30-Second Takeaway
- Consider whole blood for bleeding civilian trauma patients when available; mortality and product use appear lower than with components.
- Lay CPR for pediatric drowning should prioritize ventilations; compression-only CPR is linked to worse survival and neurologic outcomes.
- In pediatric drowning OHCA, BVM is adequate prehospital; routine field intubation or oxygen for non-arrest did not improve outcomes.
- Delays to ICU from ED or wards correlate with higher mortality; early escalation and transfer advocacy remain critical ED responsibilities.
- Bystander-initiated CPR and EMT-placed supraglottic airways both perform well, underscoring the value of early lay action and tiered airway roles.
Week ending March 14, 2026
ED pearls on trauma transfusion, drowning resuscitation, suicide risk, ICU delays, OHCA response, prehospital airways, and community stroke care
Whole blood vs component therapy in adult trauma: modest civilian mortality benefit
This systematic review and meta-analysis pooled 40 studies with 49,776 adult trauma patients receiving whole blood or component therapy for hemorrhage. In civilians, whole blood was associated with lower 24-hour mortality (OR 0.73, 95% CI 0.57-0.93) versus components, with substantial heterogeneity. The absolute 24-hour mortality reduction in civilians was about 4.6 percentage points, assuming a 20% baseline mortality. Civilians receiving whole blood also had reduced 30-day mortality and required fewer transfused units overall. No mortality benefit was seen in military settings, and wide prediction intervals suggest benefits may vary significantly between systems.
Compression-only CPR harms outcomes in pediatric drowning OHCAs
This nationwide Japanese study included 740 pediatric drowning OHCAs with layperson CPR from 2012-2023. Compression-only CPR accounted for 58.4% of cases and increased over time, while rescue-breathing CPR declined. Compared with rescue-breathing CPR, compression-only CPR was associated with higher 30-day mortality (aRR 1.38, 95% CI 1.14-1.67). Compression-only CPR also correlated with more prehospital absence of ROSC and worse 30-day neurological outcomes. The adverse association was strongest in unwitnessed arrests, emphasizing the importance of early ventilation in asphyxial pediatric arrests.
Prehospital intubation offers no advantage over BVM in pediatric drowning OHCA
This multicenter sub-analysis examined 3,188 pediatric drowning patients seen at 32 pediatric EDs from 2010-2017. Only 7% had OHCA; among them, prehospital airway management was bag-valve mask ventilation or endotracheal intubation. Intubation in OHCA was not associated with better favorable neurologic outcome (aOR 0.6, 95% CI 0.1-3.5) versus BVM. Survival to discharge also did not differ significantly with intubation versus BVM (aOR 2.0, 95% CI 0.6-7.2). In non-arrest patients, prehospital supplemental oxygen versus room air showed no significant differences in survival or neurologic outcomes.
Combining ML and ASQ improves suicide risk detection in American Indian ED patients
This retrospective cohort analyzed 26,896 ED visits by 7,897 American Indian adults at an Indian Health Service facility. Within 90 days, 0.4% of visits had suicide attempt or death, highlighting low event rates but high clinical stakes. The medium-risk ML threshold alone identified the most true positives (sensitivity 0.782; specificity 0.751) compared with ASQ or high-risk ML alone. ASQ alone had low sensitivity (0.178) despite high specificity, missing many patients who later attempted or died by suicide. Parallel testing using ASQ plus medium-risk ML achieved the highest sensitivity, while serial testing with high-risk ML plus ASQ produced the highest PPV.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.