American Journal of Emergency Medicine最新文献

{"title":"Relationship between cardiopulmonary resuscitation duration and outcomes in children with drowning-induced cardiac arrest.","authors":"Akira Komori, Hiroki Iriyama, Toshikazu Abe","doi":"10.1016/j.ajem.2024.11.004","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.11.004","url":null,"abstract":"<p><strong>Background: </strong>Due to the difficulty in making the decision to discontinue resuscitation efforts, clinicians often perform prolonged cardiopulmonary resuscitation (CPR) in children who have drowned. This study investigated the relationship between out-of-hospital CPR duration and neurological outcomes in children with drowning-induced cardiac arrest.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the All-Japan Utstein Registry from 2013 to 2021. We included patients aged ≤18 years with drowning-induced cardiac arrest who underwent CPR via emergency medical services. The study's primary outcome was a favorable neurological outcome (Cerebral Performance Category score of 1 or 2) at 1 month. We also calculated the dynamic proportion of 1-month outcomes as a function of out-of-hospital CPR duration. Moreover, we determined the sensitivity, specificity, and positive predictive value of 33 min of out-of-hospital CPR, which is the time point at which primary analysis showed a plateau in the neurological outcomes.</p><p><strong>Results: </strong>Of 14,849 children included in the registry, 992 cases of drowning-induced cardiac arrest were analyzed. The median out-of-hospital CPR duration was 20 (range, 2-164) min, with only 35 (3.5 %) patients showing favorable neurological outcomes at 1 month. The proportion of favorable neurological outcomes decreased rapidly for up to 33 min of out-of-hospital CPR and then plateaued to 0.3 %; only three patients achieved favorable neurological outcomes after 33 min of CPR. An out-of-hospital CPR duration of >33 min was associated with poor neurological outcomes (sensitivity, 0.17 [95 % confidence interval: 0.15-0.20]; specificity, 0.91 [0.77-0.98]; and positive predictive value, 0.98 [0.95-1.00]).</p><p><strong>Conclusions: </strong>Prehospital EMS-initiated CPR duration for children with drowning-induced cardiac arrest was inversely associated with one-month favorable neurological outcomes. Favorable neurological outcomes after >33 min of out-of-hospital CPR were extremely rare, though accurately predicting the outcome remains challenging.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's the optimal temperature control strategy in patients receiving ECPR after cardiac arrest? A network meta-analysis.","authors":"Jing Wang, Han Zhang, Tianlong Wang, Gang Liu, Yuan Teng, Jian Wang, Qiaoni Zhang, Shujie Yan, Bingyang Ji","doi":"10.1016/j.ajem.2024.11.001","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.11.001","url":null,"abstract":"<p><strong>Background: </strong>The optimal temperature control strategy in extracorporeal cardiopulmonary resuscitation (ECPR) patients is unknown, and several trials have reported conflicting results regarding its effectiveness. We aimed to conduct a systemic review and network meta-analysis (NMA) to assess the efficacy of temperature control in ECPR patients.</p><p><strong>Methods: </strong>Database searching of studies reporting data on temperature control strategy during ECPR in MEDLINE, EMBASE, Scopus, and Cochrane Library was performed. Primary outcomes were overall survival and neurological outcome. Pairwise meta-analysis and Bayesian NMA were performed on studies comparing outcomes among groups of moderate hypothermia (32-34 °C), mild hypothermia (34.1-36 °C) and normothermia (36.1-37.5 °C).</p><p><strong>Results: </strong>Nineteen retrospective studies were included (5622 patients). Statistically significant differences in good neurological outcome were observed in the direct comparison of moderate hypothermia and mild hypothermia (OR, 1.73; 95 % CI: 1.07-2.81) as well as moderate hypothermia and normothermia (OR, 2.14; 95 % CI: 1.24-3.67), but no significant differences were found in the NMA result. There was no difference in either survival outcome or the incidence of bleeding complications among any groups according to direct or indirect analysis.</p><p><strong>Conclusions: </strong>Direct evidence suggests that moderate hypothermia might be associated with improved neurological outcomes in ECPR patients. However, no significant differences in survival outcomes were observed in either the direct or NMA results. Given the lower level of the evidence, interpretation should be made with caution.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Info for authors","authors":"","doi":"10.1016/S0735-6757(24)00501-1","DOIUrl":"10.1016/S0735-6757(24)00501-1","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TOC","authors":"","doi":"10.1016/S0735-6757(24)00500-X","DOIUrl":"10.1016/S0735-6757(24)00500-X","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding the measurement of left atrial size as a predictor of severity of illness in sickle cell disease.","authors":"Ziyi He, Chenxi Wang, Huichuan Tian","doi":"10.1016/j.ajem.2024.10.039","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.039","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the cardiorespiratory safety of parenteral olanzapine and benzodiazepines to parenteral haloperidol/droperidol and benzodiazepines in emergency department patients","authors":"Katherine Bradley PharmD,&nbsp;Elizabeth A. Feldman PharmD,&nbsp;Joshua Schrader PharmD,&nbsp;Gregory Meola PharmD,&nbsp;Christopher D. Miller Pharm D,&nbsp;William Darko PharmD,&nbsp;Robert Seabury PharmD","doi":"10.1016/j.ajem.2024.10.044","DOIUrl":"10.1016/j.ajem.2024.10.044","url":null,"abstract":"<div><h3>Introduction</h3><div>This study sought to assess the cardiorespiratory safety of parenteral olanzapine and benzodiazepine combination treatment compared to parenteral droperidol or haloperidol and benzodiazepine combination treatment.</div></div><div><h3>Materials and methods</h3><div>This was a retrospective chart review conducted in adult emergency department patients who received intramuscular (IM) or intravenous (IV) droperidol, haloperidol, or olanzapine within one hour of IM or IV benzodiazepine. Patients were stratified into groups based on whether they received either olanzapine in combination with a benzodiazepine (<em>n</em> = 48) or droperidol or haloperidol in combination with a benzodiazepine (n = 48).</div></div><div><h3>Results</h3><div>Patients in each group had a decrease in their systolic blood pressure (SBP) after IM/IV olanzapine and IM/IV droperidol or haloperidol when used in combination with an IM/IV benzodiazepine ((Olanzapine + benzodiazepine (mmHg), median (IQR): Pre-SBP: 132 (117–151) vs. Post-SBP: 117 (99–131), <em>p</em> &lt; 0.01) (Droperidol or haloperidol + benzodiazepine (mmHg), median (IQR): Pre-SBP: 138 (122–149) vs. Post-SBP: 106 (98–127), <em>p</em> &lt; 0.01)). Both groups had similar percent SBP decreases post-combination treatment (Olanzapine + benzodiazepine (15.6 %) vs. Droperidol or haloperidol + benzodiazepine (15.2 %); <em>p</em> = 0.55). We did not observe any statistically significant between group differences for hypotension (Olanzapine + benzodiazepine: 1/48, 2.1 % vs. Droperidol or haloperidol + benzodiazepine: 3/48, 6.3 %; <em>p</em> = 0.62)), escalation in oxygen requirements (Olanzapine + benzodiazepine: 7/48, 14.6 %) vs. Droperidol or haloperidol + benzodiazepine: 5/48, 10.4 %; <em>p</em> = 0.76)), or intubation due to cardiorespiratory depression (Olanzapine + benzodiazepine: 0/0, 0 % vs. Droperidol or haloperidol + benzodiazepine: 0/0, 0 %; <em>p</em> = 1.00)).</div></div><div><h3>Conclusion</h3><div>This study found decreases in SBP after administering parenteral olanzapine and parenteral droperidol or haloperidol in combination with a parenteral benzodiazepine. The percent change in SBP and the frequency of hypotensive episodes post-combination treatment were not different between groups. There were also no differences between groups in need of increased oxygen requirements post-combination treatment or need for intubation due to cardiorespiratory depression. This study suggests parenteral olanzapine in combination with a parenteral benzodiazepine may have comparable cardiorespiratory safety versus parenteral droperidol or haloperidol in combination with a parenteral benzodiazepine when treating agitation in the adult ED.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prospective single-blinded randomized field-based trial to evaluate the prophylactic treatment of oral prochlorperazine for acute mountain sickness.","authors":"Kayla Vanderkooi, Peter Richman, Joshua White, Laura Sample, K Tom Xu, Michael Miller","doi":"10.1016/j.ajem.2024.10.048","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.048","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angioembolization for hemostasis in craniofacial fractures had a higher probability of delayed traumatic intracerebral hemorrhage.","authors":"Cheng-Yu Li, Shih-Ching Kang, Ching-Chang Chen, Po-Hsun Tu, Yu-San Tee, Chien-Hung Liao, Chi-Cheng Chuang, Chih-Yuan Fu","doi":"10.1016/j.ajem.2024.10.047","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.047","url":null,"abstract":"<p><strong>Introduction: </strong>While angioembolization is occasionally required for craniofacial fracture patients who experience massive maxillofacial hemorrhage, complications such as headache, temporal-facial pain, soft tissue necrosis, and embolic material migration leading to stroke or blindness can arise. Few studies have explored delayed or progressive intracerebral hemorrhage (ICH) following angioembolization for craniofacial fractures.</p><p><strong>Methods: </strong>A retrospective review of craniofacial fracture patients from January 1, 2015, to December 31, 2022 at our institution was conducted. We applied univariate and multivariable logistic regression (MLR) analyses to assess whether angioembolization served as an independent factor for delayed or progressive ICH. Propensity score matching (PSM) was used to balance the groups of patients who underwent angioembolization with those who did not. Outcome measurements included delayed or progressive ICH occurring within 72 hours, the need for additional neurosurgical interventions, and the length of stay (LOS) in the intensive care unit (ICU) and hospital.</p><p><strong>Results: </strong>Of the 2,519 craniofacial fracture patients studied over an 8-year period, 21 (0.8%) underwent angioembolization for maxillofacial hemorrhage. MLR analysis revealed that angioembolization was an independent factor for delayed or progressive ICH (odds ratio=5.71, p = 0.028). After 1:2 PSM, patients who underwent angioembolization had greater rates of delayed or progressive ICH (28.6% vs. 7.1%, p = 0.023), an extended hospital LOS (17.0 vs. 15.0 days, p = 0.009) and a longer ICU LOS (10.0 vs. 4.0 days, p = 0.004).</p><p><strong>Conclusions: </strong>A greater probability of delayed or progressive ICH was observed in craniofacial fracture patients who underwent angioembolization for maxillofacial hemostasis.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A high-flow nasal cannula versus noninvasive ventilation in acute exacerbations of chronic obstructive pulmonary disease","authors":"Oguzhan Haciosman,&nbsp;Huseyin Ergenc,&nbsp;Adem Az,&nbsp;Yunus Dogan,&nbsp;Ozgur Sogut","doi":"10.1016/j.ajem.2024.10.043","DOIUrl":"10.1016/j.ajem.2024.10.043","url":null,"abstract":"<div><h3>Purpose</h3><div>We investigated the efficacy and safety of a high-flow nasal cannula (HFNC) at different flow rates compared to noninvasive ventilation (NIV) in patients with acute chronic obstructive pulmonary disease (COPD) exacerbations.</div></div><div><h3>Methods</h3><div>This prospective, randomized, single-blind study assigned patients to one of three study groups. The NIV group (<em>n</em> = 47) received bilevel positive airway pressure. The HFNC-30 (<em>n</em> = 44) and HFNC-50 (<em>n</em> = 46) groups received HFNC therapy at flow rates of 30 and 50 L/min, respectively. Demographic and clinical characteristics and arterial blood gas parameters before and 30, 60, and 120 min after treatment were compared among the treatment groups.</div></div><div><h3>Results</h3><div>This study included 137 consecutive patients with acute exacerbations of COPD, comprising 90 males and 47 females, with a mean age of 68.1 ± 10.5 years. A total of 21 patients (15.33 %) were intubated, and the overall mortality rate was 10.2 %. The mean PaCO₂ levels on admission were 64.69 ± 10.81, 61.51 ± 9.03, and 62.29 ± 9.87 in the NIV, HFNC-30, and HFNC-50 groups, respectively, with no significant differences observed (<em>p</em> = 0.372). A significant reduction in mean PaCO₂ was observed in all treatment groups at 30, 60, and 120 min (<em>p</em> &lt; 0.05 for all). However, the ΔPaCO₂ at 60 min was significantly higher in the HFNC-30 group compared to the NIV group (<em>p</em> = 0.042). Additionally, neither intubation rates nor 28-day mortality differed among the treatment groups (<em>p</em> = 0.368 and <em>p</em> = 0.775, respectively).</div></div><div><h3>Conclusion</h3><div>HFNC was not inferior to NIV in improving arterial blood gas parameters, particularly PaCO₂ in patients with COPD exacerbations, especially those with hypercarbia. Moreover, HFNC at a flow rate of 30 L/min was superior to NIV for reducing PaCO₂ levels at 60 min.</div></div><div><h3>Trial Registry</h3><div>National Library of Medicine Clinical Trial Registry; No.: <span><span>NCT06495086</span><svg><path></path></svg></span>; URL: <span><span>https://clinicaltrials.gov/study/NCT06495086</span><svg><path></path></svg></span></div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal presentations in the pediatric emergency department: A decade-long retrospective analysis","authors":"Boone Rhinehart DO ,&nbsp;David Sheridan MD ,&nbsp;SunHee Chung MD ,&nbsp;Steven McGaughey MD","doi":"10.1016/j.ajem.2024.10.041","DOIUrl":"10.1016/j.ajem.2024.10.041","url":null,"abstract":"<div><h3>Background</h3><div>The global increase in neonatal visits to Pediatric Emergency Departments (PEDs) underscores the need to better understand the factors driving these visits and their implications. The often vague and nonspecific symptoms of neonates pose significant challenges for clinicians and caregivers in determining the appropriate level of care, impacting the frequency of return visits and overall effectiveness of discharge education.</div></div><div><h3>Objective</h3><div>This study aims to compile the most common chief complaints of neonates in the PED and analyze their association with admission rates and final ED diagnoses to inform educational interventions for caregivers and medical personnel.</div></div><div><h3>Methods</h3><div>This was a retrospective review of data from medical records from neonatal (≤30 days of life) presentations to the PED at a quaternary care medical center in Portland, Oregon, USA from January 2012 to December 2022.</div></div><div><h3>Results</h3><div>3175 patient encounters were identified, of which one-third (38 %) were admitted to the hospital. Certain complaints had higher admission rates than the average: temperature instability (71 % for “fever” and 89 % for “hypothermia”), breast concerns (68 %), abnormal lab results (63 %), “seizures” (53 %), and cardiac concerns (54 %). Notably, neonates presented on DOL 0 and DOL 1 had elevated admission rates of 77 % and 66 %, respectively.</div></div><div><h3>Conclusion</h3><div>This study identified specific complaints that were most likely to result in hospital admissions and return visits to the ED. This can guide targeted educational interventions for caregivers and ED providers and refinement of triage protocols to ensure that neonates receive the most appropriate and efficient care.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}