European Journal of Emergency Medicine最新文献

Background and importance: Following the return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA), a low body temperature on arrival at the hospital and on admission to the ICU is reportedly associated with increased mortality. Whether this association exists in the prehospital setting, however, is unknown.

Objective: The objective of this study was to investigate whether the initial, prehospital core temperature measured post-ROSC is independently associated with survival to hospital discharge in adult patients following OHCA.

Design, setting and participants: This retrospective observational study was conducted at East Anglian Air Ambulance, a physician-paramedic staffed Helicopter Emergency Medical Service in the East of England, UK. Adult OHCA patients attended by East Anglian Air Ambulance from 1 February 2015 to 30 June 2023, who had post-ROSC oesophageal temperature measurements were included.

Outcome measure and analysis: The primary outcome measure was survival to hospital discharge. Core temperature was defined as the first oesophageal temperature recorded following ROSC. Multivariable logistic regression evaluated the adjusted association between core temperature and survival to hospital discharge.

Main results: Resuscitation was attempted in 3990 OHCA patients during the study period, of which 552 patients were included in the final analysis. The mean age was 61 years, and 402 (72.8%) patients were male. Among them, 194 (35.1%) survived to hospital discharge. The mean core temperature was lower in nonsurvivors compared with those who survived hospital discharge; 34.6 and 35.2 °C, respectively (mean difference, -0.66; 95% CI, -0.87 to -0.44; P  < 0.001). The adjusted odds ratio for survival was 1.41 (95% CI, 1.09-1.83; P  = 0.01) for every 1.0 °C increase in core temperature between 32.5 and 36.9 °C.

Conclusion: In adult patients with ROSC following OHCA, early prehospital core temperature is independently associated with survival to hospital discharge.

Background: Noncompressible truncal hemorrhage is a major contributor to preventable deaths in trauma patients and, despite advances in emergency care, still poses a big challenge.

Objectives: This study aimed to assess the clinical efficacy of trauma resuscitation care incorporating Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) compared to standard care for managing uncontrolled torso or lower body hemorrhage.

Methods: This study utilized a target trial design with a matched case-control methodology, emulating randomized 1 : 1 allocation for patients receiving trauma resuscitation care with or without the use of REBOA. The study was conducted at a high-volume trauma center in Southern Austria, including trauma patients treated between January 2019 and October 2023, aged 16 and above, with suspected severe non-compressible torso hemorrhage. The primary outcome was 30-day in-hospital mortality. Secondary outcomes were in-hospital mortality rates at 3, 6, 24 h, and 90 days, need for damage control procedures, time to these procedures, computed tomography (CT) scan rates during resuscitation, complications, length of intensive care and in-hospital stay, and causes of death.

Results: Median age was 55 [interquartile range (IQR) 42-64] years. Median total injury severity, assessed by Injury Severity Score, was 46.5 (IQR: 43-57). There was no significant difference in 30-day in-hospital mortality between groups [9/11 (41%) vs. 9/11 (41%), odds ratio: 1.00, 95% confidence interval (CI): 0.3-3.36, P > 0.999]. Lower mortality rates within 3, 6, and 24 h were observed in the REBOA group; in a Cox proportional hazards model, hazard ratio (95% CI) for mortality in the REBOA group was 0.87 (0.35-2.15). Timing to damage control procedures did not significantly differ between groups, although patients in the REBOA group underwent significantly more CT scans. Bleeding was cited as the main cause of death less frequently in the REBOA group.

Conclusion: In severely injured patients presenting with possible major non-compressible torso hemorrhage, a systematically implemented resuscitation strategy including REBOA during the initial hospital phase, is not associated with significant changes in mortality.

Background and importance: Out-of-hospital cardiac arrest (OHCA) poses major public health issues. Pre-arrest heart function is a prognostic factor, but the specific contribution of pre-arrest echocardiographic evaluation in predicting OHCA outcome remains limited.

Objective: The primary objective was to investigate the association between left ventricular ejection fraction (LVEF) measured in echocardiography prior to OHCA and survival to hospital discharge.

Design, settings, and participants: This multicenter retrospective cohort study analyzed data from the National Taiwan University Hospital and its affiliated hospitals. We included adult nontraumatic OHCA patients who were treated by the emergency medical services (EMS) and underwent echocardiography within 6 months prior to the OHCA event from January 2016 to December 2022. Data included demographics, preexisting diseases, resuscitation events, and echocardiographic reports.

Outcomes measure and analysis: The primary outcome was the survival to hospital discharge after post-arrest care. Statistical analysis involved multivariable logistic regression to modify potential confounders, reported as adjusted odds ratio (aOR) and 95% confidence interval (CI), and evaluate the association between echocardiographic findings and survival to hospital discharge.

Main results: This study analyzed 950 patients, with 33.6% surviving to discharge. A higher pre-arrest LVEF was independently associated with increased survival. Compared to patients with LVEF < 40%, those with LVEF between 40% and 60% had significantly higher odds of survival (aOR = 3.68, 95% CI = 2.14-6.35, P < 0.001), and those with LVEF > 60% had even greater odds of survival (aOR = 5.46, 95% CI = 3.09-9.66, P < 0.001). There was also an association between lower tricuspid regurgitation pressure gradient and survival (aOR = 0.98, 95% CI = 0.97-1.00, P = 0.015). Younger age, male gender, dyslipidemia, stroke, cancer, witnessed arrest, initial shockable rhythm, and shorter low-flow time are other significant predictors of survival.

Conclusion: In adult, nontraumatic, EMS-treated OHCA patients, a higher LVEF 6 months prior to OHCA was associated with improved survival at hospital discharge.