Emergency Medicine

Community heart‑attack education did not increase EMS use and was associated with lower EMS transport.

In a stepped‑wedge trial across 8 high‑risk communities (n=1775 ACS patients), the Heart Matters program did not increase EMS transport for ACS. EMS transport was 68.6% in control versus 63.4% in the intervention period (adjusted RD −8.98%, 95% CI −17.50 to −0.46). Reductions were larger in metropolitan areas and during a flooding event, and contextual factors like COVID‑19 likely influenced results. This multicomponent campaign reached thousands but did not shorten treatment‑seeking times convincingly. 1

Nighttime OHCA linked to worse sustained ROSC and neurological survival; response interval partly mediates effect.

In 874,415 registry patients, nighttime OHCA (27.7%) had lower sustained ROSC (25.8% vs 30.6%) with aOR 0.85 (95% CI 0.84–0.86). Nighttime neurologically favorable survival was lower (6.7% vs 9.3%; aOR 0.84, 95% CI 0.82–0.86). Among those with sustained ROSC, postresuscitation survival remained lower at night (aOR 0.93, 95% CI 0.90–0.95). Mediation analysis estimated the prehospital response interval explained about 12.6% of the nighttime survival disadvantage. 2

EV‑D68 detection associated with neurologic outcomes, but association is heterogeneous and time‑dependent.

Meta‑analysis of 98 studies found pooled OR 1.39 (95% CI 1.14–1.69) for neurologic outcomes with EV‑D68 detection, with very high heterogeneity (I2 98.9%). Respiratory surveillance studies showed stronger associations (OR 1.59) while AFM case‑control studies did not demonstrate increased odds. Predicted ORs declined after 2014, and study design plus year explained ~47% of between‑study variance. Authors note funnel asymmetry and small‑study effects, limiting causal inference and generalizability. 3