What's next in emergency medicine — October 21, 2026

This edition covers what is coming to emergency medicine between November 2026 and March 2027: one trial to be presented as late-breaking science at the American Heart Association Scientific Sessions 2026 (Chicago, November 6–9) and two pending FDA decisions on acute pain and anaphylaxis. These are not results yet: they are dates on the calendar, each with an official source.

1. RACE-CARS: redesigning the whole out-of-hospital cardiac arrest system

[Ongoing trial] [United States] [Confirmed date: November 8, 2026]
What it is: Open-label cluster randomized trial (50 North Carolina counties allocated 1:1, ~20,000 patients estimated; Duke, with NHLBI as collaborator) comparing usual care with a package of rapid arrest recognition by 911 call-takers, telephone-guided CPR, community CPR/AED training and optimized first responders. Primary outcome: survival with good neurologic function (CPC 1–2) at discharge. Primary results will be presented in session LBS.04 on Sunday, November 8.
What problem it solves: Survival after out-of-hospital arrest is decided in minutes before the emergency department; today those links are improved one by one, without randomized evidence for the whole system.
Critical take: A multicomponent intervention: even if positive it will not isolate which piece worked, and transfer to our setting depends on dispatch maturity and first responder networks.
https://professional.heart.org/en/meetings/scientific-sessions/programming/late-breaking-science
https://sessions.hub.heart.org/home/article/22975212/scientificsessions26-latebreaking-science-announced
https://clinicaltrials.gov/study/NCT04660526

2. Fast-acting meloxicam for moderate-to-severe acute pain

[Pending regulatory decision] [United States] [Confirmed date: December 27, 2026]
What it is: New oral meloxicam formulation (MR-107A-02, Viatris; 505(b)(2) pathway) with a PDUFA goal date of December 27, 2026, according to Viatris's May 18, 2026 release. It rests on two randomized, double-blind phase 3 trials (herniorrhaphy, 579 randomized, NCT06215859; bunionectomy, 410 randomized, NCT06215820) versus placebo, with tramadol as active control; primary endpoint: SPID 0–48 h versus placebo.
What problem it solves: The company presents it as a potential first-line oral non-opioid option for acute pain; in the emergency department we currently combine NSAIDs and acetaminophen and turn to opioids when they fall short.
Critical take: Company-sponsored; the acceptance release states that primary and secondary endpoints were met but gives no efficacy or safety figures. These are postoperative pain models, not ED patients, and NSAID renal, gastrointestinal and cardiovascular risks do not change with faster absorption.
https://investor.viatris.com/news-releases/news-release-details/us-fda-accepts-viatris-new-drug-application-fast-acting

3. Anaphylm: sublingual epinephrine for anaphylaxis

[Pending regulatory decision] [United States] [Confirmed date: March 16, 2027]
What it is: Sublingual film of dibutepinephrine (an epinephrine prodrug; Aquestive) for type I allergic reactions, including anaphylaxis. After a complete response letter dated January 30, 2026, the company resubmitted on September 16, 2026 with human factors and pharmacokinetic studies; FDA accepted it as a Class 2 response with a PDUFA date of March 16, 2027, according to Aquestive's October 15, 2026 release.
What problem it solves: Many at-risk patients do not carry or do not use their autoinjector; a needle-free form could shorten time to epinephrine before reaching the emergency department.
Critical take: Approval would rest on pharmacokinetics (a surrogate), not clinical outcomes in anaphylaxis; absorption with oropharyngeal edema or vomiting is still an open question, and it does not replace IM epinephrine in the ED.
https://www.sec.gov/Archives/edgar/data/0001398733/000139873326000058/a2026-10x19aquestivepduf.htm

*What's next in emergency medicine — October 21, 2026*

❤️ Nov 8, 2026 — RACE-CARS (AHA 2026): system-wide package for out-of-hospital arrest in 50 counties; outcome: neurologically intact survival
💊 Dec 27, 2026 — FDA decision on fast-acting meloxicam for acute pain (non-opioid option)
💉 Mar 16, 2027 — FDA decision on Anaphylm, sublingual epinephrine for anaphylaxis

Full text and audio: https://boletinesmedicos.com/en/emergency-medicine/2026-10-21-viene.html
MedBulletins · boletinesmedicos.com

What's next in emergency medicine (November 2026 – March 2027), each with a date and an official source:

1. November 8 — RACE-CARS (AHA 2026): cluster trial across 50 North Carolina counties redesigning the whole out-of-hospital arrest system, from 911 to first responders.
2. December 27 — FDA decision on fast-acting oral meloxicam for moderate-to-severe acute pain.
3. March 16, 2027 — FDA decision on Anaphylm, a sublingual epinephrine prodrug film for anaphylaxis.

Each item comes with a critical take: sponsorship, surrogate endpoints and applicability to our setting.

Full text and audio: https://boletinesmedicos.com/en/emergency-medicine/2026-10-21-viene.html

#EmergencyMedicine #CardiacArrest #Anaphylaxis #MedEd

What's next in emergency medicine: RACE-CARS at AHA (Nov 8), FDA on fast meloxicam (Dec 27) and sublingual epinephrine (Mar 16, 2027). Sources and critical take:
https://boletinesmedicos.com/en/emergency-medicine/2026-10-21-viene.html