Journal of Emergencies, Trauma, and Shock最新文献

Introduction: Acute blood loss and uncontrolled hemorrhage in trauma require quick identification and action to restore circulating volume and save the patient. These patients have the opportunity to receive massive transfusion (MT) to reduce mortality rates and avoid overtransfusion using a suitable ratio of blood components. This study aims to systematically review and analyze the predictive factors for the activation of MT protocol (MTP) in trauma patients, which is critical for improving clinical decision-making and patient outcomes.

Methods: PubMed, ScienceDirect, Cochrane, and other sources were searched for articles from 2007 to 2020. Conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, this systematic review included original studies published in English, involving trauma patients aged 15 years or older who received MTP. The risk of bias (RoB) was assessed using the RoB in Nonrandomized Studies of Interventions-I and RoB 2 tools, and statistical analysis was performed, focusing on the homogeneity of effect sizes across trials.

Results: The articles search identified a total of 424 studies. Nine studies met all inclusion criteria. The most common predictors were age, sex, systolic blood pressure (SBP), heart rate (HR), hemoglobin (Hb) levels, international normalized ratio (INR), base excess (BE), and lactate levels. The analysis showed that parameters such as SBP, HR, Hb, INR, BE, and lactate were significantly associated with the activation of MTP. However, age and sex were not significant predictors. The survival rate was notably lower in the MTP group compared to the non-MTP group. There was no evidence of publication bias.

Conclusion: Several physiological parameters: low SBP, elevated HR, reduced Hb, increased INR, diminished BE, and elevated lactate are significantly correlated with an increased likelihood of necessitating MTP in trauma patients. Among those who received MTP, the survival rate was lower compared to the non-MTP group.

Introduction: Cardiopulmonary resuscitation (CPR) is an important lifesaving technique that must taught to everyone. As most cardiac arrests occur outside of the hospital, training the general population in the recognition of cardiac arrest and performing high-quality CPR is vital. Thus, this study aimed to compare the chest compression quality data (rate, depth, and fraction) with and without the use of feedback devices during CPR.

Methods: A crossover observational study was carried out at a tertiary hospital in September 2021. Five hundred and seventeen 1^st-year university students were recruited, and the response rate was 90% (465). A feedback device was used to collect data. The data were numerically coded and statistical software (SPSS 21) was used to perform descriptive and inferential statistical analysis, including a paired t-test.

Results: The mean compression rate with feedback was statistically significantly lower after performing one cycle of CPR (mean difference: -5.610; 95% confidence interval [CI]= -7.987--3.233; P < 0.001), the difference between mean compression depth with and without feedback was not statistically significant (mean difference: = -0.006; 95% CI = -0.190-0.177; P = 0.944), and the mean compression target (%) with feedback was statistically significantly higher (mean difference: -15.951; 95% CI = -17.894--14.009; P < 0.001).

Conclusions: We found that the use of feedback devices during layperson-simulated CPR scenarios significantly improved the quality of chest compression in terms of depth and rate and resulted in more guidelines adherence. Moreover, national programs for CPR education should be implemented.

Acute subdural hematoma (ASDH) is a type of intracranial hemorrhage and is due to the collection of blood below the inner layer of the dura but external to the brain and arachnoid membrane. It tends to occur in the temporal parietal regions. Early intervention is the key for better outcome of the patient. Management depends on neurological status and imaging. Large SDH collects along the convexity of the brain causing compression over the brain stem with midline shift. In cases of conservatively managed ASDH, spontaneous resolution usually takes weeks to months depending on the size of the bleed. In rare cases, spontaneous rapid resolution of the SDH occurs. So here, we are presenting an 11-month-old baby girl who was brought to our Emergency room/department (ER) with a history of fall and computed tomography scan was suggestion of an ASDH in the left temporoparietal region which resolves on its own in 6 h which is a rare phenomenon and needs to be highlighted.

[This corrects the article on p. 129 in vol. 17.].

Introduction: While rare, popliteal artery injury is a potentially devastating complication of knee trauma. Delayed diagnosis or inadequate management of popliteal artery injury can result in limb ischemia, amputation, and long-term disability. This study aimed to compare the treatment outcomes of popliteal artery injury between different medical centers and to reconsider the optimal protocol at our institution.

Methods: Medical records of patients sustaining traumatic popliteal artery injury from 2011 to 2022 at two institutions (one hospital: Group A; the other hospital: Group B) were retrospectively reviewed. Demographic data, radiological assessment, time course and content of initial treatment, clinical outcomes, and follow-up period were recorded.

Results: Group A included seven patients (dislocations, n = 3; fractures, n = 2; and glass penetration injuries, n = 2), with a mean follow-up period of 39 months. Group B included five patients (dislocations, n = 3 and fractures, n = 2), with a mean follow-up period of 36 months. Two patients in Group A and four patients in Group B exhibited contrast-medium resumption (average deficit: 57 mm and 60 mm, respectively). The time from injury to reperfusion was significantly shorter in Group A than in Group B (300 min vs. 749 min, P < 0.05). Group A underwent four temporary vascular shunting procedures, four external fixations, six fasciotomies, and five bypass grafting procedures. In Group B, temporary vascular shunt (TVS) was not used in any patient; however, three, two, and three patients underwent external fixation, fasciotomy, and bypass grafting, respectively. One patient in each group required above-the-knee amputation. The mean Lysholm score was 80.4 points in Group A and 72.0 points in Group B.

Conclusions: TVS considerably reduces the reperfusion time. Various options for the content and sequence of treatment must be carefully considered in advance. Early diagnosis, prompt intervention, and comprehensive management can improve the quality of care and patient outcomes.

[This corrects the article on p. 84 in vol. 17, PMID: 39070866.].

Introduction: Hemorrhagic shock demands swift intervention. Management involves the rapid infusion of blood products to restore circulation and uphold tissue perfusion. The aim of this study was to evaluate the effectiveness of prehospital plasma administration in trauma patients, comparing outcomes with normal saline. This was a meta-analysis of randomized controlled trials.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, searches were conducted in PubMed, MEDLINE, and the Cochrane Central Register of Controlled Trials from August 1, 2018, to April 4, 2023. The PubMed search string included terms related to blood plasma, prehospital care, emergency medical services, and hemorrhagic shock: (Blood Plasma [MeSH Terms] OR fresh frozen plasma [MeSH Terms] OR plasma OR fresh frozen plasma OR FFP) AND (Prehospital OR emergency care, prehospital [MeSH Terms] OR prehospital emergency care [MeSH Terms] OR prehospital OR prehospital OR EMS OR emergency medical service [MeSH Terms]) AND (hemorrhagic shock [MeSH Terms] OR hemorrhage OR hemorrhage OR hemorrhagic shock OR hemorrhagic shock). Results from the trials were pooled using a random effects model, presented as risk ratios with 95% confidence intervals.

Results: In the analysis of 760 patients from three studies, outcomes included mortality at 24 h and 28 days, multi-organ failure (MOF), acute lung injury, and vasopressor use within 24 h. Patients were divided into plasma (363) and normal saline (397) groups.

Conclusion: There is no distinction between prehospital plasma administration and normal saline concerning mortality at 24 and 28 days or the need for vasopressors within 24 h. Moreover, plasma administration did not appear to influence rates of acute lung injury or MOF.