Monthly emergency medicine bulletin — September 28, 2026

Period covered: August 29 to September 28, 2026. It was a thin month for large trials in the specialty: 52 searches were run in English, Spanish, Japanese, Chinese, Russian, Arabic, Turkish, Portuguese, German and French, and seven items were verified by opening the source. The most relevant news came from the European Society of Cardiology Congress (Munich, August 28–31) with two trials on chest pain in the emergency department, from ACEP's new procedural sedation guidelines, and from the launch of the national assessment of the Dominican Republic's emergency care system. No recycled material was added as filler.

Resuscitation and cardiac arrest (life support, airway, sedation)

1. ACEP updates its multidisciplinary guidelines on unscheduled procedural sedation

[Guideline] [United States]
The American College of Emergency Physicians published in the September issue of Annals of Emergency Medicine (vol. 88, no. 3) the "Unscheduled Procedural Sedation Multidisciplinary Delphi Consensus Guidelines," Part 1 (principles, oversight and quality monitoring) and Part 2 (clinical practice), developed by a 20-member panel with 14 organizations and approved by the ACEP Board on April 29, 2026; ACEP announced them on September 3. Key strong-consensus points: decisions should focus on sedation depth and ventilatory adequacy rather than the specific drug; urgent procedures should not be delayed solely because of fasting times (aspiration 0.97 vs 0.79 per 10,000 sedations with vs without fasting compliance); the Mallampati score should not be required; ASA class III alone does not justify restrictions (major complications 9.10 vs 4.61 per 10,000, NNT 2,227); capnography, pulse oximetry with audible tone, cardiac rhythm and blood pressure should be used routinely whenever feasible; ketofol is as safe and effective as propofol; co-administered anticholinergics are no longer recommended. Applies across all settings and ages.
Why it matters: this is a Delphi consensus, not a trial, but it is endorsed by SCCM, ACMT, ASGE, SIR, SPS, SAEM, CAEP and others, and gives hospitals grounds to revise policies that still require fasting, Mallampati or anesthesiology for ASA III; in Dominican emergency departments with limited capnography, the monitoring recommendation is the first gap to close.
https://pubmed.ncbi.nlm.nih.gov/42618173/
https://pubmed.ncbi.nlm.nih.gov/42618174/

Trauma and surgical emergencies

No verifiable items from the last 30 days in polytrauma, hemorrhage, sepsis or acute abdomen. Note: the BEST trial (India, single center, n = 188, bougie vs stylet in trauma patients with difficult airway features; first-pass success 71.3% vs 67.0%, p = 0.53; no external funding, CTRI/2022/11/047043) was published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine on August 10, 2026 and falls outside this issue's window. A trial of a 1-hour prehospital resuscitation bundle for septic shock (Critical Care Medicine, 2026) could not be verified because of restricted access and is not included.

Cardiovascular, neurological and respiratory emergencies

2. PRESC1SE-MI: the 0/1-h troponin pathway is as safe as 0/3 h but does not shorten emergency department stay

[Clinical trial] [International; coordinated from Basel, Switzerland]
Pragmatic, stepped-wedge, cluster-randomized trial presented at ESC Congress 2026 on August 29 and published simultaneously in The Lancet. Twenty hospitals in 11 countries; 67,624 consecutive presentations with suspected myocardial infarction. Co-primary safety outcome (all-cause death or new type 1 MI at 30 days): 1.1% with the 0/1-h pathway vs 1.2% with 0/3 h, adjusted OR 0.93 (95% CI 0.77–1.13), noninferiority p < 0.001. Co-primary efficacy outcome (ED length of stay): median 309 minutes in both groups (p = 0.65). An individual patient data meta-analysis of 5 trials (110,933 presentations), presented in the same session, agreed: similar safety, no reduction in length of stay and no increase in direct discharge.
Why it matters: it validates the safety of the ESC 0/1-h algorithm at scale but dismantles the promise that it "decongests" the emergency department; the bottleneck is flow, not the laboratory. Funding is not reported in the press release, and stepped-wedge designs are sensitive to temporal trends. In Dominican hospitals, adopting the 0/1-h pathway requires validated high-sensitivity troponin and fast discharge processes; without the latter there will be no operational benefit.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01654-5/abstract
https://www.eurekalert.org/news-releases/1141879

3. TARGET-CTCA: targeted coronary CT angiography after MI is ruled out does not reduce MI or cardiac death

[Clinical trial] [United Kingdom]
Published in the New England Journal of Medicine and presented at ESC Congress 2026 (Munich). 3,170 patients with acute chest pain, MI ruled out and intermediate high-sensitivity troponin values (median 8.0 ng/L; mean HEART score 3.5) from 14 UK hospitals, randomized to coronary CT angiography (median 6 days after presentation) or standard care, with a median follow-up of 3 years. Primary outcome (MI or cardiac death): 7.1% vs 7.3%, adjusted HR 0.95 (95% CI 0.73–1.23). All-cause death 4.6% vs 6.1% (HR 0.74; 95% CI 0.54–1.00), a secondary outcome. CT found obstructive disease in 22.6% and increased statins (63.4% vs 48.5% at 90 days) and antiplatelets, with no subgroup benefiting.
Why it matters: it reinforces that an intermediate troponin alone should not mandate coronary CT, sparing a scarce resource in Latin America; limitations: CT was not performed in the ED, the all-cause mortality signal is secondary and borderline, and the senior author reports consulting for Roche Diagnostics.
https://www.nejm.org/doi/abs/10.1056/NEJMoa2608903
https://www.tctmd.com/news/target-ctca-when-mis-already-ruled-out-chest-pain-imaging-doesnt-add-much

4. Early BiPAP with continuous albuterol in pediatric asthma exacerbations: negative result

[Clinical trial] [United States]
Randomized trial published in JAMA Network Open (September 2026) and announced on September 15 by the University of Colorado Anschutz. In children treated in the emergency department for an asthma exacerbation, early bilevel positive airway pressure (BiPAP) together with continuous albuterol did not reduce the duration of continuous albuterol therapy, the primary outcome.
Why it matters: we could not access the full text (access block), so sample size, secondary outcomes and funding remain unverified; with the available data there is no basis for routine BiPAP in exacerbations that respond to conventional treatment, and its use should be reserved for impending respiratory failure.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2853300
https://news.cuanschutz.edu/medicine/early-bpap-in-ed-fails-to-shorten-acute-asthma-albuterol-therapy

Emergency care organization and systems

5. The Dominican Republic launches a national assessment of its emergency and critical care system (WHO ECCSA)

[Public health] [Dominican Republic]
On August 31, 2026 the Ministry of Public Health, with PAHO/WHO technical cooperation, launched the National Diagnostic Assessment of the Emergency and Critical Care System using the Emergency and Critical Care Systems Assessment (ECCSA) tool. It evaluates five domains: governance and financing; data and quality improvement; scene care, transport and referral; facility-based and critical care; and preparedness for health emergencies and disasters. Next come the ECCSA survey, a national consensus workshop and a report with a road map, actions, timelines and indicators. The announcement acknowledges progress (9-1-1, DAEH, trauma services) and gaps: coordination between levels of care, shortage and distribution of specialists, non-standardized protocols, information systems and referral/counter-referral. In February 2026 the Council of Ministers included the trauma network among the five health-sector priorities.
Why it matters: it is the first systematic diagnosis of the Dominican system with a standardized WHO tool; it provides no figures yet, but it sets the public-policy agenda for the coming years, and the voice of emergency physicians in the survey and the workshop will decide whether the road map reflects the reality of the departments.
https://www.paho.org/es/noticias/31-8-2026-republica-dominicana-inicia-proceso-para-evaluar-fortalecer-su-sistema-atencion

6. ACEP national poll: patients expect a physician on site in the ED, and boarding drives them away

[Publication] [United States]
ACEP/Morning Consult survey of 10,000 U.S. adults (summer 2026, released September 3): 81% want a physician on site in the emergency department and 74% are concerned about quality without physician oversight; 78% are concerned about the safety of emergency care teams and 81% want stronger protections; 61% worry insurance will not cover the visit and 33% have delayed or avoided emergency care over cost; 52% would delay or avoid care if at risk of boarding.
Why it matters: it is an opinion poll with an advocacy interest (defending physician oversight versus other professionals), not a clinical study, but it quantifies the deterrent effect of crowding, relevant to the Dominican debate on overcrowded departments and availability of emergency physicians.
https://www.acepnow.com/article/september-2026-news-from-the-college/

Cross-cutting

7. Individual patient data meta-analysis: five trials of the 0/1-h pathway do not improve ED flow

[Meta-analysis] [International]
Presented at ESC Congress 2026 together with PRESC1SE-MI: 5 randomized trials and 110,933 presentations with suspected MI. The 0/1-h high-sensitivity troponin pathway had safety similar to standard care, with no reduction in ED length of stay and no increase in direct discharge.
Why it matters: it settles the operational question with the largest randomized dataset available; there is no peer-reviewed publication with effect sizes yet, so the figures should be taken as preliminary.
https://www.eurekalert.org/news-releases/1141879

Regional and multilingual coverage: searches were run in Japanese (JAAM), Chinese (急诊医学 journals), Russian, Arabic, Turkish (EMAT), Portuguese (ABRAMEDE, ANVISA), German (DGINA, Notfall + Rettungsmedizin), French (SFMU) and Italian; no verifiable emergency medicine trials, guidelines or regulatory decisions from the last 30 days were identified beyond those included. The EMAT 2026 airway guideline (Turkish Journal of Emergency Medicine) was released in December 2025 and is not included. No verified specialty-specific regulatory news from FDA, EMA, PMDA, NMPA, ANVISA, COFEPRIS or DIGEMAPS in this period.

Upcoming meetings and dates

EUSEM 2026, European Emergency Medicine Congress: held in Paris (Palais des Congrès), September 23–27, 2026; its results will be covered in the next issue.
ACEP26 Scientific Assembly: Chicago, October 5–8, 2026 (acep.org/sa).
54th Congress of the Japanese Association for Acute Medicine (JAAM 54), with the 18th Japanese Resuscitation Science Symposium: Nagasaki, October 27–29, 2026.

Monthly emergency medicine bulletin — September 28, 2026
Seven verified items from the last 30 days, from The Lancet, NEJM, Annals of Emergency Medicine, JAMA Network Open and PAHO/WHO. A thin month for large trials; no filler.
Three worth your time:
• PRESC1SE-MI (Lancet, 67,624 presentations, 20 hospitals): the 0/1-h troponin pathway is as safe as 0/3 h (death or MI at 30 days 1.1% vs 1.2%), but ED length of stay was identical, 309 min in both arms. Stepped-wedge design; funding not stated in the press release.
• TARGET-CTCA (NEJM, 3,170 patients, 14 UK hospitals, 3 years): coronary CT angiography after MI is ruled out did not reduce MI or cardiac death (7.1% vs 7.3%, HR 0.95). CT was done at 6 days, not in the ED.
• ACEP publishes its new unscheduled procedural sedation guidelines: no delays for fasting in urgent cases, Mallampati not required, routine capnography and oximetry. Delphi consensus, not a trial.
Full bulletin, with a critical reading of each study and links to the primary sources:
https://boletinesmedicos.com/en/emergencias/2026-09-28.html
#EmergencyMedicine #EMdocs #ChestPain #Troponin #ProceduralSedation

EM, Sept 2026: PRESC1SE-MI (67,624 pts) — 0/1-h troponin pathway just as safe, identical ED stay (309 min). TARGET-CTCA (3,170) — coronary CT after MI ruled out does not cut events (7.1% vs 7.3%). https://boletinesmedicos.com/en/emergencias/2026-09-28.html