30-Second Takeaway
- Ketamine offers only a small, transient MAP advantage over propofol for RSI in critically ill adults.
- New adult and pediatric sepsis guidance refine early antimicrobials, fluids, and hemodynamic targets but rest on mostly low-certainty evidence.
- TEE-guided CPR improves intra-arrest physiology but not outcomes in ED OHCA, questioning routine deployment.
- Pediatric sepsis and pediatric OHCA are uncommon but high-impact events, emphasizing system-level preparedness.
- Children with medical complexity comprise a large share of pediatric EMS transports and need dedicated prehospital and ED pathways.
Week ending March 28, 2026
ED critical care updates: sepsis, RSI choice, pediatric OHCA, and cardiac arrest interventions
Ketamine vs propofol for RSI: only modest, transient MAP benefit with ketamine
In this two-ICU RCT of 175 critically ill adults needing RSI, patients received ketamine or propofol 1:1. Lowest MAP in the first 10 minutes was 66 mmHg with ketamine and 60 mmHg with propofol (adjusted mean difference 6.0 mmHg; 95% CI 0.0 to 11.9). The modest MAP difference was not sustained over 1 hour and was not judged clinically meaningful. Cardiovascular collapse, largely driven by vasopressor escalation, occurred in 22% with ketamine and 33% with propofol. Short-term and hospital mortality were numerically higher with ketamine but with wide CIs and no clear difference.
EHR-based Pediatric Sepsis Event definition: national burden and performance
This retrospective study analyzed 3.9 million pediatric hospitalizations across two large EHR datasets to define and track Pediatric Sepsis Events (PSE). Sepsis incidence was 1.3%, with over 70% community-onset and about 62% meeting septic shock criteria. In-hospital mortality for PSE cases was 10.1%, and sepsis was present in 17.8% of pediatric in-hospital deaths. The PSE definition showed 69.9% sensitivity and 93.1% specificity versus physician-adjudicated Phoenix sepsis, with better sensitivity than administrative codes. Estimated US 2022 burden was 18,231 pediatric sepsis cases and 1,877 deaths, with no significant change from 2016–2022.
TEE-guided compression site during ED CPR does not improve OHCA outcomes
This single-center cluster RCT randomized 132 adults with ongoing nontraumatic OHCA on ED arrival to TEE-guided vs guideline-recommended CPR compression sites. Sustained ROSC (≥20 minutes) was similar: 44% with TEE-guided CPR versus 39% with conventional CPR (cluster-adjusted OR 1.21; 95% CI 0.64–2.29). Secondary outcomes, including any ROSC, ICU admission, survival to discharge, and good neurologic outcome, also did not differ significantly. TEE-guided CPR produced higher intra-CPR end-tidal CO2 during minutes 11–20 but without translating into better clinical endpoints. TEE- and CPR-related adverse events were comparable between groups.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.