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Journal update monthly top five
  1. Gabrielle Prager1,2,
  2. Govind Oliver3,
  3. Anisa Jabeen Nasir Jafar2,4,
  4. Daniel Darbyshire5,6,
  5. Richard Body3,7,
  6. Simon David Carley3,8
  1. 1 Emergency Department, Wythenshawe Hospital, Manchester, Greater Manchester, UK
  2. 2 Humanitarian and Conflict Response Institute, The University of Manchester, Manchester, UK
  3. 3 Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
  4. 4 Emergency Department, Salford Royal Hospital, Salford, UK
  5. 5 Lancaster Medical School, Lancaster University, Lancaster, Lancashire, UK
  6. 6 Emergency Department, Royal Oldham Hospital, Oldham, UK
  7. 7 Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
  8. 8 Postgraduate Medicine, Manchester Metropolitan University, Manchester, UK
  1. Correspondence to Dr Gabrielle Prager, Emergency Department, Wythenshawe Hospital, Manchester, Greater Manchester, UK; lgprager{at}

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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:

  • Worth a peek—interesting, but not yet ready for prime time.

  • Head turner—new concepts.

  • Game changer—this paper could/should change practice.

Cerebral oximetry during out-of-hospital resuscitation: pilot study of first responder implementation by Shin et al

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. …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.