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The Resus Room

Simon Laing, Rob Fenwick & James Yates

Emergency Medicine podcasts based on evidence based medicine focussed on practice in and around the resus room.

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Thursday · 38 min
October 2026; papers of the month
This month we have three really clinically relevant papers that take us from a very common ED presentation, through an everyday diagnostic dilemma, and then right into a high-risk paediatric airway. We start with abdominal pain in older adults and ask whether the history and examination are giving us as much reassurance as we think. The paper looks at how CT use, diagnostic yield, admission and surgery change with age - and whether we should think of geriatric abdominal pain as a distinct high-risk presentation. Then move on to unexplained syncope and a large UK randomised trial of immediate 14-day ambulatory ECG monitoring. The didn't reduce recurrent syncope at one year, but it found substantially more clinically significant arrhythmias, found them earlier and led to more treatment. That leaves us with a really interesting question about the difference between diagnosing more disease and improving the outcome the patient actually experiences. What will it mean for our strategies moving forwards? Finally, we look at paediatric emergency intubation through recorded video laryngoscopy. Which technical errors occur most often, which ones cluster around failure, and what can the airway coach spot early enough to change the attempt? As ever, we will take you through what the teams did, what they found, and whether any of it should change practice on your next shift. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob
September 15 · 55 min
Pupillary Reflex; Roadside to Resus
We assess the pupils in almost every significantly unwell or injured patient - but how much are they really telling us? It is easy to document 'pupils equal and reactive' and move on, yet a changing pupil may be one of the earliest outward signs of a developing intracranial catastrophe. Equally, anisocoria in a completely well patient may be longstanding and entirely benign. In this Roadside to Resus episode, we work through the anatomy and physiology of the pupillary light reflex before applying it to three important clinical situations: the blown pupil following a significant head injury, unequal or irregular pupils in a patient with a GCS of 15, and bilaterally fixed and dilated pupils in and following cardiac arrest, along with a deep dive into the evidence base. We discuss how to decide which pupil is abnormal, the warning signs of third nerve palsy and Horner's syndrome, ocular and drug-related causes, and why serial change matters more than an isolated measurement. We also explore automated pupillometry, what the NPi can add, and why fixed pupils should never be used alone to determine futility or neurological prognosis. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon. Rob & James
September 1 · 36 min
September 2026; papers of the month
Welcome back to September 2026's Papers of the Month, and this month we've got three papers that are really focused on the practical end of emergency and prehospital care. First up, we're looking at what happens after we've performed a prehospital RSI. We put a huge amount of emphasis on getting the induction right, but what about maintaining adequate anaesthesia afterwards? This paper looks at intermittent bolus sedation following prehospital emergency anaesthesia, the variation in dosing between patients, and whether we might actually be running the risk of under-sedating some of them and compromising their care. Then we're staying prehospital and asking a really simple question in trauma: how good are the physiological numbers we use to identify the sick patient? We've all used shock index, but could NEWS actually do a better job of predicting mortality, transfusion requirements and subsequent resource utilisation? And finally, we're back to RSI and rocuronium. A variety of dosing strategies can be seen in practice but could going higher improve first-pass success? And importantly, does that relationship still hold in patients with obesity or hypoperfusion? Three clinically relevant papers, plenty to challenge our current practice, and as always, lots to get into. Once again we'd love to hear any thoughts or feedback either on the website or via social media @TheResusRoom! Simon & Rob
August 2 · 35 min
August 2026; papers of the month
This month we've got another really varied mix of papers that all have the potential to influence everyday emergency and prehospital practice. We start by asking a question that's becoming increasingly relevant as prehospital critical care teams develop ever more advanced capabilities: are all those extra interventions costing us precious scene time, and if so, how much? We then move into post-cardiac arrest care with one of the biggest oxygen trials we've seen to date, looking at whether aiming for conservative oxygen targets actually improves neurological outcomes after ROSC. Finally, we tackle one of emergency medicine's diagnostic challenges, necrotising soft tissue infection. We'll look at what the latest evidence tells us about physical examination, imaging and the much-debated LRINEC score, and whether any of them are good enough to confidently rule this devastating disease in or out. As always, we'll pull apart the methodology, discuss what these studies mean for our own practice and, perhaps most importantly, ask whether they should actually change what we do tomorrow. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob
July 16 · 50 min
Laryngectomy and Tracheostomy Emergencies; Roadside to Resus
Tracheostomy and laryngectomy emergencies are classic high-acuity, low-frequency situations. They do not happen every day, but when they do, airway problems can develop quickly, and the wrong intervention can make things significantly worse. In this episode, we work through the practical approach to these patients, starting with the most important distinction: a patient with a tracheostomy may still have a patent upper airway, whereas someone who has undergone a total laryngectomy is an obligate neck breather. That single anatomical difference determines where oxygen and ventilation need to be delivered. We'll look at the different tubes, cuffs, inner cannulas, speaking valves and humidification devices you may encounter, before moving through the common causes of deterioration, particularly obstruction, displacement and bleeding. Using the National Tracheostomy Safety Project's green and red emergency algorithms, we break management down into simple, sequential steps: apply oxygen, remove attachments, remove the inner cannula, pass a suction catheter, deflate the cuff when appropriate and remove a non-functioning tube when necessary. These cases can initially feel intimidating, but a calm, structured approach can make them far more manageable. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon. Rob & James
July 1 · 31 min
July 2026; papers of the month
Welcome back to July's Papers of the Month. This month we've got three papers that tackle some of the biggest questions we face in emergency and critical care medicine. They're all very different studies, but each one looks at an intervention that many of us use, or at least think about, on a regular basis. First up, we look at ARISE FLUIDS, a major trial examining one of the longest-running debates in sepsis care. Should we be reaching for fluids or vasopressors first in septic shock? We've spent years worrying about giving too much fluid, and equally worrying about starting vasopressors too early. This study gives us some of the best evidence yet about what happens when we take a more restrictive fluid approach and start vasopressors earlier. Next, we move to cardiac arrest and the BIHCA trial, looking at sodium bicarbonate during in-hospital cardiac arrest. Despite guideline recommendations and a lack of convincing evidence, bicarbonate continues to be used in many arrests around the world. This study finally gives us some high-quality data on whether it's actually helping our patients. And finally, we head back to the ECG with a fascinating paper looking at the lead V5 T-wave to R-wave ratio as a marker of right ventricular dysfunction in pulmonary embolism. It won't change practice tomorrow, but it raises some interesting questions about what the ECG may still have to tell us about risk stratification in PE. So let's get into it! Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob
June 16 · 59 min
Excellence in Facemask Ventilation; Roadside to Resus
Face mask ventilation is one of those skills that can easily be overlooked. It's often seen as the simple bit of airway management — something that sits below the glamour of videolaryngoscopy, fibre-optics and endotracheal intubation. But the reality is that excellent face mask ventilation is one of the most important airway skills we have. In this episode, we take a deep dive into bag-valve-mask ventilation and airway adjuncts, exploring why this is far more than just putting a mask on a face and squeezing a bag. We discuss when facemask ventilation is indicated, how to identify patients who may be difficult to ventilate, and the practical steps that can dramatically improve success rates. We cover positioning, airway opening manoeuvres, mask seal techniques, the role of airway adjuncts and how to recognise whether your ventilations are actually working. We also look at troubleshooting common problems, the evidence comparing bag-mask ventilation with supraglottic airways and endotracheal intubation, and how to decide when it's time to move to another airway strategy. Whether you're working in the emergency department, prehospital environment or critical care, this episode is packed with practical tips, cognitive aids and evidence-based advice to help you deliver facemask ventilation with confidence and excellence. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon. Rob & James
June 1 · 32 min
June 2026; papers of the month
This month's episode takes us deep into trauma care, but not just the medicine we deliver but also the systems, circumstances and social factors that shape who survives and who doesn't. We start by looking at a remarkable paper from Gaza describing the use of ultrasound-guided pericardiocentesis, large-bore drainage and intrapericardial tranexamic acid as definitive management for penetrating cardiac tamponade. In a setting where immediate thoracotomy simply wasn't always possible, the authors report some pretty incredible survival figures and challenge a lot of the dogma around penetrating cardiac injury. It's a fascinating example of innovation being driven by necessity. We then move onto a huge epidemiological study from the London Trauma System exploring when and where trauma deaths occur in a mature major trauma network. The findings are stark — most deaths now occur before hospital arrival, often within minutes, and many from potentially reversible causes. It really makes us think about where the next advances in trauma care need to happen. Finally, we finish with an incredibly important and sobering paper examining knife-related deaths in children and young people across England. This isn't just about anatomy and interventions — it's about deprivation, adverse childhood experiences, safeguarding and public health. It's a paper that's difficult to read at times, but absolutely essential for anyone involved in emergency and prehospital care. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob
May 14 · 44 min
Reframing Anaphylaxis; Roadside to Resus
Anaphylaxis is one of those conditions we think we have got pretty well sorted. Recognise it early, give adrenaline, support the airway and circulation, and crack on. And in fairness, for the vast majority of patients, that approach works really well. But in this Roadside to Resus episode we take a step back and ask a pretty uncomfortable question, have we actually been thinking about anaphylaxis in the wrong way? Using some fascinating new evidence from the UK National Child Mortality Database, we explore the emerging understanding that fatal food-triggered anaphylaxis may be much more of a respiratory catastrophe than the classic circulatory collapse we often picture in our heads. The findings are genuinely thought provoking. Many of the fatal paediatric cases reviewed showed overwhelming airway and breathing compromise long before cardiovascular collapse occurred, with deterioration happening frighteningly quickly in the prehospital phase. We work through the current Resuscitation Council UK and NICE guidance, look at where diagnostic confusion still exists, and discuss why early adrenaline absolutely remains the cornerstone of treatment. But we also explore whether our mental model of anaphylaxis needs updating, particularly when it comes to respiratory assessment, escalation and oxygenation strategies. We're also incredibly grateful to be joined by Ben McKenzie, who shares the devastating personal story behind the development of the AMAX4 approach and the lessons it holds for all of us managing critically unwell patients in the ED and prehospital environment. This is a really powerful episode about recognition, trajectory and reframing how we think about severe anaphylaxis. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob
May 1 · 33 min
May 2026; papers of the month
This month's Papers of the Month is a real mix of papers that challenge some of the things we think we know, whilst also highlighting just how important systems and processes are in improving patient care. We start with intracerebral haemorrhage and the tricky issue of blood pressure management. We've all been taught that early, aggressive blood pressure reduction is key, but this paper raises some important questions about whether we may sometimes be overshooting. It looks at whether rapidly driving the blood pressure down really improves outcomes, or whether going too low may actually be associated with harm. From there, we move into trauma, with a sobering look at the timing of deaths from uncontrolled haemorrhage. Despite all of the advances in trauma systems, blood products, haemostatic resuscitation and major trauma care, this paper suggests that the overall timing of haemorrhagic deaths has changed very little in the last 30 years. It is a stark reminder that bleeding remains one of the biggest challenges we face, and that there is still plenty of work to do if we want to reduce preventable deaths. Finally, we finish with something a bit different but arguably just as important: airway governance and quality improvement. This paper from Ireland looks at how a structured programme of airway training, governance, simulation and feedback can improve first-pass success and keep complication rates low. It's a really useful reminder that good outcomes are not just about kit and technical skills, but about systems, training, competency and making sure teams maintain currency through repeated exposure and practice. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob
April 8 · 47 min
Excellence in Defibrillation; Roadside to Resus
Timely and effective defibrillation is fundamental to excellent outcomes in cardiac arrest care. But there is a growing body of evidence suggesting that how we deliver those shocks may matter just as much as when we deliver them. Over the last few years we've seen increasing interest in alternative defibrillation strategies, particularly AP pad positioning and double sequential external defibrillation, and the potential impact they can have on outcomes in refractory VF. The DOSE-VF trial was a landmark trial in the area, showing markedly better survival to hospital discharge with both vector change defibrillation and DSED compared with standard antero-lateral pad positioning. Since then, further analyses have suggested that the timing of DSED shocks, pad positioning and the vectors of defibrillation my all play an important role in improving the chances of ROSC and good neurological recovery. Now we've got new evidence from Sheldon Cheskes and colleagues exploring what may actually be driving these improved outcomes. Is it simply that AP pad positioning delivers more current? Or is there something more important about the direction that current travels through the myocardium? The findings from this piece of the puzzle has potential to change the fundamentals of resuscitation strategies. In this episode we take a deep dive into the emerging evidence around defibrillation, what the latest guidelines are saying and, importantly, what this means for practice. We're also hugely fortunate to be joined by Sheldon Cheskes himself to talk through the science behind defibrillation, the evidence and how systems can implement change. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & James
April 1 · 34 min
April 2026; papers of the month
This month we're heading firmly into the prehospital and community space, looking at how we make decisions when the diagnostics are limited and the system around us is evolving. We start with a really practical question around traumatic pneumothorax. How good are we, clinically, at spotting the patients who actually need urgent decompression? This paper takes a hard look at the performance of the classic signs we're all taught, and challenges just how much we can rely on them in isolation when it really matters . From there, we move into one of the biggest ongoing debates in prehospital trauma care: whole blood. The SWiFT trial gives us high-quality randomised data on whether early whole blood transfusion changes outcomes in major haemorrhage. It's a landmark UK study, and the results might not be quite what many were expecting . Finally, we zoom out slightly and look at how senior decision-making in the community can change patient pathways. This service evaluation explores whether bringing experienced clinicians to the patient can safely reduce conveyance for head injuries, particularly in older and anticoagulated patients, without missing significant pathology. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob
March 16 · 44 min
Decision Making; Roadside to Resus
Decision making sounds like a slightly academic, niche topic… but in reality, it sits underneath every single thing we do in emergency and pre-hospital care. Every patient contact, every test we order, every treatment we start and every one we choose not to – is a decision made in an environment that is time critical, information-light and full of uncertainty. In this episode we take a step back and look at how we actually make decisions at the front door and on the roadside. We talk about why the importance of the decision really matters, not just whether a diagnosis is possible, but how severe it is, how common it is, and whether finding it will genuinely change what we do for the patient. We explore pre-test probability and prevalence, and why knowing how often a condition really occurs in the group of patients in front of you is one of the most powerful tools in emergency medicine. We then move into testing. What actually counts as a test? It's not just bloods, scans and ECGs. It's how someone looks, how they move, what hurts when you examine them and how the story fits together. From there, we build into likelihood ratios and Bayesian thinking; how a piece of information should genuinely shift your estimate of risk, rather than just making you feel more or less comfortable. We also tackle test and treatment thresholds; the idea that there are times when we should stop chasing a diagnosis, and times when the probability is high enough that we should treat without waiting for more tests. Finally, we bring all of this back to real life, with human factors, competing priorities and the reality that sometimes the technically "correct" decision isn't the best decision in that moment. This one is all about becoming more comfortable with uncertainty and making better decisions because of it. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James
March 1 · 32 min
March 2026; papers of the month
March's Papers of the Month is here and we've got three absolute crackers to get stuck into. First up, we head prehospital to explore pseudo-pulseless electrical activity. This review challenges us to rethink how we approach organised electrical activity without a pulse. We discuss the role of POCUS, the concept of treating profound shock rather than "arrest," and what this means for decision-making and management. Next, we move to cardiac arrest physiology with a systematic review examining intra-arrest diastolic blood pressure and coronary perfusion pressure. We take a look at the proposed thresholds, the heterogeneity in the evidence, and whether haemodynamic-guided resuscitation is ready for prime time. Finally, we dive into airway nuance with a brand new taxonomy of performance errors in hyperangulated video laryngoscopy. We've covered a very similar paper before on standard geometry VL which was incredibly useful and this looks to do just the same for the alternative technique required with a hyperangulated device. We explore the microskills, the common errors, and what this means for how we train, feedback and improve our emergency intubations. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob
February 12 · 58 min
Airway Management in Trauma; Roadside to Resus
This episode is an absolute cracker! And we can say that as we've got outsider help... We've all been involved with patients where securing the airway with a prehospital anaesthetic feels intuitively right; the patient with a severe head injury after a fall from height, the unrestrained driver in a high-speed collision with devastating chest injuries, or the patient with significant maxillofacial trauma following assault. In these situations, advanced airway management appears clearly beneficial. What remains a bit ambiguous is the effect of that intervention. Does it play out into a mortality benefit and if so how should we redesign systems to meet a 24 hour need for this (with many prehospital critical care services not being available fully around the clock), bearing in mind competing financial priorities for optimum health care. Maybe it's okay that for some patients the anaesthetic is delayed to the Emergency Department? Worldwide, trauma accounts for an estimated 4.4 million deaths annually and carries a substantial economic burden. Despite decades of improvements in trauma systems, medications such as tranexamic acid, and the development of prehospital critical care teams, some key aspects of trauma care remain really difficult to study well. Prehospital emergency anaesthesia is a prime example. It is time-critical, ethically complex, highly operator dependent and almost impossible to study using conventional randomised trial designs. As a result, clinicians have largely been forced to rely on observational studies, despite the well-recognised problems of bias and confounding that accompany them. In this episode, we explore the existing evidence base and then focus on a landmark new study published in The Lancet Respiratory Medicine. This paper applies machine-learning techniques to a large UK trauma dataset to address the question; does prehospital intubation improve survival in patients who are predicted to need early airway intervention? We walk through how the authors developed a predictive model to identify high-risk patients, how doubly robust estimation was used to move beyond simple association, and how survival and health-economic outcomes were assessed. The results suggest a clinically meaningful reduction in 30-day mortality for selected high-risk trauma patients who receive prehospital intubation. And we're then joined by two of the study's authors, Amy Nelson and Julian Thompson. Together, we explore what these findings may mean for the future of prehospital emergency anaesthesia, how we should think about evidence in complex emergency care environments, and whether this type of analytical approach could reshape trauma research more broadly. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob
February 1 · 32 min
February 2026; papers of the month
Welcome back to February's Papers of the Month! We start this month looking a the right place to perform a prehospital anaesthetic. Traditionally we've been taught it should be somewhere with 360-degree access to allow the greatest safety, which means intubating in an ambulance and other locations are a no-go. But does it actually reduce complications, and what about other locations and situations? This paper explores whether location is associated with outcomes, or whether it might actually be a reasonable and sometimes advantageous to forgo that 360 access. We've talked a lot about pad position in cardiac arrest recently, mainly in the context of DSD, but what about initial pad position? Our second paper may be even more important than DSD! This one takes a look at initial pad position, antero–lateral versus antero–posterior placement and asks whether initial pad position influences return of spontaneous circulation. Finally, we take on one of the most debated topics in emergency and critical care airway management, with choice of induction agent. We look at a brilliant RCT which compares Etomidate to Ketamine and their haemodynamic stability. This one challenges some widely held assumptions, in an attempt to provide some much-needed clarity in what we should be using. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob
January 14 · 1 hr 12 min
Paediatric Seizures; Roadside to Resus
Paediatric seizures are common, time-critical events and they're something most of us will deal with, whether that's pre-hospital, in the emergency department, or on the ward. They make up around 1–2% of ED attendances, and about 1 in 20 children will have a seizure at some point. Most seizures self-terminate, but the longer they go on the harder they are to stop, and the higher the risk of harm. In paediatric seizures, time really matters. In this episode we take a step-by-step look at how to assess and manage a child who's seizing. We start with the fundamentals; how seizures are defined and classified, what status epilepticus actually means in practice, and why recognising it early makes such a difference. We then dig into the physiology behind seizures, exploring why early benzodiazepines work well and why delayed treatment often doesn't. Understanding what's happening at a receptor level helps make sense of when to escalate treatment and why different drugs work at different stages of a prolonged seizure. Pharmacology is a big part of this episode. We talk through first- and second-line anti-seizure medications, routes of administration, and how effective they really are. We cover the EcLiPSE and ConSEPT trials comparing levetiracetam and phenytoin, and look at newer evidence from the Ket-Mid study and what that might mean for managing refractory status and thinking about RSI. We also work through the approach to cases, pre-hospital management and in-hospital care aligned with UK and European recommendations. There's a clear focus on febrile seizures too, separating simple from complex presentations and helping you decide who needs investigating, admitting, or reassuring and discharging. As ever, the aim is to turn guidelines and evidence into something usable on the shop floor. Paediatric seizures are stressful, but with a structured approach, early treatment, and good airway management, they're absolutely manageable and we can make a real difference on outcomes. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James
January 1 · 32 min
January 2026; papers of the month
Welcome to January's Papers of the Month, which marks 10 years of the podcast! First up, we look at a large multicentre cohort study from the East of England examining the association between prehospital post-intubation hypotension and mortality in severe traumatic brain injury. Preventing secondary brain injury sits at the centre of what we're try to achieve in early TBI care, but this paper quantifies the impact of post-RSI hypotension in a dramatic way and the associated increase in 30-day mortality. Our second paper moves into the world of stable supraventricular tachycardia, asking whether an elevated troponin level in this cohort predicts short-term cardiovascular events. Troponin testing in SVT is common but debated: is it useful, or is it a diagnostic red herring? Finally, we look at BICARICU-2, a major multicentre RCT examining sodium bicarbonate for severe metabolic acidemia in patients with moderate–severe AKI. We explore what this means for bicarbonate use for this group of patient, both in terms of mortality rates and the need for renal replacement therapy. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob
Dec 11, 2025 · 31 min
The Wider World of Pre-hospital Care; Roadside to Resus
Welcome to this special edition of Roadside to Resus where we're diving into some of the progressive and practice-defining developments in pre-hospital emergency care. This episode brings together a superb group of clinicians, educators and leaders who are shaping the future of PHEM across the UK, and we caught up with them at the recent Faculty of Pre-hospital Care Conference entitled 'The Wider World of Pre-hospital Care'! We start with Pam Hardy, the Chair of the FPHC, who offers an introduction to the College and its ongoing work to elevate standards across pre-hospital care. Next, Camella Main guides us through the brand-new Pre-hospital Maternity Decision Tool designed to support clinicians facing complex decision making in this complex group of patients. Camella breaks down how the tool came to fruition and how teams can use it to enhance safety and decision-making on scene. We then hear from Ben Sheppey, who explores the growing move to formalise and professionalise voluntary pre-hospital care. Ben reflects on the challenges, opportunities and cultural shifts required to align voluntary responders with national standards. Harriet Tucker then walks us through the new FPHC consensus statement on managing penetrating neck injuries. She distils the key principles, the recommendations, and how the guidance aims to bring clarity to one of the most complex and time-critical presentations we face. From there, Cosmo Scurr unpacks the latest AAGBI PHEA Guideline, highlighting the key movements in delivering anaesthesia in the pre-hospital environment. We also hear from Felix Wood, who provides a sharp, practical look at crush injury and crush syndrome. Finally, Zane Perkins explores the rapidly advancing world of AI in PHEM. From practical application to decision making support. Zane describes how emerging technologies have the potential to change prehospital care in ways we may have never considered before! A huge thanks to the expert speakers for their time recording highlights from the superb conference. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James
Dec 1, 2025 · 30 min
December 2025; papers of the month
December brings us to the final Papers of the Month for 2025 and we're finishing the year with three studies that challenge assumptions across critical care and resuscitation! This time questioning the role of arterial lines in shock, looking at the true prognostic value of end-tidal CO₂ in cardiac arrest and finally to airway management in neonates. We start in the ICU with the EVERDAC trial, a large multicentre RCT exploring whether early arterial catheterisation in shock truly changes outcomes. This challenges some of the papers we've recently looked at recently which champion the benefit of early arterial line insertion! The EVERDAC trial looks at the effect they have on mortality and the results are pretty striking. Next, we move into the world of cardiac arrest with a systematic review and meta-analysis examining end-tidal CO₂ as a prognostic tool for ROSC. ETCO₂ is firmly embedded in ALS practice, but its real predictive power isn't completely clear, as we've seen in the recent ERC guidelines. This review pulls together studies with more than 3,000 patients and helps us understand more how much weight we should give to ETCO₂ and the way in which it's best utilised. Finally, we finish with a neonatal focus: a systematic review and meta-analysis comparing video versus direct laryngoscopy for urgent neonatal intubation. Success rates in NICU and delivery room intubation are notoriously low. This paper looks at the impact of video laryngoscopy on first pass success with some dramatic results, which raises important questions around training and resource allocation. Three papers, three very different patient groups, and three opportunities to reflect on how evidence continues to challenge our practice. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

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