Acute Medicine & Surgery最新文献

{"title":"Veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome caused by nitrogen dioxide inhalation: A case report","authors":"Tomoya Nishimura,&nbsp;Makoto Aoki,&nbsp;Hiroyuki Suzuki,&nbsp;Hiroya Hagiwara,&nbsp;Akira Kawauchi,&nbsp;Kenji Fujizuka,&nbsp;Mitsunobu Nakamura","doi":"10.1002/ams2.957","DOIUrl":"https://doi.org/10.1002/ams2.957","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nitrogen dioxide (NO₂) is known to cause lung injury, but there is no established treatment for acute respiratory distress syndrome (ARDS) caused by NO₂ inhalation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 35-year-old man was accidentally exposed to NO₂ fumes and presented to the emergency department. On admission, his oxygen saturation was 87% on ambient air and he was diagnosed with ARDS caused by NO₂ inhalation and immediately intubated; however, hypoxemia and hypercapnia were not ameliorated. Hence, veno-venous extracorporeal membrane oxygenation (V-V ECMO) was introduced and the ventilator settings were set for lung-protective ventilation. Methylprednisolone was also administered. After the initiation of these treatments, oxygenation gradually improved. Therefore, ECMO was weaned off on day 11 and he was extubated on day 12.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lung injury caused by NO₂ inhalation can cause ARDS, and lung-protective ventilation with V-V ECMO induction, as well as glucocorticoid administration, may be effective for this condition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.957","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140641848","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":"Emergency resuscitative thoracotomy in severe trauma: Analysis of the nation-wide registry data in Japan","authors":"Hiromu Okano,&nbsp;Takero Terayama,&nbsp;Hiroshi Okamoto,&nbsp;Tsutomu Yamazaki","doi":"10.1002/ams2.958","DOIUrl":"https://doi.org/10.1002/ams2.958","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Emergency resuscitative thoracotomy is a potentially lifesaving procedure for patients with cardiac pulmonary arrest and profound circulatory failure resulting from a severe injury. However, survival rate post-emergency resuscitative thoracotomy shows considerable variation, with many studies constrained by limited sample sizes and ambiguous criteria for inclusion. Herein, we assessed the outcomes of emergency resuscitative thoracotomy and identified predictors of futility using Japan Trauma Data Bank data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data of patients aged ≥18 years between 2004 and 2019 were analyzed. The primary outcome measure was survival at discharge. Descriptive statistics were used to compare the survivor and nonsurvivor groups. A multivariable logistic regression analysis was conducted to identify predictors of survival in patients undergoing emergency resuscitative thoracotomy while adjusting for confounding factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among patients who underwent emergency resuscitative thoracotomy, 684/5062 (13.5%) survived. Age &lt;65 years (adjusted odds ratio, 1.351; 95% confidence interval, 1.130–1.615; <i>p</i> &lt; 0.001), absence of cardiac pulmonary arrest on emergency department arrival (adjusted odds ratio, 1.694; 95% confidence interval, 1.280–2.243; <i>p</i> &lt; 0.01), Injury Severity Score &lt;16 (adjusted odds ratio, 2.195; 95% confidence interval, 1.611–2.992; <i>p</i> &lt; 0.01), and penetrating injury (adjusted odds ratio, 1.834; 95% confidence interval, 1.384–2.431; <i>p</i> &lt; 0.01) were identified as factors associated with survival at discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The survival rate for emergency resuscitative thoracotomy in Japan stands at approximately 13.5%. Factors contributing to survival include younger age, absence of cardiopulmonary arrest at emergency department arrival, lack of severe trauma, and sustaining penetrating injuries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.958","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140639649","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":"Survival of a hemodynamically unstable pediatric liver trauma patient with aortic balloon occlusion catheter during air transport: A case report","authors":"Yuichi Miyake,&nbsp;Yuko Okishio,&nbsp;Naoaki Shibata,&nbsp;Shuji Kawashima,&nbsp;Toru Nasu,&nbsp;Kentaro Ueda","doi":"10.1002/ams2.955","DOIUrl":"https://doi.org/10.1002/ams2.955","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The utility of resuscitative endovascular balloon occlusion of the aorta (REBOA) in children remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>An 11-year-old patient with liver trauma with massive extravasation was transported to a local hospital, where an emergency trauma surgery was unavailable. Following the placement of REBOA as a bridge to hemostasis, she was transferred to our hospital by a firefighting helicopter with balloon occlusion. Immediately, she underwent damage control laparotomy and transcatheter arterial embolization. She was subsequently discharged from the hospital 6 months after the accident without complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>REBOA as a bridge to hemostasis may be useful for pediatric patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.955","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140633763","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":"Usefulness of the Yokohama Advanced Cardiopulmonary Help Team in patients with acute respiratory distress syndrome","authors":"Shusuke Utada,&nbsp;Hayato Taniguchi,&nbsp;Hiroshi Honzawa,&nbsp;Tomoaki Takeda,&nbsp;Takeru Abe,&nbsp;Ichiro Takeuchi","doi":"10.1002/ams2.953","DOIUrl":"https://doi.org/10.1002/ams2.953","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate whether establishing an extracorporeal membrane oxygenation (ECMO) specialist team, termed the Yokohama Advanced Cardiopulmonary Help Team (YACHT), affected the outcomes and centralization of patients requiring ECMO in Yokohama-Yokosuka regions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study included patients aged ≥18 years and treated with venovenous-ECMO for severe acute respiratory distress syndrome (ARDS) from 2014 to 2023. The primary outcome was intensive care unit (ICU) mortality. The secondary outcomes included ICU-, mechanical ventilator-, and ECMO-free days and complications during the first 28 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 46 (12 without- and 34 with-YACHT) patients. Among with-YACHT patients, 24 were transferred to our hospital from other hospitals, 14 were assessed by dispatched ECMO physicians, and 9 were transferred after ECMO introduction. No without-YACHT patients were transferred from other hospitals. With-YACHT patients experienced coronavirus disease 2019-associated respiratory failure more frequently (0 vs. 27, <i>p</i> &lt; 0.001) and had higher Acute Physiology and Chronic Health Evaluation II scores (19 vs. 24, <i>p</i> = 0.037) and lower Respiratory Extracorporeal Membrane Oxygenation Survival Prediction scores (4 vs. 2, <i>p</i> = 0.021). ICU mortality was not significantly different between the groups (2 vs. 4, <i>p</i> = 0.67). ICU- (14 vs. 9, <i>p</i> = 0.10), ventilator- (11 vs. 5, <i>p</i> = 0.01), and ECMO-free days (20 vs. 14, <i>p</i> = 0.038) were higher before YACHT establishment. The incidences of complications were not significantly different between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Mortality was not significantly different pre- and post-YACHT establishment; however, it helped promote regionalization and centralization in Yokohama-Yokosuka areas. We will collect more cases to demonstrate YACHT's usefulness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.953","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140633789","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":"Three cases of neutralization of factor Xa inhibitors with andexanet alfa under rotational thromboelastography monitoring","authors":"Takeshi Yagi,&nbsp;Reina Kawano,&nbsp;Takuto Tomokage,&nbsp;Ryo Ayata,&nbsp;Yasutaka Koga,&nbsp;Kotaro Kaneda,&nbsp;Motoki Fujita,&nbsp;Nanami Yamanaka,&nbsp;Naomasa Mori,&nbsp;Ryosuke Tsuruta","doi":"10.1002/ams2.954","DOIUrl":"https://doi.org/10.1002/ams2.954","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Factor Xa inhibitors are direct oral anticoagulants that are extremely useful in clinical applications, safe, and do not require dose adjustment. It is desirable to be able to monitor their effects in the event of hemorrhagic complications requiring neutralization. However, it is difficult to monitor their activity and neutralization using conventional coagulation tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>We report three patients taking factor Xa inhibitors who underwent rotational thromboelastography (ROTEM) monitoring before and after neutralization with andexanet alfa. All three patients had hemorrhagic complications that required neutralization of their factor Xa inhibitors using andexanet alfa. One ROTEM parameter, the EXTEM clotting time (EXTEM-CT), was immediately shortened after andexanet alfa bolus administration, without subsequent extension of the EXTEM-CT assessed 4 h after the bolus dose.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ROTEM parameters, particularly EXTEM-CT, might be useful for monitoring neutralization of factor Xa inhibitors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.954","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140633762","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":"Secondary thrombotic microangiopathy with generalized purpura in a young woman","authors":"Tatsunori Nagamura,&nbsp;Soichiro Seno,&nbsp;Yasumasa Sekine,&nbsp;Tetsuro Kiyozumi","doi":"10.1002/ams2.949","DOIUrl":"https://doi.org/10.1002/ams2.949","url":null,"abstract":"<p>A 22-year-old woman with no previous medical history presented with shock and extensive purpura spots after a sudden rash on both upper limbs and trunk (Figure 1A–C). Blood tests revealed multiple organ failure, increased inflammatory response, and coagulation abnormalities. We started antibiotics for septic shock with purpura fulminans; however, pancytopenia with hemolytic anemia and renal failure worsened. We diagnosed thrombotic microangiopathy (TMA) including thrombotic thrombocytopenic purpura (TTP) and initiated plasma exchange (PE) on Day 3. Five PE rounds dramatically improved her condition; however, dry necrosis remained in both hands. We amputated the necrotic tissue 18 days after admission, from the distal end of the basal phalanx of the second to fifth finger. She was discharged on Day 60. The trunk healed without scarring; however, scars were left on the upper limbs (Figure 1D–F). Biopsy findings from the abdomen and left knee indicated TMA. Culture and immunological tests, including ADAMTS13 activity, were negative. She had fever, cold symptoms, and arthritis 2 days before admission, leading to viral infection-induced secondary TMA diagnosis. Secondary TMA rarely presents with extensive purpura, although its involvement in infection-related TMA is reported.<span>^{1, 2}</span> PE should be aggressively performed for secondary TMA, especially when caused by infection.</p><p>The authors declare no conflicts of interest.</p><p>Approval of the research protocol: None.</p><p>Informed consent: Informed consent was obtained from the patient and parents.</p><p>Registry and the registration no. of the study/trial: None.</p><p>Animal studies: None.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.949","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140633726","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 antithrombin administration for patients with sepsis: A systematic review, meta-analysis, and meta-regression","authors":"Takumi Tsuchida,&nbsp;Yuto Makino,&nbsp;Takeshi Wada,&nbsp;Noritaka Ushio,&nbsp;Takaaki Totoki,&nbsp;Naoki Fujie,&nbsp;Shunsuke Yasuo,&nbsp;Tadashi Matsuoka,&nbsp;Hiroyuki Koami,&nbsp;Kazuma Yamakawa,&nbsp;Toshiaki Iba","doi":"10.1002/ams2.950","DOIUrl":"https://doi.org/10.1002/ams2.950","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>There have been inconsistent reports regarding the effect of antithrombin on sepsis; furthermore, there are limited reports on how dosage affects therapeutic efficacy. Thus, we aimed to perform a systematic review and meta-analysis of the use of antithrombin for sepsis and a meta-regression analysis of antithrombin dosage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included randomized controlled trials (RCTs) and observational studies of adult patients with sepsis who received antithrombin. Outcomes included all-cause mortality and serious bleeding complications. Statistical analyses and data synthesis were performed using a random-effects model; further, meta-regression and funnel plots were used to explore heterogeneity and biases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven RCTs and six observational studies were included. Most patients in the RCTs and observational studies had severe sepsis and septic-disseminated intravascular coagulation (DIC), respectively. A meta-analysis using RCTs showed no significant differences in mortality between the antithrombin and control groups. However, the meta-analysis of observational studies indicated a trend of decreasing mortality rates with antithrombin administration (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.68–0.92; <i>p</i> = 0.002). Bleeding complications were significantly higher in the antithrombin group than in the control group in both study types (OR, 1.90; 95% CI, 1.52–2.37; <i>p</i> &lt; 0.01). The meta-regression analysis showed no correlation between antithrombin dosage and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A meta-analysis of RCTs confirmed no survival benefit of antithrombin, whereas that of observational studies, which mostly focused on septic DIC, showed a significant beneficial effect on improving outcomes. Indications of antithrombin should be considered based on its beneficial and harmful effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.950","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140606362","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":"Prognostic factors in mobility disability among elderly patients in the emergency department: A single-center retrospective study","authors":"Akiyoshi Nagatomi,&nbsp;Haruaki Wakatake,&nbsp;Yoshihiro Masui,&nbsp;Shigeki Fujitani","doi":"10.1002/ams2.951","DOIUrl":"https://doi.org/10.1002/ams2.951","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We aimed to evaluate the clinical characteristics and outcomes of elderly critically ill patients and identify prognostic factors for mobility disability at discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, retrospective cohort study investigated the period from April 2020 to January 2021. Patients ≥75 years old transferred to our emergency department and admitted to the intensive care unit (ICU) or intermediate unit in our hospital were eligible. Demographics, clinical characteristics, nutritional indicators, and nutritional screening scores were collected from chart reviews and analyzed. The primary outcome was the prevalence of mobility disability, compared to that of no mobility disability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 124 patients were included in this present study. Median age was 83.0 years (interquartile range [IQR], 79.8–87.0 years) and 48 patients (38.7%) were female. Fifty-two patients (41.9%) could not walk independently at discharge (mobility disability group). The remaining 72 patients were in the no mobility disability group. Multiple logistic regression analyses revealed clinical frailty scale (CFS) score ≥5 (odds ratio [OR] = 6.63, 95% confidence interval [CI] = 2.51–17.52, <i>p</i> &lt; 0.001), SOFA score ≥6 (OR = 6.11, 95% CI = 1.57–23.77, <i>p</i> = 0.009), and neurological disorder as the main cause on admission (OR = 4.48, 95% CI = 1.52–13.20, <i>p</i> = 0.006) were independent and significant prognostic factors for mobility disability at discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among elderly patients admitted to the emergency department, CFS ≥5, SOFA ≥6, and neurological disorders were associated with mobility disability at hospital discharge.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.951","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140606239","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":"Association between eGFR and neurological outcomes among patients with out-of-hospital cardiac arrest: A nationwide prospective study in Japan","authors":"Kenji Kandori,&nbsp;Asami Okada,&nbsp;Satoshi Nakajima,&nbsp;Tasuku Matsuyama,&nbsp;Tetsuhisa Kitamura,&nbsp;Hiromichi Narumiya,&nbsp;Ryoji Iizuka,&nbsp;Masahito Hitosugi,&nbsp;Yohei Okada","doi":"10.1002/ams2.952","DOIUrl":"https://doi.org/10.1002/ams2.952","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We aimed to investigate the association between estimated glomerular filtration rate and prognosis in out-of-hospital cardiac arrest patients and explore the heterogeneity of the association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients experiencing out-of-hospital cardiac arrest due to medical causes and registered in the JAAM-OHCA Registry between June 2014 and December 2019 were stratified into shockable rhythm, pulseless electrical activity, and asystole groups according to the cardiac rhythm at the scene. The primary outcome was a 1-month favorable neurological status. Adjusted odds ratios with 95% confidence intervals were calculated to investigate the association between estimated glomerular filtration rate and outcomes using a logistic model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 19,443 patients included, 2769 had initial shockable rhythm at the scene, 5339 had pulseless electrical activity, and 11,335 had asystole. As the estimated glomerular filtration rate decreased, the adjusted odds ratio for a 1-month favorable neurological status decreased among those with initial shockable rhythm (estimated glomerular filtration rate, adjusted odds ratio [95% CI]: 45–59 mL/min/1.73 m², 0.61 [0.47–0.79]; 30–44 mL/min/1.73 m², 0.45 [0.32–0.62]; 15–29 mL/min/1.73 m², 0.35 [0.20–0.63]; and &lt;15 mL/min/1.73 m², 0.14 [0.07–0.27]). Estimated glomerular filtration rate was associated with neurological outcomes in patients aged &lt;65 years with initial shockable rhythm but not in those aged &gt;65 years or patients with initial pulseless electrical activity or asystole.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The estimated glomerular filtration rate is associated with neurological prognosis in out-of-hospital cardiac arrest patients with initial shockable rhythm at the scene but not in those with initial non-shockable rhythm.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.952","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140606241","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":"Penetrating cardiac injury caused by multiple rib fractures following high-energy trauma: Usefulness of the exploratory video-assisted thoracoscopic surgery","authors":"Keisuke Tetsumoto,&nbsp;Masakazu Takayama,&nbsp;Tadaaki Koyama,&nbsp;Hidenao Kayawake,&nbsp;Masao Saito,&nbsp;Ken Nakamura,&nbsp;Yutaka Takahashi,&nbsp;Hiroshi Hamakawa","doi":"10.1002/ams2.938","DOIUrl":"https://doi.org/10.1002/ams2.938","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Penetrating cardiac injuries are usually fatal and associated with poor survival rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 69-year-old man was injured in a motor vehicle accident and suffered from left hemothorax and multiple rib fractures near the heart. A comprehensive assessment raised suspicions of lacerated pericardium and myocardial injury. Consequently, a thoracoscopy was performed 9 h after injury. A penetrating cardiac injury was detected and surgically treated via video-assisted thoracoscopic surgery. The patient recovered uneventfully and was discharged on postoperative day 16.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Exploratory video-assisted thoracoscopic surgery may play a key role in the primary diagnosis of patients with high-energy chest traumas with cardiac injury and simultaneously allow for the appropriate surgical interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.938","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140537792","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}