This month we’ve got three really interesting papers that shine a light on aspects of cardiac arrest management that many of us will recognise from clinical practice.

First up, we look at the feasibility of arterial line placement during ongoing cardiac arrest in the Emergency Department. In our SPEAR episode we talked about the balance between securing invasive monitoring versus the potential distraction from other essential parts of resuscitation. This paper takes a pragmatic look at whether arterial access is achievable in that critical period in the Emergency Department, the success rate and the time required.

Next up, we look at a paper that helps to give us a more accurate feel for the rate and predictors of high-risk adverse events for Emergency Department paediatric ketamine sedation.

Our final paper looks at ultrasound during cardiac arrest. Specifically, whether the hands-off time during the pulse check are longer with traditional manual checks or with ultrasound. This systematic review and meta-analysis puts some numbers to the best way to minimising hands-off time.

So whether you’re a regular on the arrest team, sedating children, or supporting resuscitation from the periphery, these papers provide some useful food for thought on where our focus should be in those critical minutes.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob

a focus on its acute presentations and the care we can deliver to improve outcomes for our patients.

Sickle cell disease (SCD) is a lifelong inherited blood disorder that affects over 15,000 people in the UK, and millions worldwide. It’s caused by the production of abnormal haemoglobin molecules, which distort red blood cells into a crescent, or “sickle,” shape. These rigid cells can block small blood vessels, leading to painful vaso-occlusive crises and organ damage.

While the condition has long been most prevalent in parts of Africa, the Middle East, the Mediterranean and India, today it’s a global health issue, and one we encounter regularly in UK emergency care. Tragically, failings in care have too often led to avoidable harm. The 2021 parliamentary report “No One’s Listening” laid bare some of these cases, highlighting missed opportunities, poor awareness, and systemic issues that cost lives, such as the death of Evan Nathan Smith.

So why are we revisiting this now? In 2024, RCEM published new Best Practice Guidelines on managing sickle cell disease in the ED. These provide clear, evidence-based standards for recognition, triage, analgesia, infection control, and safe discharge. In this episode, we take you through the key elements;

• Pathophysiology – how a genetic mutation drives sickling, vaso-occlusion and inflammation.
• Clinical presentations – from painful crises and acute chest syndrome, to stroke, anaemia, infection, priapism and pregnancy-related complications.
• Recognition and triage – why timely pain control within 30 minutes is a must, and how to spot red flags.
• Investigations and treatment – including the role of reticulocytes, the importance of knowing a patient’s baseline haemoglobin, and principles of analgesia, transfusion, oxygen, and supportive care.
• Discharge and ongoing care – ensuring safe, joined-up planning, and involving haematology and specialist pathways wherever possible.

The take-home message? Every sickle cell crisis is a medical emergency. We need to listen to patients, escalate early, involve haematology, and deliver care that meets the standards they deserve.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

Welcome back to September’s Papers of the Month. We’ve got three cracking studies for you this time, each tackling really core questions in pre-hospital and emergency care and each giving us plenty to chew over when it comes to the evidence base and what it means for our practice.

First up, we’re heading down under to Sydney with the PRECARE pilot feasibility study on pre-hospital extracorporeal CPR for refractory cardiac arrest. Now, we all know survival from refractory OHCA is pretty dismal with conventional CPR alone, and that the big limiting factor with ECPR is time to flow. So could we meaningfully shorten that window by bringing ECMO to the roadside rather than the hospital? This study tested whether pre-hospital physicians could safely and effectively deliver ECPR on scene and the results are some of the fastest low-flow times yet reported. But of course, feasibility is only one piece of the puzzle…

Next, we’re back in the UK with a service evaluation from Devon Air Ambulance looking at endotracheal intubation by critical care paramedics during cardiac arrest. Airway management in OHCA has always been a hot topic, with long-running debates over supraglottic devices versus intubation, and questions about who should be putting a tube in. This six-year dataset explores how structured education, theatre placements, and the introduction of video laryngoscopy have changed practice and whether CCPs can consistently meet the ERC’s benchmark of 95% success, or more, within two attempts.

And finally, we’re heading to Switzerland with a study on the HOPE score in hypothermic cardiac arrest. Hypothermia remains one of those rare but high-stakes presentations where patients in cardiac arrest can sometimes make remarkable recoveries if we select the right ones for extracorporeal rewarming. The HOPE score is designed to guide those decisions by predicting survival. This study takes a retrospective cohort across two hospitals and asks: does the score actually deliver in real-world practice, and can it help avoid futile attempts at ECLS?

So, three papers, ECMO on the roadside, paramedic-led intubation in cardiac arrest, and the precision of the HOPE score. As ever, plenty to think about for both the evidence and our day-to-day practice.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob