluids.

Using national NEMSIS EMS data (2017–2025), documents racial/ethnic disparities in bystander CPR for opioid-associated OHCA — a target for community resuscitation and naloxone/CPR training efforts.

Maps what advanced hemodynamic monitoring is used in early post-OHCA care and how targets are set; finds practices and treatment thresholds beyond routine arterial pressure remain poorly standardized.

Unpacks the 2026 AHA/ACC PE guideline's new "normotensive shock" state — tissue hypoperfusion despite normal blood pressure — and argues for integrating concordant clinical signs (not a single marker) to escalate treatment earlier.

Transthoracic echo mapping suggests the guideline-recommended sternal compression point may not overlie the ideal area of maximal compression / LV outflow tract, questioning standard hand placement during CPR.

Adding persistent hypoperfusion markers (prolonged capillary refill + non-falling lactate) to a high vasopressor dose (>0.5 µg/kg/min NEE) identified a refractory septic shock subgroup with ~74% mortality — better prognostic enrichment than vasopressor dose alone.

Adding a peripheral perfusion index target (PPI ≥1.4) to conventional macrohemodynamic resuscitation endpoints halved 7-day acute skin failure (14.6% vs 29.7%), improved 6-hour lactate clearance, and cut 72-hour positive fluid balance by ~600 mL; 28-day mortality was unchanged.

Passive leg raise loses accuracy in intra-abdominal hypertension (AUROC 0.71 vs 0.96 without IAH), driven by a persistently negative CVP−IAP gradient producing false negatives; the end-expiratory occlusion test and 100 mL mini-fluid challenge stayed reliable and should be preferred in these patients.

Before labeling septic shock refractory, run a parallel bedside sweep for reversible contributors — antimicrobial adequacy and source control first, then fluid responsiveness/tolerance, acidemia and sedation burden driving vasoplegia, and cardiac causes including ventriculo-arterial uncoupling and dynamic LVOT obstruction.

Only 4.3% of non-traumatic OHCA patients met prehospital ECPR criteria; the physician-led activation protocol fired in 10 of 15 eligible patients, 5 were cannulated, and 4 of 10 survived to discharge with CPC 1 — feasible but very low-yield, needing multi-system study.

Prehospital physician attendance was associated with better 30-day neurological outcome (aOR 1.49), with the strongest signal in unwitnessed arrests and no benefit detected in patients who received ECPR — hypothesis-generating for how physician-staffed units should be dispatched.

NAEMSP position statement urging EMS systems to stop treating older-adult "lift assist" and low-acuity fall calls as uniformly minor: each warrants a full assessment for occult medical causes and injuries, transport decisions should be shared and may safely include non-transport with referral, assessment should be tracked as a system quality measure, and reimbursement should support care even when no transport occurs.

In 2,583 Danish bystander-witnessed OHCA patients surviving at least 30 days, a longer time from emergency call to ROSC was associated with worse long-term outcomes — more anoxic brain damage, more nursing-home admission, and lower return-to-work — reinforcing that minimizing time-to-ROSC matters not only for immediate survival but for functional recovery.

Using the Japanese JAAM-OHCA registry, the R-EDByUS score — derived from prehospital variables alone — was externally validated for predicting poor 1-month neurological outcome (CPC 3-5) in OHCA patients transported to tertiary centers, supporting its use for early risk stratification in both the prehospital-ROSC and ongoing-CPR groups.

Large nationally representative cohort assessing whether impedance threshold device (ITD) use during non-traumatic out-of-hospital cardiac arrest is associated with better prehospital and longer-term outcomes, where prior evidence has been equivocal.

Pooling 1,249 patients from two prehospital TXA trials and stratifying by TEG LY30, trauma patients in fibrinolytic shutdown who were randomized to TXA had a markedly lower risk of death (HR 0.32), while hyperfibrinolysis independently tripled mortality risk. Supports fibrinolysis profiling to target who benefits most from early TXA.

In the first binational pediatric OHCA registry report (2017-2023), survival to 30 days/discharge among EMS-treated children was 10% (lowest in infants at 7.9%), with a bimodal incidence peaking in infants and adolescents. Bystander-witnessed arrest, initial shockable rhythm, etiology, older age, and EMS response time predicted survival — arguing for age- and context-specific prevention and resuscitation strategies.

Using a doubly-robust causal analysis of 143,130 patients from Japanese traffic multi-patient incidents, being transported first ("priority transport") carried higher risk of death/severe injury, most strongly at the shortest on-scene times — a U-shaped pattern consistent with the sickest patients being selected for rapid transport rather than harm from transport order. A methodological caution for interpreting transport-outcome associations in trauma-system research.

Across 15 studies (183,253 patients), evidence is still insufficient to say whether early/prehospital plasma helps or harms TBI patients — one cluster-RCT secondary analysis suggested lower 24-h and 30-day mortality with prehospital plasma among direct-scene transports at risk of hemorrhagic shock, but two small in-hospital trials showed no benefit (one signaling possible harm), all at very low certainty.

Systematic review of economic evaluations of prehospital OHCA care found the evidence base limited and inconsistently reported, with health-equity dimensions (PROGRESS framework) largely neglected — a call for standardized economic and equity reporting in resuscitation research.

In 18,280 severely injured adults (LITES database, 2017–2021), Black patients received prehospital airway management and intubation less often than White patients, and patients from disadvantaged neighborhoods received fewer airway interventions — disparities not significantly explained by neighborhood social determinants; because prehospital airway and intubation were each associated with ~30–37% lower in-hospital mortality, the gap carries real outcome stakes.

Pooling 6 studies (3 RCTs, 3 cohorts; 4,040 patients), prehospital whole blood did not improve 24-hour (RR 1.00) or 28/30-day mortality (RR 1.09) versus standard care; an apparent reduction in 24-hour RBC requirements lost significance on sensitivity analysis and was driven by observational cohorts at serious risk of bias — tempering expectations of a survival benefit from prehospital whole blood.

NAEMSP reframes EMS clinician mental health as a systems issue, not just an individual one, and recommends organizational leadership treat clinician wellbeing as foundational to workforce sustainability and safe patient care.

In a large multicenter US database (LiTES; 30+ EMS agencies, 8 level-1 trauma centers), potentially preventable deaths still occurred even within advanced trauma systems — underscoring specific care-process gaps as targets for moving closer to zero preventable injury deaths.

A Western Trauma Association critical-decisions algorithm for the injured older adult, giving structured guidance on field triage, frailty assessment, trauma-team activation, and ICU admission — aimed at reducing the well-documented undertriage of geriatric trauma patients.

In a physician-led HEMS cohort (n=94; 66 minithoracostomy vs 28 chest drainage), prehospital minithoracostomy did not lengthen scene time and had far fewer recorded complications than chest drainage; because allocation was non-randomized with differential complication ascertainment, the finding is hypothesis-generating rather than proof of superiority.

In a multicenter registry analysis (31,055 patients; 16,922 propensity-matched), prehospital cervical spine immobilization was not associated with lower hospital mortality or better neurological outcome (GOS) — even in the subgroup with confirmed cervical spine injury — arguing against routine, undifferentiated immobilization.

In a healthy-volunteer crossover study (n=30), combining a non-rebreather mask with a nasal cannula (each at 15 or 25 L/min) gave inferior end-expiratory oxygen than a non-rebreather alone at flush rate — flush-rate NRB should remain the preferred preoxygenation strategy for spontaneously breathing prehospital patients.

In 6,082 adults with OHCA, an intraosseous-first vascular-access strategy was more likely harmful than beneficial versus intravenous-first (81.6% posterior probability of inferiority for 30-day survival; 98% for ROSC), though any effect is likely modest — reinforcing IV-first access as the default in adult OHCA.

Across 560,240 non-traumatic OHCA encounters in the ESO Data Collaborative (2018–2024), EMS agencies varied widely in non-initiation of resuscitation (MOR 2.30) and in applying termination-of-resuscitation for TOR-eligible patients (MOR 4.13) even after case-mix adjustment — flagging substantial unwarranted variation in prehospital resuscitation decision-making.

In the prospective multicenter BASIC-OHCA cohort (33,650 EMS-treated OHCA in China), women had higher adjusted odds of prehospital ROSC (OR 1.21) and survival to admission (OR 1.33) but no advantage by discharge or 30 days, and fared worse than men in key subgroups (age ≥50, shockable rhythm, no prehospital epinephrine) — an early female advantage lost during hospital care, flagging a disparity to target.

Across 27 EMS agencies in Connecticut (1,917 non-traumatic OHCA), a structured pit-crew CPR training program was associated with an immediate rise in ROSC (aOR 1.41) and a gradual increase in neurologically intact survival (aOR 1.20 per 4-month interval) after implementation, though overall survival to discharge did not change — supporting team-based resuscitation training within existing EMS systems.

Across 1,040 pediatric air-medical intubations at 39 sites (57.7% trauma/burn), first-pass success was 86.5% overall but fell to 69.1% in infants under 1 year, who also had more post-attempt physiologic instability and less ETCO2 confirmation — flagging infants as the key training and benchmarking target.

A machine-learning triage tool (FAIT) using only early EMS/ED vitals and field-visible injuries predicted trauma transfusion need with high accuracy — AUC 0.91 for ruling out any transfusion, and 0.91-0.95 for transfusion, massive (>4 U/4h) and ultra-massive thresholds (0.87-0.91 on EMS vitals alone) — supporting prehospital forecasting of blood-product demand across blunt, penetrating and burn injury, pending prospective validation.

Across four studies, prehospital arterial-line insertion was consistently associated with longer scene time (4-34.4 min), but the evidence is weak and the clinical significance context-specific — a caution to weigh invasive prehospital BP monitoring against transport delay rather than a directive against it.

Biennial systematic review identified 71 new prehospital evidence-based guidelines (2023–2025), of higher quality than prior reviews; ~half met all high-quality (NAM) criteria — mostly CPR/cardiac and trauma compilations — providing a reference set to guide EMS protocol development and training.

A 20-expert modified Delphi produced 35 consensus criteria for pediatric prehospital blood transfusion: eligibility = known/suspected severe hemorrhage PLUS ≥1 shock indicator after first-line hemorrhage control PLUS EMS clinical judgment; aims to standardize highly variable pediatric PHT protocols (no consensus reached on EtCO2).

In a multicenter Paris-region cohort, ~1 in 5 severe trauma patients (ABC ≥2 and >20 min prehospital time) would have qualified for prehospital blood transfusion — arguing that PHT should be a routine capability, not a rarity, in advanced trauma systems.

Among 25,473 trauma patients, prehospital vitals of SBP <90 mmHg plus HR ≥110 bpm gave the highest positive predictive value (56%) for needing transfusion within 4 h of ED arrival; other criteria (SBP <70, EMS-witnessed arrest) ranged 51–53%. Supports simple physiologic triggers to select patients for prehospital blood.

CPR-induced consciousness occurred in 3.3% of OHCA and rose over 16 years; it was independently associated with markedly better survival to discharge (OR 2.71), so signs of consciousness during CPR may flag favourable physiology rather than a reason to interrupt resuscitation.

Only three quasi-experimental studies (2.9M+ EMS responses) have aligned EMS dispatch/response plans with linked patient outcomes; all pointed the same way — fewer high-priority (lights-and-sirens) responses and improved system efficiency without clear evidence of harm. Evidence base is thin, so treat as feasibility signal, not proof.

Across all of Denmark, prehospital surgical cricothyroidotomy is exceedingly rare (71 cases in 8 years) but had high procedural success (87%) in a physician-staffed EMS system; survival was low, reflecting the extremis of patients needing it. Benchmarks the "can't intubate, can't oxygenate" rescue airway.

In 11,063 registry patients, prehospital physician exposure was not associated with lower 30-day mortality (and had lower discharge GOS), whereas HEMS transport was independently associated with improved survival — questioning blanket physician staffing and pointing to patient selection and mode of transport as the real levers.

PHBTC (aligned with AABB) formally defines the scope and duties of EMS Blood Program Coordinators/Managers — storage and transport validation, continuous component monitoring, standardized education, regulatory compliance, and interagency coordination — to make civilian prehospital whole-blood programs safe and reproducible across diverse EMS systems.

In pediatric trauma, hypothermia on arrival tracked with air-EMS transport (OR 1.74), firearm injury (OR 1.97), and TBI severity (up to OR 2.40); 8.2% had missing/invalid temperatures, more often in severely injured and Black/Hispanic children — pointing to concrete targets for prehospital warming and documentation QI.

Prehospital BP lowering was associated with higher mortality in ischemic stroke versus reference and versus the 48-h window, while timing made no significant mortality difference in ICH or unspecified stroke — supporting caution with prehospital BP reduction until stroke subtype is confirmed (evidence confidence limited).

UK Faculty of Pre-Hospital Care consensus de-emphasizes aggressive fluid loading and reframes hyperkalaemia concerns in prehospital crush injury/crush syndrome, giving practicable recommendations for developed-system EMS.

Modeling the real-world cohort of 957 females of childbearing potential given prehospital RhD-positive products puts the future HDFN risk at only ~0.2-0.3% per year (one case per ~2.4-80.7 years by region), largely because most were of advanced maternal age and likely RhD-positive. Supports using RhD-positive blood in prehospital hemorrhagic shock when RhD-negative units are scarce.

In an obesity CPR manikin model, compression depth collapsed (median adequate-depth compressions fell from 98% to 0%) despite greater rescuer effort, and elevating the paramedic on a 10 cm platform did NOT help. Signals that simple ergonomic fixes are insufficient for CPR in patients with obesity — a simulation study, so treat as hypothesis-generating.

Multidisciplinary Delphi panel prioritised EMS research/knowledge gaps for older adults; evaluation after perceived low-acuity falls, fall prevention, clinician training, and geriatric trauma triage topped the list, offering a roadmap for prehospital geriatric care.

Danish registry data show prehospital capnometry was used in only ~80% of intubations but was independently associated with lower 30-day mortality (aOR 0.52); abnormal EtCO2, especially hypocapnia, tracked worse outcomes — reinforcing routine waveform capnography.

Across 467 resuscitative thoracotomy patients, EAST (signs of life) and WTA (prehospital arrest time) guidelines identified similar survivor subsets (survival ~6–7%, neurologically intact ~5–6%); both signs of life and arrest duration matter, supporting development of a unified RT guideline.

Prehospital NEWS discriminated short-term trauma mortality far better than shock index (AUROC 0.87–0.96 vs 0.48–0.79) and reliably predicted transfusion and resource needs; SI still flags patients needing urgent intervention (elevated >0.9) but performs poorly in geriatric and isolated-TBI patients — supporting NEWS for EMS trauma triage.

EMS-witnessed paediatric arrests had nearly double the adjusted odds of survival to discharge (AOR 1.91) and prehospital ROSC (AOR 1.83) versus bystander-witnessed events, while unwitnessed arrests fared far worse — underscoring early professional recognition/response and the need for paediatric-specific strategies.

Trauma kills 4.5M people/year with 84% of deaths in low/middle-income countries; over 1M deaths could be averted annually if LMIC case-fatality matched high-income levels. Long-term priorities are more blood availability, better TBI care, and improved prehospital care; immediate opportunities include trauma short courses, QI programs, an international trauma registry for benchmarking, and IATSIC-based needs assessments.

First tri-society Spanish consensus on accidental hypothermia — 37 Delphi-based recommendations across the whole rescue chain (prehospital prevention, initial assessment, transport, polytrauma care, hospital rewarming, cardiac arrest and ECMO resuscitation), giving a standardized protocol backbone.

A Bayesian-network ML model risk-stratifies trauma-induced coagulopathy early after injury; in this national cohort 75% of patients at medium-or-higher TIC risk did NOT receive TXA within 1 h — suggesting ML triage could direct earlier, more targeted TXA to those most likely to benefit.

Synthesis of prehospital/transport REBOA use shows mixed mid- to long-term survival and no firm consensus on indications; underscores that field REBOA remains investigational in traumatic arrest.

Updated 2024 NEMSIS analysis quantifies persistent rural-urban gaps in EMS response, clinical care, and on-scene mortality—evidence that geographic disparities in prehospital trauma care remain largely unclosed since 2012.

Among blunt pelvic-fracture patients (prehospital binder used in only 1.8%), binder use was not associated with lower 24-hour RBC transfusion volume or in-hospital mortality, but was associated with more pelvic angioembolization (33.0% vs 21.2%, OR 1.82) — suggesting binders shape or reflect downstream hemorrhage-control strategy rather than directly cutting transfusion needs.

Using national NEMSIS EMS data (2017–2025), documents racial/ethnic disparities in bystander CPR for opioid-associated OHCA — a target for community resuscitation and naloxone/CPR training efforts.

Head-on and single-vehicle crash characteristics independently predicted severe injury (ISS>15), mortality, and need for surgery/ICU — arguing that vehicle/collision telemetry could sharpen prehospital field triage decisions.

Only 4.3% of non-traumatic OHCA patients met prehospital ECPR criteria; the physician-led activation protocol fired in 10 of 15 eligible patients, 5 were cannulated, and 4 of 10 survived to discharge with CPC 1 — feasible but very low-yield, needing multi-system study.

Prehospital physician attendance was associated with better 30-day neurological outcome (aOR 1.49), with the strongest signal in unwitnessed arrests and no benefit detected in patients who received ECPR — hypothesis-generating for how physician-staffed units should be dispatched.

A Prehospital Guidelines Consortium expert panel curated 10 high-impact 2021–2023 primary EMS papers as a priority reading list, intended to bridge the lag between emerging evidence and formal prehospital evidence-based guidelines.

In a single-center open-label RCT of 210 older adults undergoing VATS lung resection, prophylactic high-flow nasal oxygen after extubation reduced in-hospital postoperative pulmonary complication severity (ordinal OR 0.50) and moderate-to-severe PPCs (23% vs 40%) versus conventional oxygen; the authors still caution against routine prophylactic use for all lung-resection patients.

NAEMSP position statement urging EMS systems to stop treating older-adult "lift assist" and low-acuity fall calls as uniformly minor: each warrants a full assessment for occult medical causes and injuries, transport decisions should be shared and may safely include non-transport with referral, assessment should be tracked as a system quality measure, and reimbursement should support care even when no transport occurs.

Pooled systematic review and meta-analysis comparing two bedside physiologic triage scores — the Shock Index Pediatric Age-adjusted (SIPA) and the reverse Shock Index multiplied by GCS (rSIG/rSIM) — for predicting mortality in injured children. Informs which score better flags high-risk pediatric trauma patients for early intervention.

Using the international ADAPT pediatric severe-TBI dataset, this analysis tested whether decompressive craniectomy improves long-term functional independence in children — addressing a question with little high-quality evidence and informing how aggressively to pursue surgical decompression in pediatric TBI.

In the first binational pediatric OHCA registry report (2017-2023), survival to 30 days/discharge among EMS-treated children was 10% (lowest in infants at 7.9%), with a bimodal incidence peaking in infants and adolescents. Bystander-witnessed arrest, initial shockable rhythm, etiology, older age, and EMS response time predicted survival — arguing for age- and context-specific prevention and resuscitation strategies.

Systematic review/meta-analysis comparing buried vs exposed (epicutaneous) K-wire fixation for displaced pediatric upper-extremity fractures, pooling complication rates (infection, refracture, skin erosion, implant migration) to inform whether the cheaper, anesthesia-sparing exposed technique is safe.

RCT in 52 elderly patients with displaced 3-/4-part proximal humeral fractures comparing locking-plate fixation vs sling immobilization on 12-month DASH and Constant scores — adding to the long-running debate over whether surgery outperforms conservative care for these osteoporotic fractures.

Across 115,643 hip-fracture patients, modeling age-frailty interactions separately by fixation type improved 30-day mortality risk estimation versus treating age and frailty as independent predictors.

Across 19 studies (N=1113) in children with mild-to-severe TBI, cognitive behavioral therapy for insomnia was the most consistently effective treatment for post-injury sleep-wake disturbances and persistent post-concussion symptoms, while melatonin showed mixed, non-significant pooled effects.

A joint AAST/ACS-COT clinical protocol standardizing management of blunt splenic injury across adult and pediatric patients — algorithmic guidance on non-operative management, angioembolization, and thresholds for operative intervention to reduce practice variation.

A Western Trauma Association critical-decisions algorithm for the injured older adult, giving structured guidance on field triage, frailty assessment, trauma-team activation, and ICU admission — aimed at reducing the well-documented undertriage of geriatric trauma patients.

Older trauma patients fare worse because of reduced physiologic reserve, preinjury comorbidities, and geriatric-specific syndromes; a proactive, multidisciplinary approach — early team activation, prompt resuscitation, comorbidity and syndrome management, and a focus on functional recovery — improves outcomes.

Across 154,137 Japanese non-cardiac OHCA cases, bystander rescue-breathing CPR was associated with modestly lower 30-day mortality and unfavorable neurological outcomes versus compression-only CPR — the benefit concentrated in children and in drowning/asphyxial arrests, supporting rescue breaths when the arrest is non-cardiac.

Secondary analysis of PEPaNIC links the harm from early parenteral nutrition in critically ill children to a surge in ureagenesis (rising urea/creatinine) — a marker of metabolic intolerance to high amino-acid loads — reinforcing caution about aggressive early feeding in the PICU.

In the All-Japan Utstein Registry (554,923 witnessed OHCA, 2005–2023), family-member-witnessed arrests had the lowest 1-month neurologically favorable survival (4.2% vs 10.1% for passersby vs 15.3% for friends/colleagues); the association reversed in the young (family-witnessed better at ages 20–40) but held for worse outcomes in the elderly — pointing to targeted CPR training for family members of high-risk older adults.

In matched adults ≥55 with pelvic ring fractures, operative management was associated with lower 2-year mortality (robust across analyses) and a non-robust 1-year signal, but neither benefit persisted after multivariable adjustment, while surgery carried consistently higher VTE and pneumonia. The operate-or-not decision should balance improved mobility against perioperative risk; prospective trials are needed.

Across 942 admitted pediatric burns, age-adjusted TBSA cut-points supported earlier ICU consideration at ~8-10% TBSA in toddlers and ~15% in school-age children/adolescents. ICU transfer and surgery rarely occurred without fever, and hands/joints/perineum/buttocks or persistent fever/delayed presentation warranted heightened surgical review.

Of nine Australasian guidelines for moderate-to-severe paediatric TBI, only the PREDICT guideline rated high quality; hospital-based guidelines were methodologically weak, exposing a regional consensus gap for severe paediatric TBI.

Pooled VTE frequency in severe pediatric TBI was 7% (rising to 20% with central venous lines), driven by injury severity and multimodality treatment — arguing that VTE is an under-recognized risk warranting standardized surveillance and prophylaxis consideration in children.

Among hip-fracture patients all operated within 24h, further acceleration (<6h vs 6-12h vs 12-24h) showed no mortality difference; perioperative medical complications (pneumonia, renal failure, cardiac events) were the dominant mortality drivers — supporting current 24h targets while shifting emphasis to orthogeriatric/perioperative optimization.

Across 1,040 pediatric air-medical intubations at 39 sites (57.7% trauma/burn), first-pass success was 86.5% overall but fell to 69.1% in infants under 1 year, who also had more post-attempt physiologic instability and less ETCO2 confirmation — flagging infants as the key training and benchmarking target.

In trauma patients aged 40–60 (ISS ≥9), pre-injury antithrombotic therapy raised coagulopathy rates (especially VKA/DOAC) but, after matching, showed no clinically relevant difference in mortality (6.5% vs 6.2%). Unlike in the elderly, anticoagulation may not independently worsen survival in middle-aged trauma.

Multimodal MRI synthesis finds pediatric mild TBI is associated with widespread white-matter microstructural disruption, prefrontal/parietal cortical thinning and hippocampal atrophy persisting up to a year, and network reorganization — evidence that "mild" pediatric TBI carries measurable, sometimes chronic, neurobiological changes. Mechanistic/imaging, not yet a management change.

Across 207,270 older EGS patients, hospitals with a higher operative-to-nonoperative ratio had modestly higher odds of home discharge (OR 1.10), while raw operative volume did not — suggesting management-pattern ratios may benchmark quality better than volume alone.

Older SBO patients achieved nonoperative resolution rates similar to younger patients (~69%) but had far higher complications (16.7% vs 6.7%) and mortality (6.9% vs 3.6%); decisions should weigh etiology, imaging severity and frailty rather than chronological age.

In geriatric acetabular fractures, primary "fix-and-replace" trauma arthroplasty (THA/combined hip procedure) gave better 3-month Harris Hip Scores and fewer reoperations than ORIF alone (pooled OR 2.34 favoring arthroplasty), with no difference in 90-day mortality despite longer operative time and more blood loss — supporting primary arthroplasty as first-line for selected elderly patients with comminuted fractures.

A 20-expert modified Delphi produced 35 consensus criteria for pediatric prehospital blood transfusion: eligibility = known/suspected severe hemorrhage PLUS ≥1 shock indicator after first-line hemorrhage control PLUS EMS clinical judgment; aims to standardize highly variable pediatric PHT protocols (no consensus reached on EtCO2).

In the Japanese pediatric OHCA registry, first post-ROSC PaCO2 category (hypo-, normo-, hypercapnia) showed no clear independent association with 30-day favorable neurologic outcome or survival, though estimates were imprecise — no strong signal to support a specific early CO2 target in children.

In 942 admitted pediatric burns, age-specific TBSA cutoffs stratified risk of ICU transfer, surgery and infection: consider earlier ICU review at ~8-10% adjusted TBSA in toddlers and ~15% in school-age/adolescents, with depth/site-driven surgical review (hands, joints, perineum, buttocks) and vigilance for persistent fever or delayed presentation.

Largest pediatric SSRF cohort to date: only 0.31% of 28,465 pediatric rib-fracture patients underwent surgical rib fixation, and unlike the rising adult trend, pediatric use stayed flat and confined to older children with flail chest, high ISS, or open chest injuries. SSRF-treated children had zero mortality vs 7.3% non-operative, but heavy selection means pediatric indications remain undefined.

Across 10 studies (1253 women, 1719 deliveries), cesarean rate after a prior pelvic ring injury pooled at ~40% but trial of labour succeeded in 86%. Retained implants, operative fixation, and most fracture patterns are not barriers to vaginal delivery — supporting an individualized trial of labour with shared decision-making rather than defaulting to cesarean.

Across 9,423 pediatric in-hospital cardiac arrests (2000–2023), asystole carried lower odds of ROSC and restoration of circulation than PEA, but the survival-to-discharge difference was driven almost entirely by neonates/NICU events — in older children survival did not differ. Challenges lumping PEA and asystole together as one "non-shockable" category.

EAST's annual roundup distills 13 practice-shaping 2025 studies (RCTs + large multicenter cohorts) spanning early resuscitation, timing of lifesaving interventions, analgesia/sedation, ventilator management, infection prevention, transfusion timing, perioperative antibiotics, imaging in older adults, and pediatric trauma pathways — a ready-made map of what changed this year.

In pediatric trauma, hypothermia on arrival tracked with air-EMS transport (OR 1.74), firearm injury (OR 1.97), and TBI severity (up to OR 2.40); 8.2% had missing/invalid temperatures, more often in severely injured and Black/Hispanic children — pointing to concrete targets for prehospital warming and documentation QI.

In an ED/trauma setting, oral chloral hydrate (50 mg/kg) beat oral midazolam (0.3 mg/kg) — fewer venipuncture attempts (1.30 vs 1.96), faster sedation and IV access, shorter total procedure time, higher satisfaction, comparable safety — supporting it as a preferred agent for procedural sedation in young children.

In a 3,088-patient cohort of mild TBI, patients ≥75 years (55% of the cohort) were scanned 98% of the time; a multivariable risk model had only moderate discrimination (AUC 0.69) and could safely cut CT use by just 1.5% at 100% sensitivity — rule-out strategies offer little practical benefit for reducing head CT in the very elderly.

Using linked NEDS and NVDRS data from 41 states (2019-2020), an estimated ~6,820 US children had nonfatal firearm assaults and >2,300 died over two years, with non-Hispanic Black, male, and older youth bearing disproportionate morbidity and mortality — reinforcing the case for community violence-reduction programs and firearm-policy reform.

Pediatric firearm hospitalizations rose 52% (2016–2021) with in-hospital mortality up from 6.7% to 9.8%; unintentional injuries overtook assault by 2021, and burden fell disproportionately on minority and lower-income children—pointing to prevention, storage, and access policy.

In 1776 hip-fracture patients ≥70, timing of geriatric consultation (pre- vs postoperative) was not independently associated with delirium (~19.7% vs 19.5%) or other short-term outcomes—access to geriatric co-management may matter more than its exact timing.

German proximal femur fracture cases rose 54% (2000-2023) and are projected to climb ~75% more to ~318,000/year by 2050, with 74% in patients aged 80+; direct costs roughly double to €6.4B. Modeled workforce gap of ~700 trauma surgeons and ~7,500 geriatricians — a system-planning wake-up call for geriatric trauma capacity.

Modeling the real-world cohort of 957 females of childbearing potential given prehospital RhD-positive products puts the future HDFN risk at only ~0.2-0.3% per year (one case per ~2.4-80.7 years by region), largely because most were of advanced maternal age and likely RhD-positive. Supports using RhD-positive blood in prehospital hemorrhagic shock when RhD-negative units are scarce.

A third of ski/snowboard injuries clustered on just 3% of slope length (steep, narrow, high-traffic runs), and injury type tracked with sport, sex, age and terrain rather than day-to-day weather. Points prevention at redesigning slope hotspots, sex-adjusted binding settings, routine wrist protectors for snowboarding children, and better pole-release systems.

Surgery within 48h of admission for proximal femur fractures was associated with lower in-hospital mortality, fewer complications and better discharge mobility (though delayed patients were higher-risk — possible confounding by indication).

In children with blunt trauma, cervical spine CT was highly sensitive for clinically significant injury (98.7% after accounting for retrospectively identifiable injuries) with a negative predictive value of ~100%, supporting definitive pediatric c-spine clearance based on a normal CT.

Multidisciplinary Delphi panel prioritised EMS research/knowledge gaps for older adults; evaluation after perceived low-acuity falls, fall prevention, clinician training, and geriatric trauma triage topped the list, offering a roadmap for prehospital geriatric care.

An international panel reached high consensus on 14 of 15 statements to guide shared decision-making around non-operative hip-fracture care, aimed at more consistent management of frail older adults at end of life.

In geriatric rib-fracture patients, higher STUMBL scores independently predicted 3-month mortality, delirium, and failure to return home; a cut-point >15 was sensitive but non-specific, so it best complements frailty/cognition assessment rather than replacing it.

AI/ML shows robust performance for fragility-fracture risk prediction (frequently outperforming FRAX), BMD estimation, and fracture detection, but methodological heterogeneity, bias, and limited prospective/multicenter validation still block clinical translation.

Prehospital NEWS discriminated short-term trauma mortality far better than shock index (AUROC 0.87–0.96 vs 0.48–0.79) and reliably predicted transfusion and resource needs; SI still flags patients needing urgent intervention (elevated >0.9) but performs poorly in geriatric and isolated-TBI patients — supporting NEWS for EMS trauma triage.

EMS-witnessed paediatric arrests had nearly double the adjusted odds of survival to discharge (AOR 1.91) and prehospital ROSC (AOR 1.83) versus bystander-witnessed events, while unwitnessed arrests fared far worse — underscoring early professional recognition/response and the need for paediatric-specific strategies.

Across 21 studies, AI/ML models for fragility-fracture risk prediction, BMD estimation, and outcome prognosis often outperformed traditional tools (e.g., FRAX), but methodological heterogeneity, bias risk, and scarce prospective/multicenter external validation still block clinical translation.

Across 7 years of national data, children ≤2 years old had similar adjusted in-hospital mortality and complication rates whether treated at pediatric-only hospitals or combined pediatric-adult trauma centers — reinforcing that trauma verification preserves outcomes across center types, even for infants and toddlers.

Over 12 years of Japanese national data, pediatric in-hospital cardiac arrest incidence fell (1.03 to 0.86 per 1,000 admissions) while survival to discharge rose to ~30%; most hospitals manage only 1-2 cases/year, supporting arguments for regionalization and a dedicated national resuscitation registry.

No trials directly compared vascular access methods during neonatal resuscitation; very-low-certainty evidence indicates umbilical venous and intraosseous access are both feasible, with most complications reported for intraosseous devices — highlights a major evidence gap rather than establishing a preferred route.

Systematic review found platelet quality (pH, aggregation, metabolism) is preserved in DEHP-free plasticizer systems while DEHP leaches far more than alternatives, raising modeled recipient exposure especially in neonates/pediatrics — supports the ongoing transition to phthalate-free blood collection and storage without compromising transfusion performance.

A practical framework for anticoagulated hip-fracture patients that decouples the (looser) haemostatic threshold for surgery from the (stricter) threshold for neuraxial anaesthesia, and uses active reversal plus patient blood management to keep surgery within 24-48 h rather than passively waiting out drug clearance.

ML/DL models (including transformers and gradient boosting) can outperform GCS-based tools for detecting injury and predicting outcomes in pediatric TBI, but heterogeneity and limited external validation keep them pre-clinical.

Over a decade, moderate-plus (MAIS2+) mobility-scooter injuries rose 38% (91% in ages 70-79), with rollover the commonest mechanism and traumatic brain injuries more than doubling (+103%); ~30% required admission — a growing elderly trauma burden warranting targeted prevention.

Pediatric trauma-induced coagulopathy protocol: limit crystalloid to ≤20 mL/kg then switch to blood components, transfuse on clinical signs rather than labs alone, use thromboelastography to guide products, run an MTP at 1:1–1:2 plasma:RBC (whole blood preferred when available), give TXA for severe hemorrhage, and add enoxaparin VTE prophylaxis after stabilization in selected older/pubertal low-bleeding-risk patients.

RhD-positive whole blood/RBCs should not be withheld from RhD-negative females of childbearing potential when RhD-negative units are unavailable and transfusion is clinically indicated — immediate survival outweighs future reproductive risk (modeled perinatal-death risk ~0.04%; any HDFN-complicated future pregnancy ~0.6–6.5%). Recommends selective Rh immunoglobulin prophylaxis for low-volume exposures, structured antibody surveillance, counseling, multidisciplinary follow-up, and institutional protocols; also flags an equity gap — women are ~40% less likely than comparable men to receive whole blood.

Cochrane review of RBC volume per transfusion event — an area with minimal prior evidence despite "single-unit" Choosing Wisely guidance. Highlights that per-event transfusion volume practice (including in pediatrics/neonates) rests on sparse, low-certainty data, with no firm signal that a particular volume strategy improves mortality.

SR-MA of RCTs comparing balanced crystalloids vs normal saline for pediatric DKA resuscitation (primary outcomes: time to DKA resolution, new AKI) — adds to the broader critical-care debate on avoiding hyperchloremic acidosis with balanced fluids.

Pooled VTE rate in children with lower-limb fractures was low (~0.53%); evidence on risk factors and prophylaxis efficacy is sparse, so individualized rather than routine pharmacologic thromboprophylaxis is recommended.

A Brigham trauma/acute-care-surgery group examines emergency general surgery that is likely nonbeneficial in older adults at extreme early-mortality risk — relevant to goals-of-care and operative decision-making in high-risk EGS. (Full abstract not available; verify details before podcast use.)

Adding a peripheral perfusion index target (PPI ≥1.4) to conventional macrohemodynamic resuscitation endpoints halved 7-day acute skin failure (14.6% vs 29.7%), improved 6-hour lactate clearance, and cut 72-hour positive fluid balance by ~600 mL; 28-day mortality was unchanged.

This PRISMA systematic review (3 studies, 1,111 polytrauma patients with lumbar spine fractures) found early fixation (<72 h) was associated with fewer ventilator days (4.9 vs 7.8) and shorter ICU stay (10.9 vs 13.7 d) than late fixation, but with only three moderate-quality studies these effects remain uncertain, hospital length of stay was similar, and injury severity (ISS) was the dominant driver of outcomes.

This PRISMA systematic review and meta-analysis (20 studies, 18,852 polytrauma patients) found Early Total Care, versus Damage Control Orthopedics, was associated with shorter hospital stay (~4.9 fewer days), fewer surgical procedures, lower sepsis risk (OR 0.63), and less delayed union, with no significant difference in mortality, MODS, ARDS, or infection. The evidence is largely observational, so the authors stress physiology-based patient selection rather than a blanket preference for either strategy.

In a TQIP analysis (2017-2023) of closed mandible fractures, earlier surgical fixation was associated with fewer in-hospital complications and lower resource use, challenging the prior consensus that repair timing does not affect outcomes.

Using the multicenter FixCon RCT population (n=180), tests how reliable and valid spirometry, pain scores, and quality-of-life instruments are as outcome measures for multiple rib fractures without a flail segment — informing which endpoints future chest-trauma trials should use.

Systematic review/meta-analysis comparing buried vs exposed (epicutaneous) K-wire fixation for displaced pediatric upper-extremity fractures, pooling complication rates (infection, refracture, skin erosion, implant migration) to inform whether the cheaper, anesthesia-sparing exposed technique is safe.

A data-driven analysis of 4,170 facial-fracture patients at tertiary trauma centers mapped how injury energy, sex, and age define risk groups for concomitant (sometimes life-threatening) injuries outside the face — supporting targeted screening for occult associated trauma in higher-risk presentations.

RCT in 52 elderly patients with displaced 3-/4-part proximal humeral fractures comparing locking-plate fixation vs sling immobilization on 12-month DASH and Constant scores — adding to the long-running debate over whether surgery outperforms conservative care for these osteoporotic fractures.

Across 115,643 hip-fracture patients, modeling age-frailty interactions separately by fixation type improved 30-day mortality risk estimation versus treating age and frailty as independent predictors.

In stability-indeterminate LC1 pelvic ring injuries with 12-16 mm stress displacement, surgical fixation was associated with fewer early composite adverse events (NNT ~2.5) than nonoperative care; the authors stress the finding is statistically fragile and hypothesis-generating, requiring prospective validation.

In matched adults ≥55 with pelvic ring fractures, operative management was associated with lower 2-year mortality (robust across analyses) and a non-robust 1-year signal, but neither benefit persisted after multivariable adjustment, while surgery carried consistently higher VTE and pneumonia. The operate-or-not decision should balance improved mobility against perioperative risk; prospective trials are needed.

A curriculum-based deep-learning pipeline detected active pelvic bleeding on contrast-enhanced CT in ~2 seconds with a test AUC of 0.90, outperforming residents and matching board-certified specialists. A plausible triage aid to speed hemorrhage detection in blunt pelvic trauma, pending prospective clinical validation.

In 245 sternal-fracture patients (9% mortality), moderate/complete displacement (36% vs 8%), high-sensitivity troponin T >17.5 ng/L (20% vs 2%), and ECG conduction abnormalities (33% vs 1%) were each associated with markedly higher mortality on univariate analysis — practical red flags for triage, though unadjusted and hypothesis-generating.

Among hip-fracture patients all operated within 24h, further acceleration (<6h vs 6-12h vs 12-24h) showed no mortality difference; perioperative medical complications (pneumonia, renal failure, cardiac events) were the dominant mortality drivers — supporting current 24h targets while shifting emphasis to orthogeriatric/perioperative optimization.

Despite standard 28-day LMWH prophylaxis, pelvic/acetabular fracture patients stayed hypercoagulable on serial TEG (75% at 4 weeks, 29% at 3 months) and 23% developed VTE (mostly PE), with acetabular fractures highest — signaling current prophylaxis duration may be too short and supporting study of extended/individualized regimens.

Across 178 studies, hemiarthroplasty dislocation rates ranged 0–16.6% (RCT median 2.1%) and have fallen over time. The main modifiable signal: avoid the posterior surgical approach to reduce dislocation, especially in cognitively impaired patients, and account for acetabular size/offset. Patient-reported outcomes after dislocation are essentially unstudied.

Practice-guidance paper on recognising and managing limb-threatening arterial injury in the setting of musculoskeletal trauma — emphasising early identification, time-to-revascularisation, and coordinated ortho-vascular decision-making.

In patients with >=3 rib fractures and concomitant TBI, surgical stabilization of rib fractures (SSRF) was associated with markedly lower in-hospital mortality in focal TBI (OR 0.26) and diffuse TBI, with TBI phenotype modifying the benefit. Suggests concomitant TBI should not automatically exclude patients from SSRF.

Updated WTA critical-decisions algorithm for the mangled extremity — structured guidance on assessment, resuscitation, revascularization sequencing, and limb salvage versus early amputation decision-making after severe extremity trauma.

In geriatric acetabular fractures, primary "fix-and-replace" trauma arthroplasty (THA/combined hip procedure) gave better 3-month Harris Hip Scores and fewer reoperations than ORIF alone (pooled OR 2.34 favoring arthroplasty), with no difference in 90-day mortality despite longer operative time and more blood loss — supporting primary arthroplasty as first-line for selected elderly patients with comminuted fractures.

Across 8,577 Impella-treated cardiogenic shock patients, in-hospital cardiac arrest before implantation marked a distinct high-risk phenotype (30-day mortality 48% vs 29% no-arrest; adjusted HR 1.54) with more bleeding, limb ischemia, stroke and sepsis; lactate >4, creatinine >1.5, longer arrest time and VA-ECMO predicted death, supporting early risk stratification.

Across 8 Level I centers, for stability-indeterminate LC1 (Beckmann 7-9) pelvic injuries, surgery was associated with fewer early composite adverse events overall, and notably in the 12-16 mm stress-displacement stratum (NNT ~2.5). Authors stress the finding is statistically fragile and hypothesis-generating, needing prospective validation.

In 75 complex (12-C) humeral shaft fractures, ORIF, MIPO and IM nailing all achieved acceptable union (84-93%) and comparable functional scores. MIPO trended toward fewer complications and less operative burden; IM nailing trended toward more nonunion/malunion. Underpowered — fixation choice should be tailored to fracture morphology and surgeon experience.

In multiple rib fractures, both thoracoscopic and open fixation restored thoracic volume and improved early quality of life versus conservative chest-band management; thoracoscopic fixation caused less surgical trauma with better short-term rehabilitation and equivalent thoracic recovery and complication rates. Small single-center trial.

Two-center RCT (50 patients) found closed percutaneous fixation and ORIF gave comparable 6-month function and complication rates for displaced medial malleolar fractures. The trial was not powered for equivalence, so findings are preliminary and need larger confirmation.

Largest pediatric SSRF cohort to date: only 0.31% of 28,465 pediatric rib-fracture patients underwent surgical rib fixation, and unlike the rising adult trend, pediatric use stayed flat and confined to older children with flail chest, high ISS, or open chest injuries. SSRF-treated children had zero mortality vs 7.3% non-operative, but heavy selection means pediatric indications remain undefined.

Across 10 studies (1253 women, 1719 deliveries), cesarean rate after a prior pelvic ring injury pooled at ~40% but trial of labour succeeded in 86%. Retained implants, operative fixation, and most fracture patterns are not barriers to vaginal delivery — supporting an individualized trial of labour with shared decision-making rather than defaulting to cesarean.

Across 119,393 tibial fractures, obtunded patients (sedated/intubated, GCS<9, or severe intoxication) had modestly higher fasciotomy rates for suspected acute compartment syndrome (OR 1.14) even after adjustment — when clinical exam is unreliable the threshold to operate drops, strengthening the case for objective intracompartmental pressure monitoring in sedated trauma patients.

Pooling 12 studies (336 patients), better radiological reduction (MATTA) correlated with better functional scores mainly at the extremes (excellent vs poor), but agreement was only moderate (51–58%) — reinforcing anatomic reduction as a goal while suggesting reduction quality alone does not determine outcome and that current functional scoring tools may be inadequate.

Multinational African Delphi produced 14 recommendations for NPWT in open fractures/complex wounds in resource-limited settings. Strongest agreement: use NPWT only as an adjunct to standard open-fracture care, after adequate surgical debridement, and always followed by timely definitive soft-tissue reconstruction — not as a substitute for it. Technical/organizational parameters reached lower consensus.

In combat vascular trauma, damage-control moves (extensive exposure, shunting, ligation, prophylactic fasciotomy) save life and limb but carry real iatrogenic cost; select them by physiology, ischemic burden, evacuation conditions and available expertise rather than reflexively, and repair/shunt major named arteries whenever perfusion is threatened.

Among 152 hemodynamically unstable major pelvic-ring injuries, in-hospital mortality was 7.2% and haemorrhage-related mortality just 2% (MTP activated in 45%, angioembolisation in only 5.9%) — reinforcing that mature trauma systems can achieve very low pelvic-haemorrhage mortality.

In 4,415 hip-fracture patients, surgical delay beyond 36 h was associated with significantly higher in-hospital mortality for both intracapsular and extracapsular fractures, and longer stay for intracapsular fractures — supporting prioritized early surgery, especially in patients ≥70.

Across 70 studies, extremity injuries (including amputations) are the leading blast-injury pattern; body-region distribution differs between military and civilians (more head injuries in military, more thorax/abdomen in civilians), likely reflecting protective-equipment availability — useful for preparedness and resource planning.

In 3,066 blunt rib-fracture patients, SSRF was associated with ~43% lower adjusted odds of a composite pulmonary complication (pneumonia, prolonged ventilation, or tracheostomy) and of respiratory failure versus nonoperative management, despite SSRF patients having worse chest-wall injury (higher RibScore).

In 1776 hip-fracture patients ≥70, timing of geriatric consultation (pre- vs postoperative) was not independently associated with delirium (~19.7% vs 19.5%) or other short-term outcomes—access to geriatric co-management may matter more than its exact timing.

German proximal femur fracture cases rose 54% (2000-2023) and are projected to climb ~75% more to ~318,000/year by 2050, with 74% in patients aged 80+; direct costs roughly double to €6.4B. Modeled workforce gap of ~700 trauma surgeons and ~7,500 geriatricians — a system-planning wake-up call for geriatric trauma capacity.

In 589 fracture-related infection patients, adding postoperative IV vancomycin to vancomycin-impregnated cement did not raise AKI incidence (18.1% vs 14.5%) but did cause larger creatinine rises; AKI risk was driven mainly by pre-existing CKD. Supports cautious dual antibiotic therapy with close renal monitoring, especially in CKD.

Surgery within 48h of admission for proximal femur fractures was associated with lower in-hospital mortality, fewer complications and better discharge mobility (though delayed patients were higher-risk — possible confounding by indication).

In 236 ICU patients with ≥3 rib fractures, regional analgesia was associated with less respiratory deterioration than systemic-dominant analgesia (aOR 0.44); early "treatment goal uncertainty" (present in 40%) tracked with lower regional-analgesia use and worse respiratory outcomes.

SSRF showed no mortality benefit over non-operative management in isolated flail chest, but in flail-chest patients with severe TBI it was linked to lower in-hospital mortality (OR 0.28) — though at the cost of longer ICU stay and more VAP/tracheostomy across both groups.

An international panel reached high consensus on 14 of 15 statements to guide shared decision-making around non-operative hip-fracture care, aimed at more consistent management of frail older adults at end of life.

In geriatric rib-fracture patients, higher STUMBL scores independently predicted 3-month mortality, delirium, and failure to return home; a cut-point >15 was sensitive but non-specific, so it best complements frailty/cognition assessment rather than replacing it.

Across a decade of US data, fasciotomy-treated ACS stayed rare and stable (~33/million), mostly lower-extremity and tied to open injuries and tibial shaft fractures, with 6% 30-day mortality — useful denominators for a limb-threatening emergency.

Across 255,081 US clavicle fractures, incidence rose 68% over the decade with a bimodal age distribution (peaks <19 and >80) and male predominance; rib fracture was the most common associated injury (14%) and ORIF rates climbed to ~8.5%, highest in 20–29-year-olds — useful for screening associated thoracic injury and understanding shifting operative practice.

In 355 adults (18–65) with femoral neck fractures, adding a medial buttress plate to cannulated screws sped early functional recovery but gave no long-term advantage over FNS or CCS while adding surgical trauma; implant removal, medial cortex comminution, Pauwels III and poor reduction were the key drivers of complications — argues for individualized implant choice, not universal MBP.

AI/ML shows robust performance for fragility-fracture risk prediction (frequently outperforming FRAX), BMD estimation, and fracture detection, but methodological heterogeneity, bias, and limited prospective/multicenter validation still block clinical translation.

Pooling 5 RCTs (423 patients), ERAS components cut hospital stay by ~2.6 days and reduced postoperative pain in orthopedic trauma, but with low-to-moderate certainty and unresolved safety signals (numerically higher infection, unstable DVT estimate) — larger standardized trials still needed.

In a 6-center registry of major orthopaedic surgery (including urgent hip-fracture repair), male sex (OR 2.6), urgent surgery (OR 7.2), and prior VTE (OR 5.7) independently predicted higher 24-month mortality — factors worth adding to preoperative risk assessment.

Across 21 studies, AI/ML models for fragility-fracture risk prediction, BMD estimation, and outcome prognosis often outperformed traditional tools (e.g., FRAX), but methodological heterogeneity, bias risk, and scarce prospective/multicenter external validation still block clinical translation.

SSRF use for flail chest varies enormously between centers (median OR 3.08) and is less likely in older, female, Black, and self-pay patients; higher hospital SSRF volume tracked with more ventilator-free days and shorter ICU/hospital stays (no mortality difference), suggesting how a center uses SSRF — not just whether — matters for outcomes.

Updated national first-aid standards adding guidance on pulse oximeters, bronchodilators, supplementary oxygen, repeat adrenaline in anaphylaxis, hypoglycemia correction, counterpressure maneuvers for presyncope, handling of amputated parts, exertional dehydration, and jellyfish stings.

In matched cohorts (1,868 MRSA+ vs controls), preoperative MRSA colonization roughly doubled-to-tripled odds of sepsis, pneumonia, VTE, wound dehiscence, and transfusion after lower-extremity ortho trauma surgery — supports preop MRSA screening for risk stratification and possible decolonization.

A 16-variable, admission-time score derived from the National Trauma Data Bank predicts non-home discharge after adult fracture trauma with strong discrimination (AUC 0.83), outperforming prior tools and potentially enabling earlier discharge planning; needs external validation outside the US.

US emergency-department spine injuries from e-scooters, e-bikes, and hoverboards rose ~8.4-fold over a decade (mostly fractures, predominantly in adult males) — a fast-growing trauma burden that warrants clinical anticipation and prevention/counseling efforts.

A practical framework for anticoagulated hip-fracture patients that decouples the (looser) haemostatic threshold for surgery from the (stricter) threshold for neuraxial anaesthesia, and uses active reversal plus patient blood management to keep surgery within 24-48 h rather than passively waiting out drug clearance.

For severe lower-limb trauma (Gustilo IIIB/IIIC or MESS ≥7), limb salvage and primary amputation give comparable long-term function and quality of life, but salvage carries markedly higher infection (2.5x), re-hospitalization and chronic-pain rates and a 22.7% secondary-amputation rate — supporting individualized, shared decision-making.

Severe cardiac complications after isolated sternal fracture were rare, challenging blanket telemetry/rhythm-monitoring protocols for blunt cardiac injury and supporting a more selective monitoring approach.

In patients undergoing surgical stabilization of rib fractures with a hemothorax, VATS washout gave shorter chest-tube duration than blind intra-operative pleural irrigation (independent after adjustment), but mortality, pneumonia, readmission, and ICU stay were comparable — technique choice affects tube days more than broader outcomes.

Deep-learning reconstruction improved perceived image quality and reader confidence but not sensitivity or specificity; CT still cannot exclude sacral fragility fracture, so MRI remains necessary when clinical suspicion persists after a negative CT.

A protocolized multimodal rib-fracture bundle (escalating analgesia, standardized nursing assessment, atelectasis/mucus-clearance regimen) was associated with shorter LOS (−1.4 days adjusted; 14.7→11.2 days matched), fewer rapid responses and lower odds of mechanical ventilation, and lower mortality in the matched high-morbidity sample (10.7%→6.5%) — despite only 53% protocol adherence.

Among blunt pelvic-fracture patients (prehospital binder used in only 1.8%), binder use was not associated with lower 24-hour RBC transfusion volume or in-hospital mortality, but was associated with more pelvic angioembolization (33.0% vs 21.2%, OR 1.82) — suggesting binders shape or reflect downstream hemorrhage-control strategy rather than directly cutting transfusion needs.

Prospective longitudinal cohort suggesting rib fracture location (anterior vs posterior) shapes recovery beyond fracture count/displacement alone — arguing that anatomic location should factor into chest-wall injury risk assessment and surgical decision-making.

Admission-time score built and validated on the NTDB (2019–2024) to flag adult fracture-trauma patients likely to need post-acute placement, so discharge planning can start earlier and cut length of stay.

In COPD patients with multiple rib fractures, SSRF showed no mortality benefit and more resource use versus nonoperative care, but early fixation (<72 h) was associated with shorter ICU/hospital stays and less ventilation in non-flail patients.

Pooled VTE rate in children with lower-limb fractures was low (~0.53%); evidence on risk factors and prophylaxis efficacy is sparse, so individualized rather than routine pharmacologic thromboprophylaxis is recommended.

Cryoablation during SSRF gave no opioid reduction in nonventilated patients and raised referrals for intercostal neuralgia (20% vs 4.5%), but in ventilated patients was associated with shorter ventilation (1.8 vs 5.3 days) and less pneumonia — argues for selective, acuity-driven rather than routine use.

In 158 neurologically intact thoracolumbar trauma patients, adding emergency MRI to CT changed management in 12% — almost entirely by revealing posterior ligamentous complex injuries CT missed (48 vs 16 PLC injuries). Supports indication-driven, not routine, MRI.

Deep-learning CT reconstruction raised reader confidence and image quality but did not improve sensitivity or specificity for sacral fragility fractures. A negative CT still cannot rule them out — MRI stays necessary when suspicion persists.

Across 1451 pelvic ring injuries, lateral compression patterns dominated (79%), a quarter met polytrauma criteria, 82% were managed non-operatively, and mortality was 1.4%. Useful contemporary denominator data for trauma-system and resource planning.

The Western Trauma Association issued a new critical-decisions algorithm for traumatic hemothorax, offering a bedside pathway that weighs patient physiology, hemothorax size, adequacy of pleural drainage, and evidence of ongoing hemorrhage to guide the choice between observation, tube thoracostomy, and operative intervention.

Using the multicenter FixCon RCT population (n=180), tests how reliable and valid spirometry, pain scores, and quality-of-life instruments are as outcome measures for multiple rib fractures without a flail segment — informing which endpoints future chest-trauma trials should use.

In 9 studies (10,785 patients with nonvariceal upper GI bleeding), ultra-early endoscopy (<=6 h) did not reduce mortality, rebleeding, transfusion, surgery, or length of stay versus early endoscopy (>6 h), but was linked to more ICU admissions — supporting adequate resuscitation and endoscopy within the standard 24-h window rather than rushing to <=6 h.

In a prospective multicenter cohort (1,737 SBO patients; 24% with no prior surgery), adhesive SBO in the "virgin abdomen" had a similar clinical and imaging phenotype to post-surgical adhesive SBO but was managed more operatively — suggesting the no-prior-surgery status lowers the operative threshold more than true disease severity does.

Pooling 10 RCTs (1,077 patients), pre-endoscopic prokinetics — mostly erythromycin — improved adequate gastric emptying/endoscopic visualization (OR 3.68) and reduced repeat endoscopy (OR 0.54), but showed no clear benefit for mortality, rebleeding, or transfusion; the gains are procedural rather than hard-outcome, and the evidence for metoclopramide is weaker.

A joint AAST/ACS-COT clinical protocol standardizing management of blunt splenic injury across adult and pediatric patients — algorithmic guidance on non-operative management, angioembolization, and thresholds for operative intervention to reduce practice variation.

Across 61,400 Danish patients undergoing major emergency abdominal surgery, comorbidity combinations (notably cardiac, renal, liver, and cerebrovascular disease) interacted to drive mortality beyond their isolated effects — risk tools that treat comorbidities as independent underestimate risk in multimorbid patients.

In open-abdomen management, a noninvasive fascial-traction technique increased primary fascial closure rates and reduced the incidence of incisional hernia — a low-morbidity adjunct to closing the open abdomen. (Full abstract not yet posted; bottom line taken from the published title/conclusion.)

In a physician-led HEMS cohort (n=94; 66 minithoracostomy vs 28 chest drainage), prehospital minithoracostomy did not lengthen scene time and had far fewer recorded complications than chest drainage; because allocation was non-randomized with differential complication ascertainment, the finding is hypothesis-generating rather than proof of superiority.

Across 154,137 Japanese non-cardiac OHCA cases, bystander rescue-breathing CPR was associated with modestly lower 30-day mortality and unfavorable neurological outcomes versus compression-only CPR — the benefit concentrated in children and in drowning/asphyxial arrests, supporting rescue breaths when the arrest is non-cardiac.

Across 9 studies (10,785 adults with nonvariceal upper GI bleeding), ultra-early endoscopy (≤6 h) did not reduce mortality (OR 0.88) or rebleeding versus early endoscopy (>6 h), and did not change transfusion, surgery, or length of stay — but was associated with more ICU admissions (OR 1.41). Supports adequate resuscitation and timely endoscopy within the standard 24-h window rather than rushing to ≤6 h.

In a PRISMA systematic review (8 studies) of adults with sickle cell acute chest syndrome requiring ICU or mechanical ventilation, mechanical ventilation was the strongest mortality marker (OR up to 67.5 for MV <96 h in the largest cohort), alongside pulmonary hypertension/cor pulmonale and comorbidity burden; documented bacterial infection was uncommon and procalcitonin-guided antibiotic discontinuation was safe — favoring early recognition, severity-based respiratory support, and antimicrobial stewardship.

A nurse-led respiratory care bundle in abdominal sepsis was associated with roughly halved pneumonia incidence (25.6% vs 42.2%; adjusted OR 0.39), shorter length of stay, and lower 28-day mortality (18.3% vs 22.8%), consistent across five sensitivity analyses — supporting structured pulmonary nursing bundles in this population.

Practical review of small-bore "pigtail" chest catheters as first-line for many pleural conditions — Seldinger insertion, imaging confirmation, daily system checks, and uncoiling before removal to avoid tissue injury — with a rundown of placement and indwelling complications.

Older SBO patients achieved nonoperative resolution rates similar to younger patients (~69%) but had far higher complications (16.7% vs 6.7%) and mortality (6.9% vs 3.6%); decisions should weigh etiology, imaging severity and frailty rather than chronological age.

Only 8.7% of RCTs underpinning critical care guidelines had no exclusion criteria; pregnancy, moribund status, renal/liver dysfunction and TBI were commonly excluded — a reminder to weigh external validity before applying guideline recommendations to complex ICU patients.

In patients with >=3 rib fractures and concomitant TBI, surgical stabilization of rib fractures (SSRF) was associated with markedly lower in-hospital mortality in focal TBI (OR 0.26) and diffuse TBI, with TBI phenotype modifying the benefit. Suggests concomitant TBI should not automatically exclude patients from SSRF.

Pooling 19 RCTs (11,982 patients), LMA gave faster airway placement and higher first-pass and CPR success than endotracheal intubation, with no difference in survival or mortality — supporting LMA as a reasonable, individualized alternative, especially where intubation expertise is limited or chest-compression interruptions must be minimized.

Across 33,148 patients, splenic artery embolization (SAE) was associated with lower mortality, shorter hospital and ICU stays, and less thromboembolism than surgery — with a survival benefit that persisted even in hemodynamically unstable patients, challenging guideline preference for primary surgery in unstable cases. Confounding by indication from observational data is the key caveat.

Using 8,293 cases from the Australian/NZ ANZELA-QI national audit, machine-learning models (multilayer perceptron) and multivariate logistic regression matched the established NELA risk model for predicting 30-day mortality after emergency laparotomy — AI offered no clear advantage over existing risk tools.

In multiple rib fractures, both thoracoscopic and open fixation restored thoracic volume and improved early quality of life versus conservative chest-band management; thoracoscopic fixation caused less surgical trauma with better short-term rehabilitation and equivalent thoracic recovery and complication rates. Small single-center trial.

Largest pediatric SSRF cohort to date: only 0.31% of 28,465 pediatric rib-fracture patients underwent surgical rib fixation, and unlike the rising adult trend, pediatric use stayed flat and confined to older children with flail chest, high ISS, or open chest injuries. SSRF-treated children had zero mortality vs 7.3% non-operative, but heavy selection means pediatric indications remain undefined.

In high-grade (AAST ≥4) blunt renal trauma, interventional radiology was associated with substantially lower in-hospital mortality than operative management in both hemodynamically stable (aOR 0.21) and unstable (aOR 0.08) patients, with no increase in complications — supporting angioembolization as a safe primary strategy even in unstable patients at Level I centers. Confounding by indication is the key caveat.

AKI, which hits ~half of ICU patients, is reframed as a systemic syndrome driving remote dysfunction in lung, brain, heart, liver, and immune system via inflammation and metabolite accumulation — argues clinicians should watch for multi-organ crosstalk and flags limitations of MAKE as a trial endpoint.

Across 70 studies, extremity injuries (including amputations) are the leading blast-injury pattern; body-region distribution differs between military and civilians (more head injuries in military, more thorax/abdomen in civilians), likely reflecting protective-equipment availability — useful for preparedness and resource planning.

In 3,066 blunt rib-fracture patients, SSRF was associated with ~43% lower adjusted odds of a composite pulmonary complication (pneumonia, prolonged ventilation, or tracheostomy) and of respiratory failure versus nonoperative management, despite SSRF patients having worse chest-wall injury (higher RibScore).

Among severely injured patients undergoing thoracic damage control, complications were near-universal (74%) but did NOT predict death; only blunt mechanism (OR 3.82) and admission pH <7.1 (OR 3.13) independently predicted mortality — i.e., the physiology present at arrival, not downstream ICU complications, drives outcome.

Austrian multi-society consensus offers guidance on when resuscitative thoracotomy for traumatic cardiac arrest is justified in predominantly blunt-trauma systems, where the evidence and expected benefit differ from penetrating-trauma-heavy settings.

FAST sensitivity is strongly volume-dependent — only 14% at 250 mL, 37% at 500 mL, but 74% at 1000 mL and 91% at 1500 mL — so a negative FAST does not exclude significant intra-abdominal bleeding in an unstable patient. Longitudinal (vs transverse) views of the Douglas pouch boosted sensitivity by >20%; Morison's pouch had the highest yield.

In an obesity CPR manikin model, compression depth collapsed (median adequate-depth compressions fell from 98% to 0%) despite greater rescuer effort, and elevating the paramedic on a 10 cm platform did NOT help. Signals that simple ergonomic fixes are insufficient for CPR in patients with obesity — a simulation study, so treat as hypothesis-generating.

7.2% (1 in 14) of trauma laparotomies were negative; penetrating mechanism (OR 2.37) and lower surgeon grade (registrar vs consultant, OR 2.91) independently predicted a negative laparotomy, whereas country development index and hospital resource level did not — the authors propose negative-laparotomy rate as a trauma-system performance benchmark.

Across 467 resuscitative thoracotomy patients, EAST (signs of life) and WTA (prehospital arrest time) guidelines identified similar survivor subsets (survival ~6–7%, neurologically intact ~5–6%); both signs of life and arrest duration matter, supporting development of a unified RT guideline.

In 236 ICU patients with ≥3 rib fractures, regional analgesia was associated with less respiratory deterioration than systemic-dominant analgesia (aOR 0.44); early "treatment goal uncertainty" (present in 40%) tracked with lower regional-analgesia use and worse respiratory outcomes.

SSRF showed no mortality benefit over non-operative management in isolated flail chest, but in flail-chest patients with severe TBI it was linked to lower in-hospital mortality (OR 0.28) — though at the cost of longer ICU stay and more VAP/tracheostomy across both groups.

In geriatric rib-fracture patients, higher STUMBL scores independently predicted 3-month mortality, delirium, and failure to return home; a cut-point >15 was sensitive but non-specific, so it best complements frailty/cognition assessment rather than replacing it.

A pressure-sensing "ThoraSET" trocar that signals tissue layers cut chest-tube placement time and improved accuracy (79% vs 54%) mostly for less-experienced operators — an early-stage device idea to standardize an error-prone emergency procedure, pending clinical validation.

Across 255,081 US clavicle fractures, incidence rose 68% over the decade with a bimodal age distribution (peaks <19 and >80) and male predominance; rib fracture was the most common associated injury (14%) and ORIF rates climbed to ~8.5%, highest in 20–29-year-olds — useful for screening associated thoracic injury and understanding shifting operative practice.

A structured, cost-conscious diagnostic and management algorithm for gastric outlet obstruction — CT with oral contrast plus EGD/biopsy to distinguish now-predominant malignant causes from benign peptic disease, then a staged pathway from endoscopic dilation/stenting to pyloroplasty or resection/bypass — giving acute-care surgeons a standardized approach to a heterogeneous EGS problem.

Intra-arrest TEE is highly feasible (80–100% insertion, few complications), shifts chest-compression position in 19–76% of cases and alters management in 31–48%, and links compressions over the LVOT/aortic valve to worse ROSC — yet the two existing RCTs show no improvement in survival or neurological outcome, so its patient-centred benefit remains unproven.

Practical framework for five GI oncologic emergencies (malignant obstruction, hemorrhage, perforation, cholangitis, neutropenic enterocolitis): resuscitation/sepsis control precede oncologic concerns, favor endoscopic/nonoperative options when feasible, and lower the threshold for diversion over primary anastomosis with recent antiangiogenic therapy, neutropenia, or heavy contamination.

SSRF use for flail chest varies enormously between centers (median OR 3.08) and is less likely in older, female, Black, and self-pay patients; higher hospital SSRF volume tracked with more ventilator-free days and shorter ICU/hospital stays (no mortality difference), suggesting how a center uses SSRF — not just whether — matters for outcomes.

In selected patients, non-operative management of penetrating liver injuries was associated with lower mortality (RR 0.40) and fewer complications (RR 0.83) than operative management, with no significant difference in transfusion or length of stay — supporting NOM as a viable option in appropriately selected, hemodynamically stable patients. Based on observational data only.

In isolated flail chest, starting regional anesthesia within 24 h (vs later) was associated with fewer unplanned intubations and ICU admissions, shorter hospital/ICU stays and more routine discharges — supporting prioritizing early regional analgesia.

Among modern-warfare casualties, ~1 in 4 abdominal-trauma patients required laparotomy; small-bowel, colon, liver and retroperitoneal injuries plus higher injury severity independently predicted operation, yet in-hospital mortality stayed relatively low — data to guide triage in military and civilian trauma systems.

In patients undergoing surgical stabilization of rib fractures with a hemothorax, VATS washout gave shorter chest-tube duration than blind intra-operative pleural irrigation (independent after adjustment), but mortality, pneumonia, readmission, and ICU stay were comparable — technique choice affects tube days more than broader outcomes.

Across 12 studies (2,148 patients), CASS pooled sensitivity 77.2%/specificity 90.6% and BATSS 57.9%/86.5%; neither score is adequate as a standalone tool, but CASS may help rule out intra-abdominal injury and BATSS may help rule in the need for imaging or laparotomy where CT is unavailable.

Nearly half of blunt traumatic pneumothoraces were managed without a chest tube; variation was greatest at 15–50% size, where noninvasive management gave similar complication rates and length of stay despite a 29% secondary tube thoracostomy rate.

Passive leg raise loses accuracy in intra-abdominal hypertension (AUROC 0.71 vs 0.96), producing 16 false negatives tied to a persistently negative CVP–IAP gradient; end-expiratory occlusion and the 100 mL mini-fluid challenge remained reliable and should be preferred when IAP ≥12 mmHg.

Across 4 studies (4,937 blunt abdominal trauma patients, 150 pancreatic injuries), amylase/lipase drawn <90 min post-injury had low sensitivity; delayed testing (>3 h), especially combined lipase + amylase, performed better (one study 85% sensitivity/100% specificity) — don't rely on early enzymes, repeat after 3–6 h to help decide on further imaging.

A protocolized multimodal rib-fracture bundle (escalating analgesia, standardized nursing assessment, atelectasis/mucus-clearance regimen) was associated with shorter LOS (−1.4 days adjusted; 14.7→11.2 days matched), fewer rapid responses and lower odds of mechanical ventilation, and lower mortality in the matched high-morbidity sample (10.7%→6.5%) — despite only 53% protocol adherence.

Prospective longitudinal cohort suggesting rib fracture location (anterior vs posterior) shapes recovery beyond fracture count/displacement alone — arguing that anatomic location should factor into chest-wall injury risk assessment and surgical decision-making.

Transthoracic echo mapping suggests the guideline-recommended sternal compression point may not overlie the ideal area of maximal compression / LV outflow tract, questioning standard hand placement during CPR.

Noninvasive management of medium-sized (15–50%) blunt traumatic pneumothorax gave similar length of stay and complication rates versus tube thoracostomy, supporting observation as a safe strategy where practice currently varies most.

In COPD patients with multiple rib fractures, SSRF showed no mortality benefit and more resource use versus nonoperative care, but early fixation (<72 h) was associated with shorter ICU/hospital stays and less ventilation in non-flail patients.

Passive leg raise loses accuracy in intra-abdominal hypertension (AUROC 0.71 vs 0.96 without IAH), driven by a persistently negative CVP−IAP gradient producing false negatives; the end-expiratory occlusion test and 100 mL mini-fluid challenge stayed reliable and should be preferred in these patients.

Cryoablation during SSRF gave no opioid reduction in nonventilated patients and raised referrals for intercostal neuralgia (20% vs 4.5%), but in ventilated patients was associated with shorter ventilation (1.8 vs 5.3 days) and less pneumonia — argues for selective, acuity-driven rather than routine use.

In 158 neurologically intact thoracolumbar trauma patients, adding emergency MRI to CT changed management in 12% — almost entirely by revealing posterior ligamentous complex injuries CT missed (48 vs 16 PLC injuries). Supports indication-driven, not routine, MRI.

This systematic review and Bayesian meta-analysis found no clear advantage of mechanical over manual bag-valve ventilation during CPR for return of spontaneous circulation, survival, or good neurological outcome, supporting current guidelines that do not recommend mechanical ventilation over manual ventilation during resuscitation.

This PRISMA systematic review (3 studies, 1,111 polytrauma patients with lumbar spine fractures) found early fixation (<72 h) was associated with fewer ventilator days (4.9 vs 7.8) and shorter ICU stay (10.9 vs 13.7 d) than late fixation, but with only three moderate-quality studies these effects remain uncertain, hospital length of stay was similar, and injury severity (ISS) was the dominant driver of outcomes.

Pooling 11 RCTs (4,136 adults ventilated after ROSC), restrictive/conservative oxygen targets showed no significant difference in all-cause mortality (RR 0.96) or unfavorable neurological outcome (RR 0.96) versus higher-oxygen targets; restrictive targets modestly increased ventilator-free days but raised hypoxemia risk (RR 1.65). Under current normothermia protocols the accumulated evidence trends toward futility for a restrictive approach.

In a single-center RCT of 163 ventilated ICU patients, running the spontaneous breathing trial on high-flow oxygen therapy rather than pressure-support ventilation did not improve 48-hour extubation success (87.5% vs 80.5%, NS) but was safe and, in patients aged >=65 or ventilated >=24 hours, significantly shortened ICU length of stay.

This PRISMA systematic review and meta-analysis (20 studies, 18,852 polytrauma patients) found Early Total Care, versus Damage Control Orthopedics, was associated with shorter hospital stay (~4.9 fewer days), fewer surgical procedures, lower sepsis risk (OR 0.63), and less delayed union, with no significant difference in mortality, MODS, ARDS, or infection. The evidence is largely observational, so the authors stress physiology-based patient selection rather than a blanket preference for either strategy.

In this 79-patient phase II RCT, starting angiotensin II, vasopressin, and norepinephrine together early in septic shock sped the fall in renin and lactate, lowered 72-h SOFA, and sharply cut tachyarrhythmias (15.6% vs 68.6%) versus stepwise escalation — promising physiology that was not powered to show a mortality benefit.

In 108 acute brain-injury patients (7,089 paired readings), the two commercial pupillometry indices NPi and QPi correlated and both predicted poor 6-month outcome, but QPi was far more sensitive to propofol/sufentanil. The indices are not interchangeable in sedated ICU patients, and QPi's apparent link to raised ICP is likely confounded by sedation.

In 9 studies (10,785 patients with nonvariceal upper GI bleeding), ultra-early endoscopy (<=6 h) did not reduce mortality, rebleeding, transfusion, surgery, or length of stay versus early endoscopy (>6 h), but was linked to more ICU admissions — supporting adequate resuscitation and endoscopy within the standard 24-h window rather than rushing to <=6 h.

In 211 adults ventilated >=21 days, indirect-calorimetry-guided feeding did not significantly improve weaning success (58% vs 50%) or time to liberation versus predictive-equation feeding, though it cut overfeeding and a smaller energy gap was independently associated with successful weaning — a negative primary result that still supports measuring energy expenditure.

Despite early signals that volatile anesthetics lower lung inflammation and improve oxygenation in ARDS, a recent multicenter RCT found sevoflurane reduced ventilator-free days and increased mortality versus propofol in moderate-to-severe ARDS; routine volatile ICU sedation for ARDS is not recommended outside trials.

A 2-site pilot RCT showed it is feasible to randomize ventilated subacute cervical SCI patients to moderate-low (8-10 mL/kg) vs moderate-high (14-16 mL/kg) tidal volumes, generating exploratory data on pneumonia, ventilator-free days, and inflammation — groundwork for a definitive trial rather than a practice change yet.

In a propensity-matched single-center comparison (321 blast vs 1,481 matched blunt patients), blast trauma imposed a far higher institutional resource burden — about 3.4x the composite of prolonged stay, ICU admission, or urgent surgery — with markedly higher odds of shock-room triage (OR 10.6), ≥3 operations (OR 12.4), massive-transfusion activation (OR 11.7), and ICU admission (OR 5.5), persisting across all injury-severity strata; relevant to mass-casualty and blast-event resource planning.

Exploratory REMAP-CAP analysis testing whether plasma ferritin or suPAR can flag the critically ill COVID-19 patients most likely to benefit from the IL-1 inhibitor anakinra — a treatable-traits / precision-ICU approach to immune modulation.

In high-risk ventilated patients, a structured specialist-led interprofessional weaning program achieved successful weaning in 58.3% vs 51.7% of controls (adjusted OR 1.46, 95% CI 0.99-2.17) — a benefit signal that stopped just short of statistical significance.

In 79 septic shock patients on >=0.15 ug/kg/min norepinephrine, starting angiotensin II + vasopressin + norepinephrine together (vs classic stepwise) sped renin and lactate clearance, cut 72-h SOFA by 3 points vs 0, and sharply reduced tachyarrhythmias (15.6% vs 68.6%); ICU and 28-day mortality were not significantly different in this phase II trial, so it is hypothesis-generating for a larger study.

In 11,768 NZ major trauma patients (2018–2022), over half had at least one comorbidity (rising 53%→56% over the period); comorbidity was linked to longer hospital and ICU stays, more ventilator hours, higher in-hospital and 12-month mortality, and higher cost.

A WSES GRADE-based guideline (17 PICO questions) endorsing a selective, physiology-driven approach to colorectal trauma: primary repair or resection-with-anastomosis over routine diversion for most stable patients, proximal diversion as default for extraperitoneal rectal injury, no routine presacral drainage/distal washout, antibiotics ≤24h, and early enteral nutrition in selected patients.

A Western Trauma Association critical-decisions algorithm for the injured older adult, giving structured guidance on field triage, frailty assessment, trauma-team activation, and ICU admission — aimed at reducing the well-documented undertriage of geriatric trauma patients.

In a propensity-matched TQIP analysis (174 pairs), starting hyperosmolar therapy (hypertonic saline or mannitol) within 3 h of admission in severe TBI did not change operative interventions or mortality versus a later start, but was associated with fewer ICU days and ventilator days.

In 211 adults ventilated ≥21 days, indirect calorimetry-guided feeding produced numerically higher weaning success (58% vs 50%) and lower 1-year mortality (48% vs 56%) than predictive-equation feeding but without statistical significance; a smaller gap between measured and delivered energy was independently linked to successful weaning, supporting larger trials of measured-energy-guided nutrition.

Secondary analysis of PEPaNIC links the harm from early parenteral nutrition in critically ill children to a surge in ureagenesis (rising urea/creatinine) — a marker of metabolic intolerance to high amino-acid loads — reinforcing caution about aggressive early feeding in the PICU.

Across 9 studies (10,785 adults with nonvariceal upper GI bleeding), ultra-early endoscopy (≤6 h) did not reduce mortality (OR 0.88) or rebleeding versus early endoscopy (>6 h), and did not change transfusion, surgery, or length of stay — but was associated with more ICU admissions (OR 1.41). Supports adequate resuscitation and timely endoscopy within the standard 24-h window rather than rushing to ≤6 h.

In a PRISMA systematic review (8 studies) of adults with sickle cell acute chest syndrome requiring ICU or mechanical ventilation, mechanical ventilation was the strongest mortality marker (OR up to 67.5 for MV <96 h in the largest cohort), alongside pulmonary hypertension/cor pulmonale and comorbidity burden; documented bacterial infection was uncommon and procalcitonin-guided antibiotic discontinuation was safe — favoring early recognition, severity-based respiratory support, and antimicrobial stewardship.

A European expert panel endorsed the ultra-short-acting β1-blocker landiolol for rate control in selected septic-shock patients with new-onset AF — correct reversible triggers first, assess hemodynamics before rate control, start without a bolus at low doses titrated to an initial HR target <110 bpm under echo/hemodynamic monitoring. No consensus was reached on optimal duration or use with severe LV dysfunction.

In a 4-year Victorian OHCA registry, 0.8% of arrests were caused by foreign-body airway obstruction. Magill's forceps and intubation were the most effective interventions for restoring ventilation (73% each), whereas laryngeal mask airways were commonly used but rarely effective (7%). Survival was dismal (3.6% overall; zero survivors among patients >65), reinforcing the primacy of prompt bystander relief and the need to assess futility.

Across 942 admitted pediatric burns, age-adjusted TBSA cut-points supported earlier ICU consideration at ~8-10% TBSA in toddlers and ~15% in school-age children/adolescents. ICU transfer and surgery rarely occurred without fever, and hands/joints/perineum/buttocks or persistent fever/delayed presentation warranted heightened surgical review.

Both severe/iatrogenic hyperglycaemia and hypoglycaemia should be avoided; tight glucose control helps only with a validated protocol that prevents severe hypoglycaemia (e.g. early parenteral nutrition), otherwise intermediate targets are the safer default — glucose targets should be tailored to clinical context.

A nurse-led respiratory care bundle in abdominal sepsis was associated with roughly halved pneumonia incidence (25.6% vs 42.2%; adjusted OR 0.39), shorter length of stay, and lower 28-day mortality (18.3% vs 22.8%), consistent across five sensitivity analyses — supporting structured pulmonary nursing bundles in this population.

In aortic dissection/aneurysm transports, esmolol, labetalol, or nicardipine as single agents achieved similar odds of hitting HR/SBP targets versus combinations; labetalol alone had the least hypotension and esmolol the most — suggesting single-agent therapy is a reasonable option when combination beta+CCB isn't feasible en route.

Across four studies, prehospital arterial-line insertion was consistently associated with longer scene time (4-34.4 min), but the evidence is weak and the clinical significance context-specific — a caution to weigh invasive prehospital BP monitoring against transport delay rather than a directive against it.

Across 8 studies (8,173 patients, 7 RCTs), balanced crystalloids reduced mortality vs saline (RR 0.92, 95% CI 0.86–0.98; moderate certainty) plus less AKI, hyperchloremia, and RRT, and more ICU/ventilator/vasopressor-free days. Supports preferring balanced crystalloids over saline in sepsis resuscitation.

In sepsis, the drop in arterial pH during ED-to-ICU transition (ΔpH) independently predicted 28-day mortality across acid-base categories, with the strongest signal in patients with a normal baseline pH (adjusted HR 4.43). ΔpH flags acute deterioration in patients who otherwise look stable.

In ICU patients on CRRT or sustained low-efficiency dialysis (many also on ECMO), actual body weight plus RRT intensity and duration were the main determinants of vancomycin exposure. Monte Carlo simulation produced an optimised dosing nomogram to hit the MRSA efficacy target (AUC/MIC ≥400) while staying below the toxicity threshold (AUC ≥700).

Among ICU patients who fail to wean, three distinct phenotypes emerge defined by separation-attempt count and timing of withdrawal-of-life-sustaining-therapy (WLST); failed first separation attempts were tightly linked to WLST decisions and 78% ICU mortality, flagging an early high-risk trajectory.

Only 8.7% of RCTs underpinning critical care guidelines had no exclusion criteria; pregnancy, moribund status, renal/liver dysfunction and TBI were commonly excluded — a reminder to weigh external validity before applying guideline recommendations to complex ICU patients.

A non-invasive index combining airway occlusion pressure, inspiratory time and respiratory rate closely tracked esophageal pressure-time product and detected dangerously high or low inspiratory effort (AUC 0.91) in mechanically ventilated patients — a bedside alternative to invasive esophageal manometry for titrating support and limiting VILI/diaphragm injury.

Across 8,577 Impella-treated cardiogenic shock patients, in-hospital cardiac arrest before implantation marked a distinct high-risk phenotype (30-day mortality 48% vs 29% no-arrest; adjusted HR 1.54) with more bleeding, limb ischemia, stroke and sepsis; lactate >4, creatinine >1.5, longer arrest time and VA-ECMO predicted death, supporting early risk stratification.

In 942 admitted pediatric burns, age-specific TBSA cutoffs stratified risk of ICU transfer, surgery and infection: consider earlier ICU review at ~8-10% adjusted TBSA in toddlers and ~15% in school-age/adolescents, with depth/site-driven surgical review (hands, joints, perineum, buttocks) and vigilance for persistent fever or delayed presentation.

Across 33,148 patients, splenic artery embolization (SAE) was associated with lower mortality, shorter hospital and ICU stays, and less thromboembolism than surgery — with a survival benefit that persisted even in hemodynamically unstable patients, challenging guideline preference for primary surgery in unstable cases. Confounding by indication from observational data is the key caveat.

Hantavirus cardiopulmonary syndrome remains highly lethal (20.5% in-hospital mortality; ~30-33% among those needing mechanical ventilation or ECMO) and demands heavy respiratory support; mortality rose during the COVID-19 pandemic, underscoring ICU surge vulnerability.

Pooling 8 studies (8,173 patients; 7 RCTs), balanced crystalloids reduced mortality versus normal saline (RR 0.92, 95% CI 0.86-0.98) with fewer episodes of acute kidney injury, hyperchloremia, and renal replacement therapy, plus more ICU-, ventilator-, and vasopressor-free days — supporting preferential use of balanced solutions over saline for fluid resuscitation in sepsis (moderate certainty).

AKI, which hits ~half of ICU patients, is reframed as a systemic syndrome driving remote dysfunction in lung, brain, heart, liver, and immune system via inflammation and metabolite accumulation — argues clinicians should watch for multi-organ crosstalk and flags limitations of MAKE as a trial endpoint.

Synthesis of 10 studies shows ICU patients and families actively use problem-, emotion-, and meaning-focused coping during delirium; families are a primary coping resource while managing their own distress — supports family-centred, coping-informed psychosocial interventions. Notably no quantitative studies existed, flagging an evidence gap.

In 3,066 blunt rib-fracture patients, SSRF was associated with ~43% lower adjusted odds of a composite pulmonary complication (pneumonia, prolonged ventilation, or tracheostomy) and of respiratory failure versus nonoperative management, despite SSRF patients having worse chest-wall injury (higher RibScore).

A single ICU-specific VR video (early or late) did not improve PTSD, anxiety, depression, or quality of life at 6 months versus standard care in ICU survivors, though patients rated it highly for understanding their ICU stay — negative trial that argues future VR for post-intensive-care syndrome should be multi-session, personalized, and targeted to high-risk patients.

EAST's annual roundup distills 13 practice-shaping 2025 studies (RCTs + large multicenter cohorts) spanning early resuscitation, timing of lifesaving interventions, analgesia/sedation, ventilator management, infection prevention, transfusion timing, perioperative antibiotics, imaging in older adults, and pediatric trauma pathways — a ready-made map of what changed this year.

In an ED/trauma setting, oral chloral hydrate (50 mg/kg) beat oral midazolam (0.3 mg/kg) — fewer venipuncture attempts (1.30 vs 1.96), faster sedation and IV access, shorter total procedure time, higher satisfaction, comparable safety — supporting it as a preferred agent for procedural sedation in young children.

Among severely injured patients undergoing thoracic damage control, complications were near-universal (74%) but did NOT predict death; only blunt mechanism (OR 3.82) and admission pH <7.1 (OR 3.13) independently predicted mortality — i.e., the physiology present at arrival, not downstream ICU complications, drives outcome.

Older observational data linking high protein intake to lower ICU mortality likely reflect statistical artefacts (immortal-time, confounding-by-indication, collider bias, etc.); recent RCTs (EFFORT 2023, PRECISe 2024, TARGET Protein 2025) show no benefit — a useful reminder to weight the trials over the cohorts when setting ICU protein targets.

New AAST/ACS-COT protocol standardizes nutrition in adult trauma: screen all for malnutrition, use indirect calorimetry in the critically ill, start early enteral feeds once resuscitation is complete (continuous gastric, post-pyloric if high aspiration risk), reserve parenteral nutrition for enteral contraindications, and individualize enteral timing in shock/vasopressors given mesenteric ischemia risk; immunonutrition, glutamine, and pro/prebiotics are not recommended.

State-of-the-art review frames trauma-related ARDS as a "multi-hit" process (initial injury + dysregulated inflammation + secondary insults like transfusion, infection, fat embolism); management stays largely supportive with lung-protective ventilation, multimodal imaging (CXR, lung ultrasound, CT) for risk stratification, pain control, hemodynamic optimization and timely surgery, with individualized approaches for TBI and hypothermia.

Beta-blockade in the ICU remains context-dependent: established benefit in acute MI, tachyarrhythmias, hypertensive emergencies, thyroid storm and variceal-bleed prevention, but evidence is limited/conflicting in septic shock, TBI, acute heart failure and burns. Safety depends on agent/dose, patient phenotype, timing, and whether it is continuation vs de novo initiation — argues for a phenotype-driven, physiology-guided approach.

In 169 ventilated patients (sepsis/acute respiratory failure) across 5 Korean ICUs, a protocolized six-step early mobilization program did not improve functional status (FSS-ICU) at ICU discharge or patient-reported outcomes at 12 months vs usual care, despite earlier/more mobilization; a signal that only patients reaching higher mobilization steps (sit-to-stand+) had better function suggests dose/achievement, not protocol assignment, may matter.

UK Faculty of Pre-Hospital Care consensus de-emphasizes aggressive fluid loading and reframes hyperkalaemia concerns in prehospital crush injury/crush syndrome, giving practicable recommendations for developed-system EMS.

Delphi consensus of 24 ICU experts sets lab/blood-count thresholds for safe early mobilization (hemoglobin, platelets, lactate, INR, pH, potassium), recommends deferring mobilization during transfusion, and flags Hb drop ≥2 g/dL/24h or platelet fall ≥20%/24h as contraindications.

In 1776 hip-fracture patients ≥70, timing of geriatric consultation (pre- vs postoperative) was not independently associated with delirium (~19.7% vs 19.5%) or other short-term outcomes—access to geriatric co-management may matter more than its exact timing.

ARDS complicates up to a third of acute brain injury patients and forces a real trade-off — lung-protective low-tidal-volume/higher-PEEP ventilation raises PaCO2 and can worsen intracranial pressure, while tight CO2 control deviates from ARDS strategy. Argues for physiology-driven, patient-specific ventilation guided by multimodal neuromonitoring (ICP, brain tissue oxygenation) rather than protocolised care.

In adults with >20% TBSA burns, first excision within 48h was associated with lower adjusted 90-day mortality (aOR 2.3 for delayed excision) despite more early sepsis — supports early excision in modern burn care.

The revised SOFA-2 systematically reclassifies organ-dysfunction severity vs original SOFA; patients scored equal by one system remain heterogeneous in mortality by the other — the two provide complementary, not interchangeable, information.

High-flow oxygen via ETT during SBTs generated flow/port-dependent airway pressure and lung-volume gains with lower driving pressure and better oxygenation than T-piece, positioning tracheal HFO as a distinct weaning strategy (clinical outcomes still unproven).

In ventilated acute brain injury patients, higher tidal volume helped only when respiratory system elastance was low; optimal tidal volume falls and optimal rate rises as elastance increases, with ~1 cmH2O driving pressure ≈ 3 breaths/min in prognostic weight — argues for elastance/driving-pressure-guided settings.

In 187 cancer patients with septic shock, a liberal (Hb 9 g/dL) vs restrictive (7 g/dL) transfusion strategy gave no difference in 12-h lactate clearance or 28-day mortality, but more thrombotic events with liberal — no support for routinely preferring either strategy.

Practical bedside framework for individualizing ARDS ventilation beyond guideline targets — starting settings, meeting driving-pressure goals, assessing recruitability/PEEP, and managing respiratory drive during the shift from controlled to assisted ventilation.

Meta-analysis (16 studies, 16,702 patients) found a pooled VAP incidence of 31.6% in ventilated patients with acute cerebrovascular disease; older age (≥65) and COPD were the most consistent risk factors — flagging targets for prevention in this understudied neurocritical population.

In 256 circulatory shock patients, 48-hour mean cerebral tissue oxygen saturation (NIRS) did not predict delirium, but lower values were associated with higher 90-day mortality — suggesting cerebral NIRS may flag mortality risk rather than delirium.

In 236 ICU patients with ≥3 rib fractures, regional analgesia was associated with less respiratory deterioration than systemic-dominant analgesia (aOR 0.44); early "treatment goal uncertainty" (present in 40%) tracked with lower regional-analgesia use and worse respiratory outcomes.

SSRF showed no mortality benefit over non-operative management in isolated flail chest, but in flail-chest patients with severe TBI it was linked to lower in-hospital mortality (OR 0.28) — though at the cost of longer ICU stay and more VAP/tracheostomy across both groups.

In geriatric rib-fracture patients, higher STUMBL scores independently predicted 3-month mortality, delirium, and failure to return home; a cut-point >15 was sensitive but non-specific, so it best complements frailty/cognition assessment rather than replacing it.

Proned ICU patients are at risk of chemosis, exposure keratopathy and raised intraocular pressure, with lagophthalmos, deep sedation, high PEEP and prolonged proning as associated factors; heterogeneity prevents incidence estimates, but the review supports structured eye protection and repeated ocular assessment before/during/after proning.

In the ERIC cluster-randomized trial, daily ICU tele-rounding did not improve weaning success rates but delivered significantly more spontaneous breathing trials (51% vs 27% of patient-days) and shortened mechanical ventilation duration in successfully weaned patients (7 vs 9 days) — telemedicine helps exploit existing weaning potential.

k-means clustering of nine routine ED variables in the Korean Sepsis Alliance registry identified six reproducible sepsis phenotypes (7-day mortality 6.7%–31.8%) that behave as a continuous severity spectrum; decomposing bundle non-compliance separates appropriate withholding from urgency-related delay — a distinction one-dimensional severity scores miss, relevant to phenotype-stratified resuscitation.

RBC transfusion reasons vary by intensity: hypotension and tachycardia were the top physiological triggers in non-major/major transfusions, but hypotension was cited far less in massive transfusion — arguing that transfusion intensity and clinical context, not hemoglobin alone, should frame transfusion-practice evaluation.

In trauma ICU patients, statin users had markedly lower VTE despite similar prophylaxis (8% vs 19%), with statin use independently associated with reduced VTE (OR 0.21) even in the highest-risk stratum (RAP>=10, 28% VTE). Hypothesis-generating; single-center, needs prospective confirmation.

Practical framework for five GI oncologic emergencies (malignant obstruction, hemorrhage, perforation, cholangitis, neutropenic enterocolitis): resuscitation/sepsis control precede oncologic concerns, favor endoscopic/nonoperative options when feasible, and lower the threshold for diversion over primary anastomosis with recent antiangiogenic therapy, neutropenia, or heavy contamination.

Clustering nine routine ED variables identified six reproducible sepsis phenotypes spanning a continuous severity spectrum (7-day mortality 6.7%–31.8%); decomposing bundle "non-compliance" showed it mixes appropriate withholding vs urgency-related delay in phenotype-specific proportions — a distinction one-dimensional severity scores miss, supporting phenotype-stratified resuscitation.

In trauma patients receiving only 1–3 units of RBCs, early empiric calcium supplementation in hypocalcemic patients was independently associated with more AKI, ARDS, DVT, and PE — challenging the growing practice of giving calcium with the first unit of blood, at least in low-volume transfusion. Hypothesis-generating; single-center, retrospective.

SSRF use for flail chest varies enormously between centers (median OR 3.08) and is less likely in older, female, Black, and self-pay patients; higher hospital SSRF volume tracked with more ventilator-free days and shorter ICU/hospital stays (no mortality difference), suggesting how a center uses SSRF — not just whether — matters for outcomes.

Early enteral nutrition (<48h) in TBI trended toward lower short-term mortality (significant in the RCT-only sensitivity analysis, RR 0.58) and reduced ventilation time, ICU/hospital stay, sepsis, VAP, and stress ulcers versus delayed feeding, with only more diarrhea — but high bias and heterogeneity mean larger RCTs are still needed.

In the ERIC ICU telemedicine trial, daily tele-rounding did not improve weaning success rates but drove nearly twice as many spontaneous breathing trials and shortened ventilation duration in successfully weaned patients (7 vs 9 days), suggesting telemedicine helps ICUs act on existing weaning potential.

In matched cohorts (1,868 MRSA+ vs controls), preoperative MRSA colonization roughly doubled-to-tripled odds of sepsis, pneumonia, VTE, wound dehiscence, and transfusion after lower-extremity ortho trauma surgery — supports preop MRSA screening for risk stratification and possible decolonization.

First tri-society Spanish consensus on accidental hypothermia — 37 Delphi-based recommendations across the whole rescue chain (prehospital prevention, initial assessment, transport, polytrauma care, hospital rewarming, cardiac arrest and ECMO resuscitation), giving a standardized protocol backbone.

In isolated flail chest, starting regional anesthesia within 24 h (vs later) was associated with fewer unplanned intubations and ICU admissions, shorter hospital/ICU stays and more routine discharges — supporting prioritizing early regional analgesia.

Pooled RCT evidence weighing intensive versus liberal glucose targets in ICU patients; reinforces that tighter control raises hypoglycemia risk without a clear mortality benefit, supporting moderate glucose targets.

Authoritative ICM review argues for moving beyond fixed ICP thresholds toward individualized, multimodal-guided management in TBI and other acute brain injury—reframing how ICP data should drive bedside decisions.

In a large global-network cohort, burn patients who developed shock within 7 days had markedly higher acute kidney injury (RR 1.65), renal replacement therapy (RR 4.42) and mortality (RR 2.60 at 3 months) than matched non-shock burn patients, with elevated 1-year RRT and death persisting — supports intensified renal surveillance and kidney-protective strategies after burn shock.

An EAST committee provides a practical framework for acute-care surgeons to evaluate AI/large-language-model tools — covering bias, validation, implementation, and governance — as these products proliferate in the ED, OR, and ICU.

IPD meta-analysis of 56 studies (1,248 patients) found covert consciousness (volitional brain responses without behavioral output) is common but varies by etiology — less detectable after anoxic or cerebrovascular injury than after TBI, and more common in minimally conscious state minus. Detection was independent of time since injury, task paradigm, and modality, arguing for standardized protocols in neuro-ICU prognostication.

In patients undergoing surgical stabilization of rib fractures with a hemothorax, VATS washout gave shorter chest-tube duration than blind intra-operative pleural irrigation (independent after adjustment), but mortality, pneumonia, readmission, and ICU stay were comparable — technique choice affects tube days more than broader outcomes.

Bicarbonate did not reduce 90-day mortality overall but cut renal replacement therapy initiation from 50.7% to 34.8% (NNT 6.3), and in the pH ≤7.10 subgroup it reduced 90-day mortality (RR 0.80) — arguing for earlier correction of profound acidemia.

Passive leg raise loses accuracy in intra-abdominal hypertension (AUROC 0.71 vs 0.96), producing 16 false negatives tied to a persistently negative CVP–IAP gradient; end-expiratory occlusion and the 100 mL mini-fluid challenge remained reliable and should be preferred when IAP ≥12 mmHg.

Before labelling septic shock refractory, run a parallel bedside sweep for reversible contributors — antimicrobial adequacy and source control first, then fluid responsiveness/tolerance, acidemia and sedation burden, and cardiac mechanisms including ventriculo-arterial uncoupling and dynamic LVOT obstruction.

Prone positioning is now a core early component of lung-protective ventilation for intubated ARDS with P/F <150, working by reducing lung stress and strain rather than by oxygenation alone; awake proning still needs confirmation outside COVID.

Immunocompromised patients made up ~19% of critically ill viral SARI admissions and had nearly double the adjusted odds of in-hospital mortality (aOR 1.93) despite receiving more antivirals and corticosteroids.

A protocolized multimodal rib-fracture bundle (escalating analgesia, standardized nursing assessment, atelectasis/mucus-clearance regimen) was associated with shorter LOS (−1.4 days adjusted; 14.7→11.2 days matched), fewer rapid responses and lower odds of mechanical ventilation, and lower mortality in the matched high-morbidity sample (10.7%→6.5%) — despite only 53% protocol adherence.

Synthesis of 25 years of trials argues fixed, isolated hemodynamic/metabolic targets (e.g., early goal-directed therapy) have repeatedly failed to reproduce outcome benefits; the field is shifting toward physiology-guided, phenotype-driven resuscitation using reversible tests in short decision cycles and rapidly responsive signals such as capillary refill time (ANDROMEDA-SHOCK-1/2).

Review arguing that fixed cerebral perfusion pressure thresholds miss individual autoregulation; noninvasive bedside transcranial Doppler can help personalize perfusion-pressure targets in acute brain injury.

In COPD patients with multiple rib fractures, SSRF showed no mortality benefit and more resource use versus nonoperative care, but early fixation (<72 h) was associated with shorter ICU/hospital stays and less ventilation in non-flail patients.

Head-on and single-vehicle crash characteristics independently predicted severe injury (ISS>15), mortality, and need for surgery/ICU — arguing that vehicle/collision telemetry could sharpen prehospital field triage decisions.

Adding persistent hypoperfusion markers (prolonged capillary refill + non-falling lactate) to a high vasopressor dose (>0.5 µg/kg/min NEE) identified a refractory septic shock subgroup with ~74% mortality — better prognostic enrichment than vasopressor dose alone.

Ultra-low tidal volume (4 mL/kg) versus 6 mL/kg in COVID ARDS showed no mortality difference at 1 year but a small, significant decline in cognition (MoCA), possibly linked to higher PaCO₂ — a caution against permissive hypercapnia strategies.

Adding a peripheral perfusion index target (PPI ≥1.4) to conventional macrohemodynamic resuscitation endpoints halved 7-day acute skin failure (14.6% vs 29.7%), improved 6-hour lactate clearance, and cut 72-hour positive fluid balance by ~600 mL; 28-day mortality was unchanged.

Passive leg raise loses accuracy in intra-abdominal hypertension (AUROC 0.71 vs 0.96 without IAH), driven by a persistently negative CVP−IAP gradient producing false negatives; the end-expiratory occlusion test and 100 mL mini-fluid challenge stayed reliable and should be preferred in these patients.

Before labeling septic shock refractory, run a parallel bedside sweep for reversible contributors — antimicrobial adequacy and source control first, then fluid responsiveness/tolerance, acidemia and sedation burden driving vasoplegia, and cardiac causes including ventriculo-arterial uncoupling and dynamic LVOT obstruction.

Immunocompromised patients made up ~1 in 5 ICU admissions for viral severe acute respiratory infection and carried nearly double the adjusted odds of in-hospital death (aOR 1.93) despite receiving more antivirals and corticosteroids.

Body composition phenotype matters more than BMI in ICU recovery — preserved muscle mass may protect, while visceral adiposity or sarcopenia predicts prolonged ventilation and ICU-acquired weakness; the panel calls for weight-rated mobilisation equipment, targeted nutrition, secretion clearance and positioning, and structured post-ICU follow-up.

Cryoablation during SSRF gave no opioid reduction in nonventilated patients and raised referrals for intercostal neuralgia (20% vs 4.5%), but in ventilated patients was associated with shorter ventilation (1.8 vs 5.3 days) and less pneumonia — argues for selective, acuity-driven rather than routine use.

The Western Trauma Association issued an updated critical-decisions algorithm for blunt cerebrovascular injury, giving a practical pathway for screening, imaging, and antithrombotic management of these often-occult carotid/vertebral artery injuries.

In the British Columbia registry, opioid-associated OHCA (13% of cases, median age 40) showed no overall difference in favourable neurological survival versus undifferentiated arrest, but the relationship between Utstein predictors and outcomes differed by sex, initial rhythm, and witnessed status — a caution that mixing opioid cases into observational OHCA analyses can distort findings.

This scoping review found battlefield pain management (morphine, oral transmucosal fentanyl citrate, ketamine, regional anesthesia) is well documented, but palliative and end-of-life care for expectant/dying combatants remains sparse and largely extrapolated from civilian data, with little training or doctrinal guidance — a widening gap as large-scale combat operations make non-survivable injuries more likely.

Across 16 guidelines/consensus documents, initial adult TBI care agrees on the fundamentals — early neurological assessment, airway protection, avoiding hypotension and hypoxemia, and timely CT — but still diverges on blood-pressure and cerebral-perfusion-pressure targets, repeat imaging, definitions of neurological deterioration, escalation/observation protocols, and seizure and VTE prophylaxis; the authors call for harmonizing definitions and pathways.

A WSES GRADE-based guideline (17 PICO questions) endorsing a selective, physiology-driven approach to colorectal trauma: primary repair or resection-with-anastomosis over routine diversion for most stable patients, proximal diversion as default for extraperitoneal rectal injury, no routine presacral drainage/distal washout, antibiotics ≤24h, and early enteral nutrition in selected patients.

In a PRISMA systematic review (8 studies) of adults with sickle cell acute chest syndrome requiring ICU or mechanical ventilation, mechanical ventilation was the strongest mortality marker (OR up to 67.5 for MV <96 h in the largest cohort), alongside pulmonary hypertension/cor pulmonale and comorbidity burden; documented bacterial infection was uncommon and procalcitonin-guided antibiotic discontinuation was safe — favoring early recognition, severity-based respiratory support, and antimicrobial stewardship.

In matched adults ≥55 with pelvic ring fractures, operative management was associated with lower 2-year mortality (robust across analyses) and a non-robust 1-year signal, but neither benefit persisted after multivariable adjustment, while surgery carried consistently higher VTE and pneumonia. The operate-or-not decision should balance improved mobility against perioperative risk; prospective trials are needed.

Pooled VTE frequency in severe pediatric TBI was 7% (rising to 20% with central venous lines), driven by injury severity and multimodality treatment — arguing that VTE is an under-recognized risk warranting standardized surveillance and prophylaxis consideration in children.

Despite standard 28-day LMWH prophylaxis, pelvic/acetabular fracture patients stayed hypercoagulable on serial TEG (75% at 4 weeks, 29% at 3 months) and 23% developed VTE (mostly PE), with acetabular fractures highest — signaling current prophylaxis duration may be too short and supporting study of extended/individualized regimens.

New EAST guideline (25 studies) conditionally favors antibiotics alone over percutaneous cholecystostomy plus antibiotics in high-risk patients with acute calculous cholecystitis, and supports removing a cholecystostomy catheter without interval cholecystectomy once inflammation resolves and cystic duct patency is confirmed.

Practice-focused review for the trauma/general surgeon reframing acute extremity compartment syndrome: the classic "6 P's" are misleading — pain out of proportion, refractory to analgesia, is often the ONLY early sign, while the other 5 P's mark late/missed disease with preventable harm. Early fasciotomy remains the only effective treatment. Consolidates the updated 2025 AAOS clinical practice guideline, ACS TQIP best-practice, and BOA/AAGBI consensus.

In trauma patients aged 40–60 (ISS ≥9), pre-injury antithrombotic therapy raised coagulopathy rates (especially VKA/DOAC) but, after matching, showed no clinically relevant difference in mortality (6.5% vs 6.2%). Unlike in the elderly, anticoagulation may not independently worsen survival in middle-aged trauma.

Scoping review that informed a 5-center New Zealand consensus VTE-prophylaxis guideline. Bottom line for trauma/TBI: mechanical prophylaxis (intermittent pneumatic compression) for essentially all patients, with LMWH started 24–72 h postoperatively — or after confirmed stable neuroimaging in TBI — consistently reducing VTE without a rise in major bleeding; timing and duration individualized by subgroup.

EAST's annual roundup distills 13 practice-shaping 2025 studies (RCTs + large multicenter cohorts) spanning early resuscitation, timing of lifesaving interventions, analgesia/sedation, ventilator management, infection prevention, transfusion timing, perioperative antibiotics, imaging in older adults, and pediatric trauma pathways — a ready-made map of what changed this year.

A derived/internally-validated risk score classified ~45% of isolated-TBI patients as low risk, in whom early (<24 h) pharmacologic prophylaxis was associated with lower mortality, DVT, and PE. Associative and hypothesis-generating — prospective validation with serial imaging needed before use, but it reframes the "wait 72 h" default.

In the subset with supratherapeutic INR >6 (n=23) needing urgent surgery, high-dose 4F-PCC (50 IU/kg) achieved effective hemostasis in 100% with no thromboembolic events, supporting the maximum-dose strategy for severe VKA-associated coagulopathy.

In 589 fracture-related infection patients, adding postoperative IV vancomycin to vancomycin-impregnated cement did not raise AKI incidence (18.1% vs 14.5%) but did cause larger creatinine rises; AKI risk was driven mainly by pre-existing CKD. Supports cautious dual antibiotic therapy with close renal monitoring, especially in CKD.

Survey of 467 surgeons across 64 countries plus a WSES Delphi produced grade-linked expert statements for acute appendicitis, targeting persistent variability in stump closure, drainage, antibiotic duration and follow-up in complicated disease.

In 236 ICU patients with ≥3 rib fractures, regional analgesia was associated with less respiratory deterioration than systemic-dominant analgesia (aOR 0.44); early "treatment goal uncertainty" (present in 40%) tracked with lower regional-analgesia use and worse respiratory outcomes.

Pooling 5 RCTs (423 patients), ERAS components cut hospital stay by ~2.6 days and reduced postoperative pain in orthopedic trauma, but with low-to-moderate certainty and unresolved safety signals (numerically higher infection, unstable DVT estimate) — larger standardized trials still needed.

In a 6-center registry of major orthopaedic surgery (including urgent hip-fracture repair), male sex (OR 2.6), urgent surgery (OR 7.2), and prior VTE (OR 5.7) independently predicted higher 24-month mortality — factors worth adding to preoperative risk assessment.

In trauma ICU patients, statin users had markedly lower VTE despite similar prophylaxis (8% vs 19%), with statin use independently associated with reduced VTE (OR 0.21) even in the highest-risk stratum (RAP>=10, 28% VTE). Hypothesis-generating; single-center, needs prospective confirmation.

A bedside whole-blood coagulometer (ClotChek) distinguished meaningfully anticoagulated apixaban/rivaroxaban patients from normals with high accuracy (AUC 0.91–0.96) — a potential rapid point-of-care test to guide reversal decisions in bleeding/trauma patients on DOACs, though it still needs clinical outcome validation.

In matched cohorts (1,868 MRSA+ vs controls), preoperative MRSA colonization roughly doubled-to-tripled odds of sepsis, pneumonia, VTE, wound dehiscence, and transfusion after lower-extremity ortho trauma surgery — supports preop MRSA screening for risk stratification and possible decolonization.

In isolated flail chest, starting regional anesthesia within 24 h (vs later) was associated with fewer unplanned intubations and ICU admissions, shorter hospital/ICU stays and more routine discharges — supporting prioritizing early regional analgesia.

A practical framework for anticoagulated hip-fracture patients that decouples the (looser) haemostatic threshold for surgery from the (stricter) threshold for neuraxial anaesthesia, and uses active reversal plus patient blood management to keep surgery within 24-48 h rather than passively waiting out drug clearance.

CTA has replaced angiography as first-line for stable patients; revascularization beats ligation for penetrating zone II injury, endovascular/hybrid approaches suit zones I and III, and blunt carotid injury is managed non-operatively with antithrombotic therapy started as early as feasible — agent, dose and duration remain unsettled.

In isolated mild TBI after ground-level falls, DOAC use was not associated with worse radiographic progression or outcomes, and pharmacologic reversal (4F-PCC or andexanet alfa) conferred no measurable benefit — supporting selective rather than routine reversal.

A protocolized multimodal rib-fracture bundle (escalating analgesia, standardized nursing assessment, atelectasis/mucus-clearance regimen) was associated with shorter LOS (−1.4 days adjusted; 14.7→11.2 days matched), fewer rapid responses and lower odds of mechanical ventilation, and lower mortality in the matched high-morbidity sample (10.7%→6.5%) — despite only 53% protocol adherence.

Pediatric trauma-induced coagulopathy protocol: limit crystalloid to ≤20 mL/kg then switch to blood components, transfuse on clinical signs rather than labs alone, use thromboelastography to guide products, run an MTP at 1:1–1:2 plasma:RBC (whole blood preferred when available), give TXA for severe hemorrhage, and add enoxaparin VTE prophylaxis after stabilization in selected older/pubertal low-bleeding-risk patients.

Using national NEMSIS EMS data (2017–2025), documents racial/ethnic disparities in bystander CPR for opioid-associated OHCA — a target for community resuscitation and naloxone/CPR training efforts.

In isolated mild TBI after ground-level falls, DOAC use was not associated with worse radiographic progression or outcomes, and pharmacologic reversal (4F-PCC or andexanet) offered no measurable benefit — supporting selective rather than routine reversal.

Pooled VTE rate in children with lower-limb fractures was low (~0.53%); evidence on risk factors and prophylaxis efficacy is sparse, so individualized rather than routine pharmacologic thromboprophylaxis is recommended.

Cryoablation during SSRF gave no opioid reduction in nonventilated patients and raised referrals for intercostal neuralgia (20% vs 4.5%), but in ventilated patients was associated with shorter ventilation (1.8 vs 5.3 days) and less pneumonia — argues for selective, acuity-driven rather than routine use.

This PRISMA systematic review (3 studies, 1,111 polytrauma patients with lumbar spine fractures) found early fixation (<72 h) was associated with fewer ventilator days (4.9 vs 7.8) and shorter ICU stay (10.9 vs 13.7 d) than late fixation, but with only three moderate-quality studies these effects remain uncertain, hospital length of stay was similar, and injury severity (ISS) was the dominant driver of outcomes.

The Western Trauma Association issued an updated critical-decisions algorithm for blunt cerebrovascular injury, giving a practical pathway for screening, imaging, and antithrombotic management of these often-occult carotid/vertebral artery injuries.

In 3,686 propensity-matched OHCA patients whose rhythm converted from non-shockable to shockable, amiodarone during resuscitation was associated with higher ROSC-on-admission (26.7% vs 23.0%), 24-hour survival (21.4% vs 14.7%), and survival to discharge (6.5% vs 4.2%); the gain in favourable neurological outcome was not statistically significant. Suggests a group currently outside the "after three shocks" guideline may still benefit from amiodarone.

Using the Japanese JAAM-OHCA registry, the R-EDByUS score — derived from prehospital variables alone — was externally validated for predicting poor 1-month neurological outcome (CPC 3-5) in OHCA patients transported to tertiary centers, supporting its use for early risk stratification in both the prehospital-ROSC and ongoing-CPR groups.