Monthly emergency and critical care medicine bulletin — October 11, 2026

Period covered: September 29 to October 11, 2026 (13 days since the previous issue of September 28). It was a short period, light on large trials: the ESICM congress (LIVES 2026, Lisbon) begins its scientific sessions on October 12, and its results will appear in the next issue. Studies from the European Emergency Medicine Congress (EUSEM, Paris, September 23–27) and one Indian publication from September 24 that the previous issue did not capture are included and flagged as outside the period. This issue contains eight items. No items from Latin America or the Dominican Republic were identified in this period.

Resuscitation and cardiac arrest

1. AED-carrying drones: a hybrid strategy would put a defibrillator at the patient's side within 5 minutes in more than 95% of arrests

[Congress] [France] [Outside the period: September 26]
Geospatial simulation presented at EUSEM 2026 using 28,349 out-of-hospital cardiac arrests (2011–2024) in seven departments of Île-de-France (excluding central Paris). Three strategies were compared: fixed AEDs only, drones with a light fixed network, and a hybrid. The hybrid cut AED access time by a mean of 3.76 minutes and delivered an AED within 5 minutes in more than 95% of cases, versus 30–40% with road retrieval from existing fixed sites; 200 drone bases plus 871 fixed sites would reach 99.4% coverage. Improving access with fixed devices alone would require adding 1,712 AEDs to the existing 1,893.
Why it matters: this is a theoretical model (straight-line flight, no regulatory or weather constraints, a congress abstract not peer reviewed) that did not measure survival; it informs planning, not practice, and in the Dominican context the priority remains a cardiac arrest registry and a basic public-access AED network.
Source: https://www.eusem.org/news/1165-press-release-drones-could-speed-up-delivery-of-automated-external-defibrillators-to-patients-suffering-cardiac-arrest
Source: https://news-medical.net/news/20260925/Drone-delivered-AEDs-could-reduce-defibrillation-delays-after-cardiac-arrest.aspx

Sepsis, shock and intensive care

2. FDA: Class I recall of BD Alaris infusion sets for low-flow inaccuracy, and of the Draeger VentStar Resus Neo circuit

[Regulatory FDA] [United States]
On September 29 the FDA classified as a Class I recall (the most serious type), with an update on October 5, the issue affecting certain BD Alaris infusion sets compatible with the 8100 Pump Module (Guardrails Suite MX software up to v12.6): sets with restrictive components (closed male luer connectors, filters, check valves, Y-sites, microbore tubing) perform worse than previously disclosed, mainly at rates below 1 mL/h and bolus volumes of 5 mL or less, risking under- or over-infusion, delayed occlusion alarms and inaccurate boluses; critically ill, neonatal and pediatric patients face the greatest risk. BD had reported no serious injuries or deaths as of August 19. The FDA recommends discarding discontinued sets, prioritizing alternatives for critical care, neonatal and pediatric areas, and using an alternative pump, such as the Alaris Syringe Module, when performance is not clinically appropriate. Separately, on October 2 the FDA classified as Class I the removal of Draeger VentStar Resus Neo circuits (model MP00310) because of hose cracks that can cause leaks or disconnection, with a risk of desaturation, hypoxia or death.
Why it matters: this directly affects low-rate infusions of vasopressors and sedatives in the ICU; if your hospital uses Alaris pumps, review inventory with pharmacy and biomedical engineering and favor syringe pumps for critical low-rate drugs.
Source: https://www.fda.gov/medical-devices/medical-device-recalls-and-early-alerts/infusion-set-recall-bd-and-carefusion-303-inc-remove-bd-alaris-pump-infusion-sets
Source: https://www.fda.gov/medical-devices/medical-device-recalls-and-early-alerts/early-alert-breathing-circuit-issue-draeger

3. FDA Breakthrough Device designation for selective cytopheretic device (SCD) therapy in sepsis-associated hyperinflammation

[Industry] [United States]
SeaStar Medical announced on October 7 that the FDA granted Breakthrough Device designation to its Selective Cytopheretic Device, integrated into the continuous kidney replacement therapy circuit, for adults with hyperinflammation due to sepsis or a septic condition. Supporting data are pediatric: 77% survival in the QUELIMMUNE studies (approved under a Humanitarian Device Exemption whose label states effectiveness has not been demonstrated) and 76% survival at day 28 in the first 21 children of the SAVE registry. The adult pivotal trial, NEUTRALIZE-AKI (339 ICU patients with acute kidney injury; composite of 90-day mortality or dialysis dependence), includes a prespecified sepsis analysis.
Why it matters: a designation is neither an approval nor evidence of efficacy; this is a manufacturer press release relying on historical controls. NEUTRALIZE-AKI results are needed before any enthusiasm.
Source: https://www.globenewswire.com/news-release/2026/10/07/3376442/0/en/fda-grants-seastar-medical-breakthrough-device-designation-for-its-scd-therapy-for-the-treatment-of-hyperinflammation-in-adult-patients-with-sepsis-or-a-septic-condition.html

Time-critical emergencies and toxicology

4. SAVIOR: a short 36-hour antivenom regimen did not significantly reduce mortality versus a 72-hour regimen in Russell's viper envenomation, but was associated with less AKI and shock

[Clinical trial] [India] [Outside the period: September 24]
Parallel-group randomized trial, described as double-blind (the authors acknowledge blinding was incomplete), at a rural public tertiary hospital in southern India (CTRI/2022/12/048418), published in the Indian Journal of Critical Care Medicine. A total of 193 patients were randomized and 162 completed the protocol. Both arms received a 100 mL loading dose; regimen 1 continued with 60 mL every 6 hours up to 36 hours and regimen 2 with 20 mL every 6 hours up to 72 hours. In-hospital mortality (primary outcome, intention to treat): 8.5% (8 of 94) versus 17.2% (17 of 99) (p = 0.08, not significant). In the per-protocol analysis, the short regimen had faster clinical recovery (median 48 vs 72 hours, p < 0.001), less acute kidney injury (23.2% vs 51.2%, p < 0.001) and less shock (15.9% vs 30.0%, p = 0.03).
Why it matters: single-center, with a non-significant primary outcome and favorable but non-confirmatory secondary outcomes; Russell's viper and Indian antivenom differ from those in our region (the authors themselves caution against generalizing to other regions), so the finding does not translate directly to Caribbean envenomations.
Source: https://doi.org/10.5005/jp-journals-10071-25285

5. High-sensitivity troponin in the ambulance: one third of chest pain patients stayed home

[Congress] [Netherlands] [Outside the period: September 25]
Before-after study presented at EUSEM 2026 (preliminary results) in the Rotterdam-Rijnmond ambulance service, 2022–2025, with 1,022 chest pain patients (539 before and 483 after). Crews calculated the HEART score with point-of-care high-sensitivity troponin; non-conveyance criteria were a low HEART score, troponin below 4 ng/L and no suspicion of another serious condition. Patients left at home: 3.5% (19 of 539) before versus 34.2% (165 of 483) after; 30-day major adverse cardiac events among those left at home: 0.6% (1 of 165).
Why it matters: non-randomized design, only 86% complete follow-up, and the test evaluated is made by QuidelOrtho; a promising way to decongest emergency departments, but it requires validated point-of-care troponin and a prehospital system with follow-up, which is not widely available in the Dominican Republic.
Source: https://www.eusem.org/news/1161-press-release-over-a-third-of-patients-with-chest-pains-could-avoid-going-to-emergency-departments-if-ambulance-crews-use-new-blood-test
Source: https://www.news-medical.net/news/20260925/New-pre-hospital-blood-test-educes-unnecessary-emergency-department-visits-for-chest-pain.aspx

Cross-cutting

6. Crowding and corridor care: every 10% increase in ED occupancy is associated with 1% higher 28-day mortality

[Congress] [United Kingdom] [Outside the period: September 25]
Observational study presented at EUSEM 2026 with 19,034 patients from 134 emergency departments in England, Wales and Northern Ireland in 2025. Mean occupancy was 175%. Each 10% increase in occupancy was associated with a 1% higher risk of all-cause death at 28 days, and corridor care was also associated with higher mortality; compared with a one-space-per-patient scenario, crowding could have contributed to about 554 deaths per week (plausible range 33 to 1,083).
Why it matters: association, not causation, with a very wide interval and no peer-reviewed publication yet; still, it provides a quantitative data point for discussions about crowded EDs and boarding in Dominican hospitals.
Source: https://www.news-medical.net/news/20260925/Study-links-emergency-department-overcrowding-to-higher-patient-mortality.aspx

7. Violence against emergency staff: three in four clinicians witnessed it in the past year

[Publication] [International, 81 countries] [Outside the period: September 25]
International online survey by the EUSEM Emergency Medicine Day Working Group (Petrino et al., European Journal of Emergency Medicine) of 1,306 clinicians from 81 countries (May–June 2026). 75.5% witnessed workplace violence in the past year; verbal aggression 87.8% and physical assault 42.3%; perpetrators were patients (67.6%) and relatives or friends (44.1%); 48.3% felt it had worsened over five years; only 51.1% had prevention training and 27.1% had no access to psychosocial support. Respondents perceived their services as better prepared for a mass casualty incident than for everyday violence.
Why it matters: a voluntary sample with about 40% of questionnaires excluded, so prevalence may be biased; but the lack of training and support is a concrete, inexpensive gap to close in any Latin American emergency department.
Source: https://www.eusem.org/news/1160-press-release-violence-against-emergency-workers-is-increasing-hospital-overcrowding-is-a-major-contributor-emergency-medical-services-are-better-prepared-for-a-mass-casualty-incident-than-for-everyday-violence
Source: https://www.news-medical.net/news/20260925/hospital-overcrowding-drives-increasing-violence-against-emergency-healthcare-workers.aspx

8. AI in triage: a large language model with synthetic dialogues assigns ESI with 71% accuracy in a simulated Hajj scenario

[Publication] [Saudi Arabia]
Simulation study from King Abdulaziz University (Jeddah) published October 9 in Diagnostics. Using 1,000 MIMIC-IV-ED cases (200 per Emergency Severity Index level), synthetic nurse-patient dialogues were generated with GPT-4.1 and GPT-5.2 was evaluated. With structured data plus dialogue, accuracy was 71.1% (95% CI 68.3–73.9) versus 41.8% with structured data alone; under-triage fell from 31.6% to 6.4% (for ESI 1–2, from 68.5% to 5.5%), with 22.5% over-triage. In 50 cases compared with nurses, the model achieved a weighted kappa of 0.902 versus 0.833–0.838.
Why it matters: dialogues were generated from the true ESI label, which may leak the answer to the model and inflate performance; it is a simulation without real clinical validation, voice or noise. It does not justify deploying AI triage, but it illustrates how to evaluate it rigorously first.
Source: https://www.mdpi.com/2075-4418/16/20/3268

Upcoming meetings and dates

ESICM LIVES 2026, 39th Annual Congress of the European Society of Intensive Care Medicine: Lisbon (Lisboa Congress Centre), October 10–14; scientific sessions October 12–14. Featured abstracts include PRAISE (Netherlands, multicomponent intervention to reduce ICU agitation and physical restraint, stepped-wedge trial) and EMERALD (UK, randomized feasibility trial of trauma-focused therapy for post-traumatic stress after critical illness).
https://www.esicm.org/events/39th-annual-congress-lisbon/
54th Annual Meeting of the Japanese Association for Acute Medicine (JAAM 54): Nagasaki, October 27–29.

Monthly emergency and critical care medicine bulletin — October 11, 2026
Eight verified items from the FDA, Indian Journal of Critical Care Medicine, Diagnostics, European Journal of Emergency Medicine, SeaStar Medical and the EUSEM 2026 congress.
Three worth your time:
• FDA Class I recall of BD Alaris infusion sets: inaccuracy below 1 mL/h and with boluses of 5 mL or less, a risk for ICU vasopressors and sedatives. No serious injuries reported as of August 19.
• SAVIOR (India, 193 randomized patients): 36-hour vs 72-hour antivenom for Russell's viper bites; mortality 8.5% vs 17.2% (p = 0.08, not significant) and less AKI (23% vs 51%). Single center.
• ED crowding (UK, 19,034 patients): each 10% rise in occupancy is associated with 1% higher 28-day mortality. Observational, not yet peer reviewed.
Full bulletin, with a critical appraisal of every study and links to its sources:
https://boletinesmedicos.com/en/emergencias/2026-10-11.html
#EmergencyMedicine #CriticalCare #Sepsis #Toxicology #EDCrowding

Emergency medicine, Oct 2026: FDA Class I recall of BD Alaris sets for inaccuracy below 1 mL/h. SAVIOR: 36-h vs 72-h antivenom, mortality 8.5% vs 17.2% (p 0.08, not significant). https://boletinesmedicos.com/en/emergencias/2026-10-11.html