Clinical and Experimental Emergency Medicine最新文献

{"title":"Use of biomarkers in the early diagnosis of Ischemic Stroke: A Systematic Review.","authors":"José-Manuel León, Rosa Castillo-Olate, Jeffrey Penny","doi":"10.15441/ceem.25.167","DOIUrl":"https://doi.org/10.15441/ceem.25.167","url":null,"abstract":"<p><strong>Objective: </strong>The diagnosis of acute ischemic stroke (AIS) is time-sensitive and reliant on neuroimaging, which is not always immediately accessible. This systematic review aims to identify and evaluate bloodbased biomarkers with potential to support early diagnostic decision-making and facilitate prompt referral for confirmatory imaging and treatment.</p><p><strong>Methods: </strong>Following the PRISMA guidelines, a systematic search of PubMed, Web of Science, LILACS, Medline, Scopus, Scielo, Epistemonikos and TRIP Data Base was conducted for primary studies published in the last five years. Original studies evaluating blood-based biomarkers collected within 12 hours of symptom onset for early diagnosis of AIS were included. The methodological quality of included studies was assessed using the QUADAS-2 tool.</p><p><strong>Results: </strong>Ten studies met the inclusion criteria, investigating a range of biomarkers including proteins, non-coding RNAs, and lipids. Most studies were case-control in design, with overall risk of bias rated as low to moderate. Multi-marker panels combining biomarkers with clinical scales (e.g., D-dimer and GFAP with FAST-ED; AUC = 0.95), and lipidomics-based models (AUC = 0.968), demonstrated the highest diagnostic performance. Several individual non-coding RNAs also showed promising accuracy (AUC > 0.85).</p><p><strong>Conclusion: </strong>Blood-based biomarkers, especially when used in multi-marker panels, demonstrate considerable potential as triage tools for early AIS diagnosis. Their application in point-of-care settings could reduce diagnostic uncertainty and accelerate time to treatment. However, prospective validation in real-world emergency environments is essential prior to clinical implementation.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the rescuer's posture and position, or manikin position on the efficacy and efficiency of chest compressions during cardiopulmonary resuscitation in adults: a systematic review.","authors":"Maria Bhudarally, Tiago Atalaia, Hugo Pereira, Cláudia Febra, António Palmeira, José Pedro Morgado, Pedro Aleixo","doi":"10.15441/ceem.25.145","DOIUrl":"https://doi.org/10.15441/ceem.25.145","url":null,"abstract":"<p><strong>Background: </strong>Rescuer posture, position, and patient height during chest compressions (CC) influence its efficacy and efficiency. No clear recommendations exist on these aspects. It is essential to systematize the existing knowledge, especially for nurses and healthcare providers involved in resuscitation.</p><p><strong>Purpose: </strong>To conduct a systematic review about the impact of rescuer posture, position, and manikin/patient height on CC efficacy and efficiency.</p><p><strong>Methods: </strong>The study followed PRISMA guidelines and was registered on PROSPERO. Eligibility criteria included peer-reviewed articles or conference papers comparing different rescuer postures, positions, or manikin/patient heights during CC performed with both hands, regarding efficacy or efficiency. Databases consulted: MEDLINE Complete, SPORTDiscus, Cochrane Reviews, and CINAHL Complete. Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies.</p><p><strong>Results: </strong>Of 6539 articles, only 34 met inclusion criteria. All were observational, used manikins, and were classified as weak in global methodological quality. Compared with standing, several studies suggested the kneeling posture may be associated with more effective and efficient CC. Evidence regarding the optimal patient height, including potential anthropometric-based adjustments, remains limited. Findings across the included studies indicated that variations in hand position appeared to have minimal influence on CC quality. Some studies reported decreased CC quality when rescuers performed CC while walking.</p><p><strong>Conclusions: </strong>The available evidence suggested that performing CC while kneeling on a firm surface may be beneficial when feasible. Future research is needed to further evaluate the impact of bed height, self-selected rescuer position, and their relevance to emergency practice.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Advanced Airway Management Strategies with 72-Hour Survival in Out-of-Hospital Cardiac Arrest: Video Laryngoscopy vs. Direct Laryngoscopy vs. Supraglottic Airways.","authors":"Min Woo Kim, Jeong Ho Park, Ki Jeong Hong, Kyoung Jun Song, Sang Do Shin","doi":"10.15441/ceem.25.282","DOIUrl":"https://doi.org/10.15441/ceem.25.282","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to compare the 72-hour survival of the endotracheal intubation (ETI) with video laryngoscope (VL), ETI with direct laryngoscope (DL), and supraglottic airway (SGA) in out-of-hospital cardiac arrest (OHCA) patients in Korea.</p><p><strong>Methods: </strong>This study included adult OHCA patients who received advanced airway management by designated response teams for severe disease, using a nationwide OHCA registry in South Korea from July 2019 to December 2021. The primary outcome was 72-hour survival, and secondary outcomes were survival to hospital discharge and good neurological recovery. Multivariable logistic regression was used, adjusted for confounders, to compare the outcomes among the three airway management methods.</p><p><strong>Results: </strong>Among 77,629 OHCA cases, 10,857 were included. SGA was attempted in 9,379 cases, ETI with DL in 493 cases, and ETI with VL in 985 cases. The rates of any prehospital ROSC and 72-hour survival were 13.3% and 11.0% for SGA, 16.0% and 11.4% for ETI with DL, and 18.2% and 11.9% for ETI with VL. Compared to SGA, ETI with VL was significantly associated with 72-hour survival: adjusted odds ratio (OR) [95% confidence interval (CI)] 1.34 (1.06-1.70) for ETI with VL and 1.13 (0.81-1.56) for ETI with DL). There was no significant association between the type of AAM and survival to discharge or good neurological recovery.</p><p><strong>Conclusion: </strong>In an emergency medical service system staffed by advanced emergency medical technician-level providers, ETI with VL might be associated with improved 72-hour survival compared to SGA. However, this short-term benefit did not extend to survival to hospital discharge.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145803115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of pediatric patients with heat-related illness transferred to emergency departments: a descriptive analysis from Japan.","authors":"Yohei Okada, Marcus Eng Hock Ong, Tadashi Ishihara, Shoji Yokobori, Jun Kanda","doi":"10.15441/ceem.24.343","DOIUrl":"10.15441/ceem.24.343","url":null,"abstract":"<p><strong>Objective: </strong>Children are particularly vulnerable to heat-related illnesses due to their unique physiological and behavioral characteristics. Understanding the epidemiology and clinical features of heat-related illnesses in children is crucial for guiding targeted preventive measures and management strategies. This descriptive study aims to investigate the characteristics of pediatric patients with heat-related illness who were transferred to emergency departments in Japan.</p><p><strong>Methods: </strong>This study was a secondary analysis of the Heatstroke Study, led by the Heatstroke and Hypothermia Surveillance Committee of the Japanese Association for Acute Medicine. This study included pediatric patients (<18 years) with heat-related illness transferred to emergency departments in the summer from 2017 to 2021. We summarized the circumstances of onset, clinical characteristics, and outcomes.</p><p><strong>Results: </strong>Of the 3,154 registered patients, 146 children were included. Of them, 60% were male, with a median age of 15 years (interquartile range, 13-16 years). The most cases occurred in August (47%), and most (80%) were associated with sports activities and with outdoor settings (70%). Cases with a body temperature above 40 °C were rare (3%). Most cases were admitted to hospitals (75% to the general ward and 16% to the intensive care unit), and patients admitted to intensive care unit had altered consciousness with increased serum creatinine. There were two cases of mortality, both of which were out-of-hospital cardiac arrest.</p><p><strong>Conclusion: </strong>Most pediatric cases with heat-related illness were middle or high school students, occurred in August, and were related to outdoor sports activity. Patients admitted to hospitals suffered altered consciousness, dehydration, and acute kidney injury.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"369-379"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A giant renal cyst mimicking ascites: importance of evaluating gravity-dependent areas by ultrasound.","authors":"Ryo Ichibayashi, Manami Oki, Takashi Ishii","doi":"10.15441/ceem.25.132","DOIUrl":"10.15441/ceem.25.132","url":null,"abstract":"","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"12 4","pages":"414-415"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epinephrine-induced lactic acidosis during the management of anaphylactic shock: a case report.","authors":"Hyo Suk Oh, Chi Ryang Chung, Chi-Min Park, Gee Young Suh, Ryoung-Eun Ko","doi":"10.15441/ceem.24.239","DOIUrl":"10.15441/ceem.24.239","url":null,"abstract":"<p><p>In a case of contrast media-induced anaphylactic shock managed with epinephrine, a 57-year-old male patient developed lactic acidosis without cardiogenic shock or global hypoperfusion, highlighting epinephrine's potential to trigger lactic acidosis. Despite the previous management of similar reactions with antihistamines and corticosteroids, this case required intensive care unit admission and emergency intervention for alarmingly high lactate level. The rapid resolution of acidosis following epinephrine discontinuation underscores the need for careful monitoring and consideration of alternative vasopressor strategies in severe anaphylaxis, illustrating the complex relationship between epinephrine's metabolic effects and anaphylaxis-induced tissue hypoperfusion.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"400-404"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12861706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of ketamine versus etomidate for rapid sequence intubation of critically ill patients in terms of mortality and success rate: a systematic review and meta-analysis of randomized controlled trials.","authors":"Anjishnujit Bandyopadhyay, Partha Haldar, Chhavi Sawhney, Abhishek Singh","doi":"10.15441/ceem.24.363","DOIUrl":"10.15441/ceem.24.363","url":null,"abstract":"<p><strong>Objective: </strong>Etomidate and ketamine are hemodynamically stable induction agents for rapid sequence intubation (RSI) of critically ill patients. Despite their relative stability in terms of hemodynamics, how the choice of agent affects mortality and the success of the procedure is debatable and has not yet been explored via systematic review and meta-analysis. The objective of this systematic review is to compare the efficacy of ketamine and etomidate for RSI in terms of mortality, hemodynamic parameters, and success rate.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Embase, and the Web of Science was conducted from the starting date of each database until April 2024. Randomized controlled trials comparing the safety and efficacy of ketamine and etomidate as induction drugs for critically ill patients undergoing RSI were included. The primary outcome was the risk of 28-day mortality, and the secondary outcomes included the success rate and postinduction hypotension. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis.</p><p><strong>Results: </strong>Four studies with 1,663 patients were meta-analyzed, and no statistically significant difference between the two drugs was found for 28-day mortality (RR, 0.95; 95% CI, 0.72-1.25; heterogeneity I2=39%; level of certainty of evidence per GRADE, moderate), first-pass success rate (RR, 1.00; 95% CI, 0.97-1.03), or postinduction cardiac arrest (RR, 1.10; 95% CI, 0.62-1.96). Postinduction hypotension was higher in the ketamine group (RR, 1.30; 95% CI, 1.03-1.64), but the result was not statistically significant.</p><p><strong>Conclusion: </strong>Mortality outcomes did not differ when ketamine or etomidate was used for RSI in critically ill patients. Ketamine, however, was associated with a non-significantly higher risk of postinduction hypotension.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"331-341"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of regional wall motion abnormalities in patients with occlusion myocardial infarction with and without ST-elevation myocardial infarction (STEMI).","authors":"Alexander Bracey, H Pendell Meyers, Caleb Watkins, Gautam R Shroff, Daniel Lee, Adam Singer J, Stephen W Smith","doi":"10.15441/ceem.24.373","DOIUrl":"10.15441/ceem.24.373","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to determine whether there are similar rates of regional wall motion abnormalities (RWMAs) in patients with acute coronary occlusion myocardial infarction (OMI) with and without ST-elevation myocardial infarction (STEMI) on electrocardiogram (ECG).</p><p><strong>Methods: </strong>We performed a retrospective review of a database of patients at high risk for acute coronary syndrome with previously established outcomes for the presence of OMI in order to compare rates of RWMA in patients presenting with STEMI(+) OMI versus STEMI(-) OMI. Furthermore, we compared how often the RWMA aligned with the anatomical territory observed on ECG.</p><p><strong>Results: </strong>Among 808 patients, 551 underwent formal echocardiography, including 256 of 265 OMI patients and 295 of 543 patients with no occlusion. Of the 256 OMI patients that underwent formal echocardiography, only 105 (41.0%) met STEMI criteria. Among them, 94 of 105 (89.5%) STEMI(+) OMI patients had RWMAs compared to 124 of 151 (82.1%) STEMI(-) OMI patients (P=0.10; 95 confidence interval, -1.63% to 15.6%). Both groups had a greater prevalence of RWMA than the non-OMI group (45%). RWMA matched the anatomic territory predicted by ECG in 92.5% of STEMI(+) OMI, 82.3% of STEMI(-) OMI, and 2.9% of the no-occlusion cohort.</p><p><strong>Conclusion: </strong>Location of RWMAs was well-correlated with ECG findings regardless of the presence or absence of STEMI criteria. A prospective study is warranted to determine the utility of echocardiography in the detection of STEMI(-) OMI.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"342-349"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Entrustable professional activity-aligned workplace-based assessments in the emergency department: perceptions of emergency medicine residents and assessors.","authors":"Kyung Hye Park, Young Taeck Oh, Ju Ok Park","doi":"10.15441/ceem.24.377","DOIUrl":"10.15441/ceem.24.377","url":null,"abstract":"<p><strong>Objective: </strong>Workplace-based assessment (WBA) plays a crucial role in assessing entrustable professional activities (EPAs) in the competency-based medical education era. This pilot study explored the perceptions of residents and assessors of two WBAs for three Korean Society of Emergency Medicine EPAs.</p><p><strong>Methods: </strong>Eight emergency medicine (EM) residents underwent WBAs, with mini-clinical evaluation exercises (mini-CEX) conducted by nine EM faculty members and multisource feedback (MSF) provided by two internal medicine faculty members and four emergency room nurses, for a total of 69 assessments. We conducted an anonymous online survey to gather feedback on experiences, perceptions, and recommendations for improving WBA, such as mini-CEX and MSF, with responses scored on a 5-point Likert scale.</p><p><strong>Results: </strong>Of the 23 initial participants, 15 (65.2%) responded, including 5 residents and 10 assessors. EM faculty viewed mini-CEX favorably, noting its strong integration of supervision and effectiveness in assessing resident performance. EM residents reported comfort issues during assessments, preferring immediate feedback and multiple assessors. MSF was generally perceived positively but showed discrepancies in the utilities of rating scales and feedback types, indicating potential areas for improvement.</p><p><strong>Conclusion: </strong>Two WBAs for three Korean Society of Emergency Medicine EPAs were found to be feasible and acceptable in the context of Korean EM residency training. However, perceptions varied between assessors and residents, necessitating clear communication about WBA objectives and processes. Our findings are useful for shaping future EPA-based training programs, balancing traditional and WBA methods, and enhancing feedback quality.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":"12 4","pages":"391-399"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound as a tool in prehospital settings: a scoping review.","authors":"Jose Luis Piñeros-Alvarez, Jose Daniel Yusty Prada, Esteban Portuguez","doi":"10.15441/ceem.24.374","DOIUrl":"10.15441/ceem.24.374","url":null,"abstract":"<p><p>Point-of-care ultrasound (POCUS) is a valuable tool in the prehospital management of critically ill patients, particularly patients with trauma, dyspnea, or shock. This review aims to evaluate the diagnostic and therapeutic applications, limitations, and implementation challenges of POCUS in prehospital care. Key findings are that ultrasound, particularly the extended Focused Assessment with Sonography in Trauma (eFAST) protocol, offers high specificity in identifying severe hemorrhage in trauma cases, although its sensitivity varies depending on the clinical context and operator experience. In dyspnea, pulmonary ultrasound significantly enhances diagnostic accuracy, aiding early detection of heart failure and other respiratory conditions. For shock, focused echocardiography facilitates rapid diagnosis and timely therapeutic decisions, improving patient outcomes. However, the effectiveness of POCUS is highly dependent on the operator's expertise, and challenges such as time, space, and resource limitations in prehospital settings may impact its use. Furthermore, local studies in Latin America assessing the impact of prehospital ultrasound on morbidity and mortality reduction are lacking. Based on our review, we recommend standardized training programs, increased availability of portable ultrasound devices, and prospective studies on cost-benefit analysis to optimize POCUS implementation in prehospital systems, particularly in resource-limited regions. Prehospital ultrasound has the potential to revolutionize patient care by improving diagnostic precision and reducing time to definitive treatment, but its successful implementation requires strategic integration of technology, education, and research.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"320-330"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12861705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}