This month’s update has been prepared by the Emergency Medicine & Intensive Care Research Group (EMERGING) from Manchester. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper. The papers are ranked as follows: ### Topic: Prehospital care #### Outcome rating: Head turner Predicting which patients will survive an out-of-hospital cardiac arrest (OHCA) with good functional outcomes could help guide resuscitative efforts. This prospective observational study from a single county in Washington state, USA, examined the value of non-invasive regional cerebral oxygen saturation (rSO2) for predicting return of spontaneous circulation (ROSC) and survival with a cerebral performance category (CPC) score of 1 or 2. From 97 patients with OHCA, 59 had defibrillation and rSO2 measurement and were enrolled. Twenty-eight achieved ROSC. Eight had a good neurological outcome. While there was no difference in rSO2 prior to resuscitation efforts, within 5 min of resuscitation by a first responder, those who would go on to achieve ROSC had a higher median rSO2 (51% vs 43%, p=0.03). Similarly, among those achieving ROSC, those with good neurological function had a higher median rSO2 at 5 min post-ROSC (74% vs 60%, p=0.04). Those providing resuscitation were blinded to the rSO2 readings, eliminating one source of bias. However, this is a small sample, conducted with precise timings, limiting generalisability. The analyses were somewhat exploratory given our limited understanding of optimal time to measure rSO2, highlighting the need for prospective validation. …

中文翻译：

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杂志每月更新前五名

本月的更新由曼彻斯特的急诊医学和重症监护研究小组 (EMERGING) 准备。我们使用了多模式搜索策略，利用免费的开放获取医学教育资源和文献搜索。我们确定了五篇最有趣和最相关的论文（由共识决定），并强调了每篇论文的主要发现、关键局限性和临床底线。这些论文的排名如下：### 主题：院前护理#### 结果评级：头部特纳预测哪些患者将在院外心脏骤停 (OHCA) 中存活并具有良好的功能结果可以帮助指导复苏工作。这项来自美国华盛顿州一个县的前瞻性观察研究，检查无创局部脑氧饱和度 (rSO2) 对预测自主循环恢复 (ROSC) 和脑功能类别 (CPC) 评分为 1 或 2 分的生存率的价值。97 名 OHCA 患者中，59 名进行了除颤和 rSO2测量并被录取。28 人达到 ROSC。八人有良好的神经系统结果。虽然复苏前的 rSO2 没有差异，但在急救人员实施复苏后 5 分钟内，那些将继续实现 ROSC 的人的 rSO2 中值较高（51% 对 43%，p=0.03）。同样，在达到 ROSC 的患者中，神经功能良好的患者在 ROSC 后 5 分钟的 rSO2 中值较高（74% 对 60%，p=0.04）。那些提供复苏的人对 rSO2 读数不知情，从而消除了一种偏差来源。然而，这是一个小样本，以精确的时间进行，限制了普遍性。鉴于我们对测量 rSO2 的最佳时间的理解有限，这些分析具有一定的探索性，强调了前瞻性验证的必要性。…