First10EM Journal Club: May 2026

The May edition of the Journal Club is out now! This is a long podcast, but packed full of fun EBM and some practice changing papers and we even manage to escape our usual evidentiary nihilism.

Links are in the description below to the PDFs and you can listen on your favourite app or just watch the video on Youtube

Whole Blood in Trauma: First big RCT under-doses, underwhelms

Smith JE, Cardigan R, Sanderson E, Silsby L, Rourke C, Barnard EBG, Basham P, Antonacci G, Charlewood R, Dallas N, Davies J, Goodwin E, Hawton A, Hudson C, Lucas J, Keen K, Lyon RM, Nolan B, Perkins GD, Rundell V, Smith L, Stanworth SJ, Weaver A, Woolley T, Green L; SWiFT Trial Group. Prehospital Whole Blood in Traumatic Hemorrhage – a Randomized Controlled Trial. N Engl J Med. 2026 Mar 17. doi: 10.1056/NEJMoa2516043. Epub ahead of print. PMID: 41841706

Bottom line: This first RCT of whole blood in trauma showed no benefit over component therapy. We definitely need, and will see, many more trials of whole blood in the future.

You can read more from Justin here. 

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More negative data on BP targets

Sajdeya R, Yanez ND, Kampp M, Goodman MD, Zonies D, Togioka B, Nunn A, Winfield RD, Martin ND, Kohli A, Huynh TT, Okonkwo DO, Poblete RA, Gilmore EJ, Chesnut RM, Bunnell AE, Ohnuma T, Hashemaghaie M, Treggiari MM. Early Blood Pressure Targets in Acute Spinal Cord Injury: A Randomized Clinical Trial. JAMA Netw Open. 2025 Sep 2;8(9):e2525364. doi: 10.1001/jamanetworkopen.2025.25364. PMID: 40965887

Bottom line: This small, flawed RCT demonstrated no benefit from higher blood pressure targets (MAP 85-90) when compared to conventional targets (MAP 65-70), but does demonstrate harm. There is tremendous uncertainty, but we should clearly favour conventional BP targets until new research is published.

Justin’s full rant can be found here.

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Two Trials of PE interventions

Lookstein RA, Konstantinides SV, Weinberg I, Dohad SY, Rosol Z, Kopeć G, Moriarty JM, Parikh SA, Holden A, Channick RN, McDonald B, Nagarsheth KH, Yamada K, Rosovsky RP; STORM-PE Trial Investigators. Randomized Controlled Trial of Mechanical Thrombectomy With Anticoagulation Versus Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Outcomes From the STORM-PE Trial. Circulation. 2026 Jan 6;153(1):21-34. doi: 10.1161/CIRCULATIONAHA.125.077232. Epub 2025 Nov 3. PMID: 41183181.

Bottom line: This is basically a pilot trial, looking at disease oriented rather than patient oriented outcomes. It is an unblinded trial, designed and run by the device manufacturer. Even with those biases, the results are completely underwhelming.

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Kjaergaard J, Bang LE, Sonne-Holm E, Wiberg S, Holmvang L, Lassen JF, Sørensen R, Høfsten DE, Ulriksen PS, Jawad S, Palm P, Søe C, Ersbøll MK, Boesgaard S, Møller JE, Thune JJ, Hassager C, Tilsted HH, Lønborg J, Egstrup M, Kristiansen OP, Seven E, Lindholm MG, Eskesen K, Fanø S, Carlsen J. Randomized trial of low-dose -, ultrasound assisted thrombolysis or heparin for pulmonary embolism. Cardiovasc Res. 2026 Jan 29:cvag038. doi: 10.1093/cvr/cvag038. PMID: 41610160

Bottom line: Although thrombolysis might improve the radiological clot burden, there is harm and no evidence of patient-oriented benefits

Morgenstern’s deep thoughts on these two papers can be found in this post. 

You can read my big picture review of modern PE management here.

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Methamphetamine use disorder: light at the end of the tunnel?

McKetin R, Shoptaw S, Saunders L, Nguyen L, Clare PJ, Dore GJ, Turner A, Dean OM, Kelly PJ, Arunogiri S, Koeijers J, Degan TJ, Degenhardt L, Farrell M, Goodman-Meza D, Sinclair B, Reid D, Cordaro F, Hill H, Lundin R, Hayllar J, Christmass M, Liaw W, Liu D, Woods A, Brewerton B, Holyoak E, Wu BT, Maher H, O’Dea N, Keygan J, Kontogiannis A, Palmer L, Morrison C, Wrobel A, Hyland B, Kiden G, Romeo V, Kyaw KWY, Byrne M, Colledge-Frisby S, Zahra E, Berk M. Mirtazapine for Methamphetamine Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2026 Apr 1:e260159. doi: 10.1001/jamapsychiatry.2026.0159. PMID: 41920558

Bottom line: In this double-blind placebo-controlled RCT, mirtazapine resulted in less self-reported days using methamphetamine in the next 28 days.

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Emergency Docs should decide who needs a CTPA, Radiologists should report CTPAs

Tan H, Chandru P. Radiologist Approval for CTPA in the ED: A Single-Centre Pilot Study Did Not Demonstrate a Statistically Significant Difference in Diagnostic Yield. Emerg Med Australas. 2026 Feb;38(1):e70237. doi: 10.1111/1742-6723.70237. PMID: 41705429

Bottom line: Not a great trial, probably not gonna change practice… but might help at your next department meeting about CTPA processes.

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New antibiotic, not as effective as old treatment: maybe save it for when we need it in 10 years!

Luckey A, Balasegaram M, Barbee LA, Batteiger TA, Broadhurst H, Cohen SE, Delany-Moretlwe S, de Vries HJC, Dionne JA, Gill K, Kenyon C, Kittiyaowamarn R, Lewis D, Mueller JP, Naicker V, O’Brien S, O’Donnell JP, Phanuphak N, Spooner E, Srinivasan S, Taylor SN, Unemo M, Zwane Z, Hook EW 3rd; Zoliflodacin Phase 3 Study Group. Zoliflodacin versus ceftriaxone plus azithromycin for treatment of uncomplicated urogenital gonorrhoea: an international, randomised, controlled, open-label, phase 3, non-inferiority clinical trial. Lancet. 2026 Jan 10;407(10524):147-160. doi: 10.1016/S0140-6736(25)01953-1. Epub 2025 Dec 11. PMID: 41391465

Justin has a thing: complaining about non-interiority trials.

Bottom line: Zoliflodacin is clearly inferior to the current standard of care, despite the very misleading conclusions in this paper.

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No OUCH study: Ibuprofen monotherapy for minor injuries

Ali S, Klassen TP, Candelaria P, Bhatt M, Sawyer S, Stang A, Yaskina M, Heath A, Pechlivanoglou P, Offringa M, Drendel AL, Hickes S, Poonai N; KidsCAN PERC Innovative Pediatric Clinical Trials No OUCH Study Team. Acetaminophen (Paracetamol) or Opioid Analgesia Added to Ibuprofen for Children’s Musculoskeletal Injury: Two Randomized Clinical Trials. JAMA. 2026 Mar 10;335(10):863-873. doi: 10.1001/jama.2025.25033. PMID: 41505155

Bottom line: for minor painful MSK injuries adding paracetamol or opiates to ibuprofen was not helpful.

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Pericardiocentesis + TXA for traumatic Tamponade

Qandil M, Ransom P, Shammala MA, Srour A, Khafaja M, Alkhateeb N, Jafar AJN, Abughali S. Pericardiocentesis, drainage and instilled tranexamic acid: definitive management in a 25-case series of penetrating cardiac tamponade. Injury. 2026 Feb 16:113106. doi: 10.1016/j.injury.2026.113106. Epub ahead of print. PMID: 41760498

Bottom line: an amazing case series collected in a war zone challenges our thinking about penetrating chest trauma.

You can read my full discussion and thoughts from the authors here: Pericardiocentesis in a War Zone

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Avalanche Burial Rescue: prolonging the agony?

Eisendle F, Roveri G, Rauch S, Thomassen Ø, Dal Cappello T, Assmus J, Malacrida S, Kammerer T, Schweizer J, Borasio N, Dörck V, Falk M, Falla M, Fruzzetti N, Maxenti M, Mydske S, Sasso GM, Vinetti G, Wallner B, Brattebø G, Brugger H, Strapazzon G. Respiratory Gas Shifts to Delay Asphyxiation in Critical Avalanche Burial: A Randomized Clinical Trial. JAMA. 2025 Oct 8;334(19):1720–7. doi: 10.1001/jama.2025.16837. Epub ahead of print. PMID: 4106066

Bottom line: There is enough air in snow for a basic fan to allow respiration under 50 cm of snow for up to 35 minutes. That is interesting, but perhaps not all that useful information. 

You can read all about the logistics of avalanche rescue here: Avalanche Survival in Broome

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