TY - JOUR T1 - Journal update monthly top five JF - Emergency Medicine Journal JO - Emerg Med J SP - 721 LP - 722 DO - 10.1136/emermed-2022-212725 VL - 39 IS - 9 AU - Caroline Leech AU - Imogen Virgo AU - Arun George AU - Miriam Anderson AU - Helen Spindler AU - Hannah Bolan AU - Jennifer Waters Y1 - 2022/09/01 UR - http://emj.bmj.com/content/39/9/721.abstract N2 - This month’s update is from the ED team at the University Hospital Coventry. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches, to identify the five most interesting and relevant recently published papers. Below we highlight the main findings, key limitations and clinical bottom line for each paper.The papers are ranked as:Worth a peek—interesting, but not yet ready for prime time.Head turner—new concepts.Game changer—this paper could/should change practice.Topic: cardiac arrestRating: worth a peekCurrent practice is to perform urgent coronary angiogram (CAG) in patients who had an out-of-hospital cardiac arrest (OHCA) with post-resuscitation ST-segment elevation and no other obvious cause of arrest. However, consensus is lacking on whether patients with no ST-segment elevation should undergo CAG. Three prior trials have suggested no benefit because the rate of acute coronary lesion is much lower.This French multicentre randomised controlled trial differed from prior studies in that it included patients with non-shockable rhythms. Adult patients who were resuscitated after cardiac arrest were randomised to emergency CAG (straight to catheterisation laboratory) or delayed CAG (after 48–96 hours) Primary outcome measures were 180-day survival and cerebral performance category 1 or 2. The study was underpowered as the initial enrolment objective was not met and funding was withdrawn. Of the 141 patients allocated to the emergency CAG group, 89% received CAG and mean time was 2 hours from OHCA. Of the 138 patients allocated to delayed CAG, only 54% received the intervention; among these, mean time to procedure was 65 hours from OHCA. Reasons for not undergoing a delayed CAG included early death from a neurological or cardiorespiratory aetiology.There was no difference … ER -