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In this large multicenter observational cohort study, 0.3% of patients presenting with potential acute aortic syndrome (AAS) symptoms ended up having AAS. Clinician gestalt outperformed the available clinical decision rules (CDRs).

Source
Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. Emerg Med J. 2024;41(3):136-144. Published 2024 Feb 20. 

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An artificial intelligence (AI) ECG model outperformed standard STEMI criteria in identifying occlusion myocardial infarction (OMI) confirmed by coronary angiography.

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International evaluation of an artificial intelligence–powered electrocardiogram model detecting acute coronary occlusion myocardial infarction, European Heart Journal - Digital Health, 2023. https://doi.org/10.1093/ehjdh/ztad074

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This single-center prospective study found that in 2,275 ECGs with a computerized interpretation of “normal” and “otherwise normal,” there was a negative predictive value (NPV) of 100% for STEMI, with no final diagnoses of ACS or STEMI, and none required cardiac catheterization that visit.

Source
Validity of Computer-interpreted "Normal" and "Otherwise Normal" ECG in Emergency Department Triage Patients. West J Emerg Med. 2024;25(1):3-8. doi:10.5811/westjem.58464

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In out-of-hospital cardiac arrest (OHCA) patients with refractory ventricular fibrillation (RVF), there was an association with short-interval (<75ms) dual sequential external defibrillation (DSED) and higher probability of termination of ventricular fibrillation (VF) and return of spontaneous circulation (ROSC) compared with longer DSED intervals.

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The impact of double sequential shock timing on outcomes during refractory out-of-hospital cardiac arrest. Resuscitation. 2024 Jan;194:110082. doi: 10.1016/j.resuscitation.2023.110082. Epub 2023 Dec 11.

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This article outlines the updated 2023 guidelines for diagnosis and management of atrial fibrillation. Continue reading for ways to incorporate them into your emergency medicine practice.

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Use of a high-sensitivity troponin (hsTn) HEART pathway resulted in a small (but significant) increase in percentage of patients diagnosed with acute myocardial infarction (AMI) during index ED visit, and a small but significant decreased in diagnosis of AMI within 30 days after the visit when compared with conventional troponin assays (cTn). It also resulted in reduced hospital admission, stress testing, and coronary revascularization.

Source
Emergency Department Cardiac Risk Stratification With High-Sensitivity vs Conventional Troponin HEART Pathway. JAMA Netw Open. 2023 Dec 1;6(12):e2348351. doi: 10.1001/jamanetworkopen.2023.48351.

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High-dose nitroglycerin improves outcomes in patients with sympathetic crashing acute pulmonary edema (SCAPE) without significant side effects when compared to low-dose nitroglycerin.

Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith

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This secondary analysis of the STOP CP cohort study found that in isolation, using a 0/2 hour hs-cTnT rule-out protocol did not achieve a NPV ≥ 99% for 30-day cardiac death or MI (CDMI). When combined with a low risk History, ECG, Age, and Risk factor (HEAR) score, it did - but at the cost of significantly decreased efficacy (ruling out only 30.7% of patients).

Source
Performance of the 0/2-Hour hs-cTnT Accelerated Diagnostic Protocol in a Multisite United States Cohort. Acad Emerg Med. 2023 Nov 4. doi: 10.1111/acem.14827. Epub ahead of print.

Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith

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Liberalizing the transfusion threshold to 10 g/dL (compared to 7-8 g/dL) for patients with myocardial infarction did not improve composite outcomes of myocardial infarction or death at 30 days.  

Source
Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. N Engl J Med. 2023 Nov 11. doi: 10.1056/NEJMoa2307983. Epub ahead of print.

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A randomized trial of patients in septic shock on norepinephrine found no benefit in those treated with an infusion of landiolol (β1-blocker). The trial was stopped early for concern of potential harm in the intervention group.

Source
Landiolol and Organ Failure in Patients With Septic Shock: The STRESS-L Randomized Clinical Trial. JAMA. 2023 Nov 7;330(17):1641-1652. doi: 10.1001/jama.2023.20134.