30-Second Takeaway
- SGAs achieved substantially higher first-pass and final airway success than ETI in a large OHCA EMS cohort.
- Adding prehospital GFAP testing improved diagnostic accuracy of LVO scores for ischemic stroke triage.
- Post-overdose MOUD initiation remained low in Medicaid, especially among patients not already on treatment.
- Buprenorphine treatment days were linked to markedly lower overdose risk, without evidence of dose-related harm.
- Significant system gaps and disparities emerged in OHCA first responder activation, ECPR use, trauma-related suicide risk, and pediatric telemedicine access.
Week ending January 17, 2026
Prehospital cardiac arrest, stroke triage, and opioid use disorder: systems and equity targets for the ED-facing emergency physician
Supraglottic airways outperform ETI as first device in OHCA, with better outcomes when switching from failed ETI
In over 650,000 adult OHCA EMS encounters with advanced airway attempts, SGA achieved higher first-pass success than ETI (93% vs 71%). Despite this, ETI remained the predominant initial device, used in about 70% of cases nationally. When the first ETI attempt failed, most clinicians persisted with ETI, yet switching from ETI to SGA yielded higher final airway success. These data support protocols that favor early SGA use or prompt switch to SGA after failed ETI in prehospital cardiac arrest. ED teams receiving these patients should anticipate SGA use and avoid unnecessary early exchanges in ongoing resuscitation.
GFAP plus prehospital LVO scores improves accuracy for identifying thrombectomy candidates
Among 353 suspected stroke patients, 101 had LVO confirmed by CT angiography. Adding a negative prehospital GFAP test to LVO scores significantly increased AUCs for LVO detection across five common scales. For example, AUC for the FAST-ED score rose from 0.859 to 0.899 when combined with GFAP results. Similar gains were seen for RACE, 3ISS, EMSA, and CPSS, all with P<0.001. These findings suggest biomarker-augmented scores could refine direct-to-thrombectomy routing decisions and reduce inappropriate bypass of non-LVO or hemorrhagic strokes.
MOUD after overdose is uncommon in Medicaid, especially for patients not already in treatment
In 318,536 Medicaid overdose encounters, only 26.0% had MOUD dispensed in the 6 months after discharge. Prior MOUD exposure strongly predicted follow-up treatment, with a clear gradient by baseline adherence. Compared with no prior MOUD, the adjusted hazard of follow-up MOUD was 16-fold higher for those highly adherent at baseline. Timely follow-up MOUD within 30 days was more common among those with prior treatment than those naïve to MOUD. Large gaps in post-overdose MOUD highlight the ED and inpatient stay as critical but underused opportunities for initiation and linkage.
Buprenorphine treatment days cut overdose risk by ~60% in the fentanyl era without dose-related harm
In 8,676 Rhode Island patients initiating buprenorphine, just over half of follow-up days were covered by an active prescription. Across 365 days, 545 opioid overdoses occurred in 411 patients. Days on buprenorphine were associated with a 61% lower overdose risk than off-treatment days (adjusted risk ratio 0.39). Daily buprenorphine doses did not differ between days with and without overdose events. These findings support maintaining and potentially escalating buprenorphine doses for fentanyl-exposed patients without increased overdose risk, reinforcing ED-initiated therapy.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.