September 2025; papers of the month

16 snips

Sep 1, 2025

Dive into groundbreaking research highlighting pre-hospital eCPR for cardiac arrest, exploring its feasibility and promising survival rates. Discover the evolution of intubation techniques with critical care paramedics and how structured training enhances success. The analysis of hypothermic cardiac arrest using the HOPE score reveals critical insights into patient rewarming strategies. Each topic blends humor with vital discussions, challenging traditional practices in emergency care.

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INSIGHT

Pre-Hospital ECPR Is Feasible

Pre-hospital ECPR by trained physician-led teams is feasible and can shorten low-flow times significantly.
The PRECARE pilot achieved mean low-flow of 39 minutes and successful on-scene cannulation in all treated patients.

ADVICE

Optimise Dispatch And Team Placement

Dispatch criteria and geospatial placement of teams must be optimised to reach patients quickly.
Use early call triage and en-route updates to avoid inappropriate dispatch and improve case selection.

INSIGHT

Simulation Bridges Experience Gaps

Most pre-hospital clinicians in the PRECARE team had limited prior ECMO experience before intensive simulation and planning.
Rigorous simulation and integration with existing protocols enabled safe delivery despite limited initial experience.

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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