Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"title":"Risk factors for adverse incidents in patients during helicopter emergency medical services transports: a scoping review.","authors":"Changchang Chen, Kai Zhang, Zhenhua Liu, Tongjie Zhang, Jialu Li, Qian Yang, Ning Zha, Yiming Li, Huan Xu, Xuejun Hu, Hongjuan Lang","doi":"10.1186/s13049-026-01627-z","DOIUrl":"10.1186/s13049-026-01627-z","url":null,"abstract":"<p><strong>Introduction: </strong>Risk management is essential for maintaining the quality and safety of helicopter emergency medical services (HEMS) worldwide. The scarcity of consolidated evidence on HEMS-specific risk factors hinders effective early prevention and risk mitigation. This scoping review aimed to summarize and map current research progress on risk factors for adverse incidents in patients during HEMS transports.</p><p><strong>Methods: </strong>This review was performed following the PRISMA-ScR guidelines. Five electronic databases (PubMed, Web of Science Core Collection, ProQuest, CNKI, Wanfang Databases) were searched from January 1, 2006 to April 9, 2026. Studies in English or Chinese that focused on risk factors during HEMS were included. Two independent reviewers carried out study selection, quality assessment and data extraction.</p><p><strong>Results: </strong>A total of 48 peer-reviewed studies were included. The results revealed that risk factors varied across man, machine, environment, management (MMEM) system. Patient factors included baseline characteristics, disease-related characteristics, demand for medical interventions, and special patient populations. Crew factors encompassed operational execution, decision-making judgement, physiological and psychological factors, and team collaboration. Machinery factors comprised medical equipment and consumables, mission support and service systems, and aircraft platforms and airworthiness. Environment factors included natural environment factors, environment temporal characteristics, aircraft environment factors, and ground environment factors. Management factors involved system, procedure, culture, resource allocation, team management, and technical support.</p><p><strong>Conclusions: </strong>The findings highlighted the multifaceted risk factors during HEMS transports. This synthesis underscores that effective risk mitigation requires a systematic approach addressing patient, crew, machinery, environment, and management elements. Future efforts should focus on developing individualized, patient-centered risk assessments tailored to specific acute conditions. Enhancing preparedness in these key areas is crucial for the early prevention of adverse events and for ultimately improving the safety and quality of care for HEMS.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of optimal operator positioning on transcranial Doppler acquisition: a randomized controlled trial.","authors":"Théophile Vieux, Tatiana Randriamandimby, Roger Kadji Kalabang, Jérôme Bokobza, Rémi Girerd, Tomislav Petrovic, Frédéric Lapostolle","doi":"10.1186/s13049-026-01619-z","DOIUrl":"10.1186/s13049-026-01619-z","url":null,"abstract":"<p><strong>Background: </strong>Ergonomic conditions during ultrasound procedures may influence both acquisition time and image quality. In transcranial Doppler, positioning at the patient's head could improve operator comfort and performance. This study aimed to evaluate whether a standardized seated position at the patient's head enables faster acquisition of interpretable images and could improve image quality.</p><p><strong>Methods: </strong>We conducted a multicenter randomized controlled trial between August and December 2024 including emergency medicine residents without prior training in transcranial Doppler. Participants were randomized to either a free positioning group or a standardized seated position at the patient's head. Each participant performed bilateral acquisitions of the middle cerebral artery. Acquisition time was recorded, and image quality was assessed blindly by an expert panel using a semi-quantitative scale.</p><p><strong>Results: </strong>Forty-four residents were included, yielding 88 measurements (46 in the intervention group and 42 in the control group). Baseline characteristics were similar except for a higher number of validated semesters in the intervention group. Mean acquisition time was shorter in the intervention group (99.4 ± 47.1 s) than in the control group (121.7 ± 52.9 s), with a mean difference of 22.3 s (95% CI 1.2-43.3; p = 0.038). Image quality scores did not differ significantly between groups (16.6 ± 5.0 vs. 18.0 ± 5.0; mean difference - 1.4, 95% CI -3.5-0.7; p = 0.20).</p><p><strong>Conclusions: </strong>Standardized operator positioning at the patient's head was associated with faster acquisition of transcranial Doppler images, without a significant difference in image quality.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13371448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of emergency medical services volume on outcomes and management in prehospital traumatic cardiac arrest: a retrospective cohort study.","authors":"Baptiste Morcel, Youri Yordanov, Eric Mercier, Jean-Stéphane David, Tobias Gauss, Karim Tazarourte, Axel Benhamed","doi":"10.1186/s13049-026-01622-4","DOIUrl":"10.1186/s13049-026-01622-4","url":null,"abstract":"<p><strong>Background: </strong>While volume-outcome relationships for non-traumatic out-of-hospital cardiac arrest have been reported in hospital settings, the impact of prehospital exposure, particularly for the rare and clinically complex entity of traumatic cardiac arrest (TCA), remains uncertain and may influence emergency medical services (EMS) proficiency and survival. The study aimed to assess the relationship between exposure of emergency medical services to traumatic cardiac arrest cases and patients' survival.</p><p><strong>Methods: </strong>We conducted a multicentre retrospective cohort study using data from the French nationwide out of hospital cardiac arrest registry (RéAC) from July 2011 to March 2023. EMS volume was defined by the number of traumatic cardiac arrests managed by physician-staffed EMS per year of participation in the registry. The primary outcome was survival upon hospital admission. Secondary outcomes included return of spontaneous circulation (ROSC), 30-day survival, and 30-day survival with a favourable neurological outcome. We also investigated key prehospital management variables such as epinephrine administration, intubation, haemorrhage control procedures, fluid resuscitation, blood transfusion, thoracostomy, on-scene time and transport time. A multivariable mixed model was used to account for differences in baseline characteristics.</p><p><strong>Results: </strong>Among 151,658 out-of-hospital cardiac arrest, 6,263 were identified as TCA (age 45 years [IQR 29;63]; 77% male) treated across 175 EMS bases. EMS volume ranged from 0.02 to 3.28 TCA per year. No significant relationship was observed between EMS volume and survival to hospital admission (OR 1.00; 95% CI [0.99-1.01]; p = 0.7), as well as with ROSC (OR 1.00; 95% CI [0.99-1.01]; p > 0.9), 30-day survival (OR 1.01; 95% CI [0.98-1.05]; p = 0.4) or 30-day survival with favourable neurological outcome (OR 1.02; 95% CI [0.97-1.07]; p = 0.4). Similarly, no significant associations were observed in pre-hospital interventions or on-scene and transportation times.</p><p><strong>Conclusions: </strong>EMS activity was not associated with differences in outcomes or management for traumatic cardiac arrest. Its rarity and lethality may hinder the acquisition and maintenance of provider expertise, highlighting the importance of targeted training.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of freeze-dried plasma in a world of whole blood: a Canadian prehospital and transport perspective.","authors":"Michael Peddle, Jan Trojanowski, Brodie Nolan","doi":"10.1186/s13049-026-01629-x","DOIUrl":"10.1186/s13049-026-01629-x","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhage is the leading preventable cause of trauma death, and timely transfusion remains a major challenge in Canada, particularly in rural and remote regions where long transport times create \"blood deserts.\" Whole blood has re-emerged as the gold standard for resuscitation, but donor limitations, short shelf-life, and cold-chain requirements restrict its universal deployment.</p><p><strong>Role of freeze-dried plasma: </strong>Freeze-dried plasma (FDP) offers a complementary solution with unique advantages for Canadian prehospital and transport systems. FDP is pathogen-reduced, shelf-stable for up to two years at room temperature, lightweight, and rapidly reconstituted at the point of care. Evidence from military and civilian studies demonstrates its logistical feasibility and safety, particularly in settings with prolonged transport times. FDP has been successfully integrated into NATO and Canadian Armed Forces operations and is increasingly recognized internationally as a practical adjunct to whole blood. In Canada, heterogeneous access to prehospital transfusion, high wastage rates of thawed plasma, and the inequities faced by Indigenous and remote communities highlight the urgent need for alternative strategies.</p><p><strong>Conclusion: </strong>FDP and whole blood are not competing but rather they are complementary therapies in a prehospital transfusion system. FDP represents a scalable, equitable, and operationally feasible option to extend balanced resuscitation to patients in rural and remote Canada. A coordinated national strategy, including regulatory approval, pilot projects, and outcome evaluation through networks such as CAN-PATT, is essential to move FDP from battlefield innovation to civilian standard of care.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 Suppl 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13231581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway management skills and devices on Italian helicopter emergency medical service: a national survey.","authors":"Federico Crimaldi, Martina Pastore, Andrea Agarossi, Riccardo Stucchi, Riccardo Fiameni, Gabriele Perotti, Roberto Fumagalli, Alba Ripoll-Gallardo","doi":"10.1186/s13049-026-01625-1","DOIUrl":"10.1186/s13049-026-01625-1","url":null,"abstract":"<p><strong>Background: </strong>Airway management is a critical priority for HEMS teams, as failure to secure the airway remains a major determinant of mortality and long-term disability. The present study was designed to evaluate the variability of advanced airway management devices and medications availability across all HEMS units in Italy. In addition, crew composition and specialty training of HEMS personnel were assessed. As a whole, this survey aims at highlighting areas for improvement of airway management during HEMS operations.</p><p><strong>Methods: </strong>This observational cross-sectional study was carried out between May and September 2024. A web-based questionnaire was distributed to all active HEMS bases in Italy. The questionnaire consisted of two main sections: Section A addressed the availability of basic and advanced airway management equipment and medications, whereas Section B focused on crew characteristics, including number, role, experience, and training. A composite index to capture \"airway preparedness\" (API) was designed based on Difficult Airway Society 2025 guidelines. Selected items were assigned a weighted value and the final score ranged 0-40.</p><p><strong>Results: </strong>Of 55 active HEMS bases, 48 completed the questionnaire (response rate: 87%). Manual ventilation devices, a direct laryngoscope, a complete set of Macintosh adult blades, an end-tidal CO₂ monitoring device, and supraglottic airway devices were consistently available. A videolaryngoscope was present in most bases (39, 81%). Either surgical or Seldinger cricothyroidotomy kits were present in 94%. Medications for rapid sequence intubation were universally available, although sugammadex was stocked in only 36 bases (75%). A physician was present in all surveyed units (100%). However, specific training in airway management was not provided in 37 bases (77%), and 44% did not require a minimum number of prior endotracheal intubations for new personnel. Only 13 bases (27%) reported the adoption of airway management guidelines for prehospital care. The mean ± SD national API was 25.7 ± 7.4, ranging from a regional mean of 37 ± 1.4 to a regional mean of 11.2 ± 5.3.</p><p><strong>Conclusion: </strong>The study demonstrated substantial heterogeneity in equipment, personnel background, and training across Italian HEMS bases. Although only few bases reported adherence to specific guidelines, the devices and medications recommended in the literature for the management of unexpected difficult airways were widely available.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eye-related emergency calls and prehospital management in region Zealand, Danmark: a register-based cohort study.","authors":"Natalie Jensen, Stig Nikolaj Fasmer Blomberg, Torben Lykke Sørensen, Amalie Elisabeth Thiele-Nygaard, Thea Palsgaard Møller, Magnus Rafner, Astrid Merete Blomberg, Helle Collatz Christensen","doi":"10.1186/s13049-026-01618-0","DOIUrl":"10.1186/s13049-026-01618-0","url":null,"abstract":"<p><strong>Background: </strong>Eye-related symptoms ranging from mild irritation to acute vision loss can lead to emergency calls. While many cases are benign, others involve chemical exposures or trauma requiring urgent care to prevent permanent damage. Prehospital characteristics, dispatch categorization, and early management of eye-related emergencies remain unexplored. The aim of this study was to provide a systematic description of eye-related emergency calls, including patient characteristics, dispatch categorization, and prehospital management, within the framework of the Danish Index for Emergency Care.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of all emergency calls [1-1-2] in Region Zealand, Denmark, from November 2017 to June 2025, describing eye symptoms. We linked data from the Computer-Aided Dispatch (CAD) system, the Prehospital Patient Records (PPJ), and the Danish National Patient Registry (NPR). Patient demographics, paramedic assessment of primary problem, on-scene symptoms, prehospital treatments and hospital outcomes were analysed using descriptive statistics.</p><p><strong>Results: </strong>A total of 376 patients were identified calling 1-1-2 and registered with eye related symptoms as the main complaint. Of these, 36 (9.6%) were excluded due to missing patient identifiers or prehospital patient records, leaving 340 in the cohort. Median age was 49.5 years (IQR 29-68), and 62.1% were male. Most calls were categorized as priority B (urgent situation not assessed as acute life-threatening) (70.9%). The leading primary problems were chemical exposures (31.5%), vision loss (25.9%), and ocular trauma (18.2%). Vision disturbance (54.4%) was the most frequently prehospital reported symptom. Prehospital interventions were rarely documented, with irrigation being the most reported procedure (27.1%). Notably, 39 of 340 patients (11.5%) were suspected of stroke prehospitally, and among 283 admitted to hospital, 21 (7.4%) received a confirmed TIA or stroke diagnosis. The median length of stay was 3.7 h (IQR 2.0-7.7). Most frequent discharge diagnoses were injury of the eye and orbit (17.7%), burn and corrosion confined to eye and adnexa (9.9%), and foreign body on external eye (7.8%).</p><p><strong>Conclusion: </strong>Eye-related emergency calls were primarily caused by chemical exposures, vision loss, and trauma, with relatively short hospital stays. Several patients classified as eye-related problems were later diagnosed with stroke, highlighting the need for better dispatcher recognition of visual stroke symptoms.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Need-standardised comparisons are required before inferring sex and gender bias in major trauma care.","authors":"Pieter Fouche","doi":"10.1186/s13049-026-01624-2","DOIUrl":"10.1186/s13049-026-01624-2","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylaxis of opioid-induced nausea in helicopter emergency medical service: a prospective quasi-experimental study.","authors":"Jürgen Knapp, Robin Strohm, Markus Huber, Roland Albrecht, Urs Pietsch","doi":"10.1186/s13049-026-01626-0","DOIUrl":"10.1186/s13049-026-01626-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;In prehospital emergency medicine, opioids are usually used to treat acute traumatic pain. A common side effect of opioids is nausea. To prevent this, the prophylactic administration of 5-HT&lt;sub&gt;3&lt;/sub&gt; antagonists such as ondansetron has become established in clinical practice, even though there is currently no evidence to support its use. Aromatherapy is also used as an alternative non-pharmacological method for the treatment of nausea. We therefore investigated whether the prophylactic administration of ondansetron or prophylactic aromatherapy after opioid administration is beneficial to the patient.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients over the age of 16 who received opioid therapy due to acute traumatic pain by the crews of a total of six HEMS bases between February 2024 and April 2025 were prospectively included. Nausea prophylaxis after opioid-based pain therapy was performed according to a fixed rotating 7-day schedule: no nausea prophylaxis, medication-based nausea prophylaxis with ondansetron 4 mg intravenously, and aromatherapy-based nausea prophylaxis by inhalation of isopropanol. A nausea score was evaluated at the time of opioid administration and upon handover at the destination hospital, using a numeric rating scale (NRS) between 0 (no nausea) and 10 (maximum nausea). Primary endpoint was the change in NRS between the time before opioid administration and the time of patient handover at the emergency department. Secondary endpoints were incidence of moderate and severe nausea (defined as an NRS &gt; 3), the incidence of vomiting during prehospital patient care and need of rescue medication (ondansetron for therapeutic use).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 205 patients were included in the analysis. Eighty-six in the \"no prophylaxis\" group, 64 in the ondansetron group, and 55 in the aromatherapy group. We found a median change in NRS of 0 (interquartile range 0-0) points across all groups. An increase in NRS was observed in 15% of patients in the no prophylaxis group, 14% in the ondansetron group, and 15% in the aromatherapy group. An NRS &gt; 3 was observed in 14% of patients in the no prophylaxis group and in 11% of patients in both the ondansetron and aromatherapy groups. Vomiting occurred in 4% of patients in the no prophylaxis group, 2% in the ondansetron group, and in none of the aromatherapy group. Therapeutic administration of ondansetron was necessary in 4 patients in the \"no prophylaxis\" group and in one patient in the aromatherapy group. None of the patients experienced any improvement in nausea as a result, three of these patients from the \"no prophylaxis\" group vomited after ondansetron administration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Neither the prophylactic administration of ondansetron nor aromatherapy seem to be beneficial for the prevention of opioid-induced nausea in unselected patients in the setting of prehospital emergency medicine. Larger randomized controlled trials ","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of carotid artery Doppler ultrasound for resuscitation outcomes in patients with cardiac arrest.","authors":"Shuaishuai Zhou, Sa Wang, Shurong Xu, Jue Fang, Rui Zhang, Danping Yan, Yajie Liu, Meiling Wang, Yuwei Wang","doi":"10.1186/s13049-026-01620-6","DOIUrl":"10.1186/s13049-026-01620-6","url":null,"abstract":"<p><strong>Objective: </strong>Carotid artery Doppler ultrasound, as a non-invasive monitoring method, offers higher clinical utility during cardiopulmonary resuscitation (CPR) compared to invasive techniques. This study aimed to investigate the application of real-time carotid Doppler ultrasound in CPR patients and analyze the predictive efficacy of waveform-derived parameters for return of spontaneous circulation (ROSC).</p><p><strong>Methods: </strong>This prospective observational study consecutively enrolled adult patients who underwent CPR in the emergency department of a tertiary hospital in Zhejiang Province between March 2024 and March 2025. ROSC was defined as the first documented confirmation at a scheduled pulse/rhythm check, independent of Doppler findings. Patients were divided into ROSC and non-ROSC groups based on whether ROSC was obtained. Baseline characteristics and carotid Doppler parameters were analyzed to evaluate their prognostic value. Univariate analysis compared baseline characteristics, CPR data, and carotid Doppler parameters between groups. Receiver operating characteristic (ROC) curves were plotted to assess the predictive value of statistically significant indicators for ROSC.</p><p><strong>Results: </strong>Among 51 patients (23 in the ROSC group, 28 in the non-ROSC group). Significant differences were observed in carotid blood flow parameters between groups, including VTI、Vmax、Vmin、TAV、MD*、RI、dv.MAX (all P < 0.05). ROC analysis showed AUC values of 0.811 (VTI), 0.758 (Vmax), 0.727 (Vmin), 0.751 (cMD*) and 0.72 (dv.MAX), with optimal cutoffs of 18.8 87.1,19, 2318 and 8.75, respectively. Because ROSC was adjudicated at scheduled pulse/rhythm checks, the prespecified 60-second Doppler window before documented ROSC may have partially overlapped with spontaneous rather than purely compression-generated flow.</p><p><strong>Conclusion: </strong>Carotid Doppler parameters (VTI、Vmax、Vmin、TAV、MD*、RI、dv.MAX) significantly differ between ROSC and non-ROSC groups. These parameters may provide objective hemodynamic insights during CPR. However, these findings should be interpreted cautiously because the Doppler window preceding documented ROSC may have partially included ROSC-transition flow; therefore, the results are exploratory and require prospective multicenter validation.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Civilian penetrating traumatic brain injury in South-East Norway.","authors":"Mads Aarhus, Dag Ferner Netteland, Cathrine Tverdal, Vidar Stenset, Pål Rønning, Eirik Helseth","doi":"10.1186/s13049-026-01623-3","DOIUrl":"10.1186/s13049-026-01623-3","url":null,"abstract":"<p><strong>Background: </strong>Civilian penetrating traumatic brain injury (cpTBI) is a rare entity associated with severe and often devastating consequences. Guidelines recommend CT angiography (CTA), prophylactic antibiotics (AB) and antiseizure medication (ASM), early surgical revision with dural closure whenever feasible, and intracranial pressure (ICP)-guided therapy. The study aimed to investigate guideline compliance, as well as outcome after cpTBI for patients admitted to Oslo University Hospital (OUH).</p><p><strong>Methods: </strong>We identified and included cpTBI patients admitted to OUH between 2015 and 2023 through the Oslo TBI Registry - Neurosurgery. Guideline adherence was assessed and variables associated with 30-day mortality and Glasgow Outcome Scale (GOS) were examined using standard uni- and multivariable techniques.</p><p><strong>Results: </strong>The incidence of cpTBI was 1.9/1.000.000 with a 30-day mortality rate of 42.3%. Among the survivors, 70% achieved a favourable outcome (GOS 4 and 5) at 6 months. CTA was obtained at an acceptable rate (81%) in concordance with guidelines, but the guideline compliance for AB (12%) and ASM (29%) was substantially lower-than-expected. Surgery started within 12 h after injury in 58%, and ICP was monitored in 53.5% of patients with GCS < 9.</p><p><strong>Conclusions: </strong>Despite high mortality in cpTBI, most survivors achieved favourable outcome. We found a lower-than-expected guideline compliance for prophylactic AB and ASM, ICP monitoring, and surgical revision within 12 h. Thus, we identified several key factors that can improve cpTBI treatment at our institution. For patients considered potential survivors, management should be aggressive and aligned with established TBI treatment principles, including early vascular imaging with CTA, prompt wound debridement with dural closure, and prophylactic administration of AB and ASM.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}