Emergency Medicine

Extended-release injectable vs sublingual buprenorphine from the ED: similar engagement, rare precipitated withdrawal

This multicenter ED RCT randomized 1,994 adults with untreated opioid use disorder to extended-release injectable vs sublingual buprenorphine initiation. Seven-day treatment engagement was similar (adjusted 40.5% vs 38.5%; difference 1.6%, 95% CI -2.8% to 6.0%). Thirty-day engagement, overdose events, and precipitated withdrawal were likewise similar, with precipitated withdrawal rare in both groups. Most participants were fentanyl positive, supporting the feasibility and safety of both ED induction strategies in contemporary opioid markets. 1

ED blood pressure lowering before thrombectomy linked to worse stroke outcomes

This registry-based cohort included 492 patients with anterior circulation large-vessel occlusion undergoing endovascular thrombectomy. About 11% received active intravenous antihypertensives in the ED before thrombectomy and were compared with those without BP lowering. After propensity matching, ED BP lowering was associated with worse 3‑month mRS distribution (adjusted OR 0.38; 95% CI 0.18-0.80). These patients also had greater infarct growth without reduction in symptomatic intracerebral hemorrhage. Findings support caution with routine pre-thrombectomy BP reduction absent compelling indications. 2

Conservative oxygen targets in ventilated adults show no overall outcome advantage

This meta-analysis pooled nine RCTs totaling 20,447 mechanically ventilated ICU adults randomized to conservative vs liberal oxygen targets. Ninety-day mortality did not differ (RR 1.01; 95% CI 0.94-1.09), and ICU length of stay was similar between strategies. Organ support–free days and adverse events were also comparable overall. Conservative targets yielded more vasopressor-free days in sepsis and a possible survival signal post–cardiac arrest, though subgroup estimates were imprecise. For general ICU populations, results support flexible oxygen titration within either range rather than strict restriction. 3

Video-guided dispatcher CPR improves OHCA neurologic outcome and survival

This nationwide Korean cohort analyzed 35,471 EMS-treated out-of-hospital cardiac arrests receiving dispatcher-assisted CPR. Only 7% received video-guided instructions, yet they had higher good neurologic outcome at discharge (aOR 1.64; 95% CI 1.39-1.92). Video guidance also improved prehospital ROSC (aOR 1.29; 95% CI 1.18-1.41) and survival to discharge (aOR 1.50; 95% CI 1.33-1.69). Instruction and CPR start times were modestly longer with video, but the outcome benefits persisted after adjustment and propensity matching. 4