World journal of emergency medicine最新文献

Background: Oxygen supply is a common procedure performed by emergency medical services (EMS); however, whether prehospital oxygen or fraction of inspired oxygen (FiO₂) therapy predict mortality has not been studied to date. This study aims to determine mortality associated with oxygen therapy in unselected patients with acute disease who underwent prehospital care.

Methods: This was a prospective, observational, cohort, multicenter, EMS-delivery, ambulance-based study. Adults with unselected acute disease who were managed by EMS and evacuated with high priority to the emergency department of four hospitals in three Spanish provinces. Epidemiological variables, on-scene vital signs, and prehospital blood analysis data were collected. The primary outcome was short- (2-, 7-, and 30-day), medium- (90- and 180-day), and long-term (365-day) all-cause cumulative mortality. The samples were a priori split according to thresholds of their received FiO₂(FiO₂=0.21, that is without oxygen therapy; FiO₂ between 0.22 and 0.49; and FiO₂≥0.5). The categorical variables FiO₂, epidemiological variables, vital signs, prehospital point-of-care testing (POCT) and patient outcomes were fitted with a logistic regression model. Additionally, a propensity score matching and a survival analysis were used.

Results: The final sample included 7,494 patients, 70.3% of whom did not receive oxygen therapy, 15% with a FiO₂ between 0.22 and 0.49, and 14.7% with a FiO₂≥0.5. The 2-day mortality was 0.4%, 5.3%, and 22.9% respectively (P<0.001). The 365-day mortality was 9.9%, 33.1%, and 50.5% respectively (P<0.001). Finally, the FiO₂ predictive capacities 2-,30-, and 365-day mortality were AUC=0.870 (95%CI: 0.840-0.899), 0.810 (95%CI: 0.784-0.837), 0.704 (95%CI: 0.679-0.728), respectively.

Conclusion: Prehospital oxygen therapy by thresholds of FiO₂ was linked to death and allowed mortality prediction. This finding could provide an aid for EMS providers, allowing to assess more individualized patient risk.

Background: Acute kidney injury (AKI) is a severe and fatal complication of acute heart failure (AHF). Existing studies on AKI following AHF in the Chinese population have scarce insights available from the emergency department (ED). This study aimed to investigate the predictive factors of patients with AHF complicated with AKI in a Chinese ED cohort, and to establish a risk prediction model.

Methods: Hospitalized patients diagnosed with AHF in the ED from December 2016 to September 2023 were included. The overall dataset were divided into the training set and the testing set at a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for AKI in patients with AHF in the training set, leading to the development of a risk prediction model. The performance of the model was further assessed.

Results: A total of 789 patients with AHF were enrolled, with an AKI incidence of 29.7%. The mortality rates of the AKI and non-AKI groups were 23.1% and 7.6%, respectively. Logistic regression analysis showed that the levels of white blood cell (OR=2.368; 95%CI: 1.502-3.733, P<0.001), albumin (OR=2.669; 95%CI: 1.601-4.451, P<0.001), serum creatinine (OR=3.221; 95%CI: 1.935-5.363, P<0.001), and hemoglobin (OR=2.009; 95%CI: 1.259-3.205, P=0.003), maximum 24-h furosemide dosage (OR=2.196; 95%CI: 1.346-3.582, P=0.002), the use of non-invasive ventilation (OR=2.419; 95%CI: 1.454-4.024, P=0.001), and diabetes mellitus (OR=3.192; 95%CI: 2.014-5.059, P<0.001) were independent risk factors for AKI after AHF. These factors were subsequently incorporated into a risk prediction model. The area under the receiver operating characteristic (AUROC) curve for the predictive model was 0.815 (95%CI: 0.776-0.854) and 0.802 (95%CI: 0.776-0.854) in the training set and the testing set, respectively.

Conclusion: This risk prediction model might assist physician to predict AKI following AHF effectively in the emergency setting.

Background: In this study, we aimed to evaluate the impact of mechanical ventilator (MV) utilizaton during cardiopulmonary resuscitation (CPR) on out-of-hospital cardiac arrest (OHCA) patient clinical outcomes in the emergency department.

Methods: This single-centered, retrospective, case-control study analyzed electronic medical records. Patients aged >18 years with non-traumatic OHCA who were treated at an emergency medical center between January 2019 and December 2023 were included. These patients were accessed according to the ventilatory method used: MV ventilation (volume control, tidal volume 6-8 mL/kg, frequency 10 beat per minute, inspiratory time 1 s) and manual resuscitator bag valve (BV) ventilation. The primary outcome was the return of spontaneous circulation (ROSC). After 1:1 propensity score matching, the clinical outcomes were analyzed.

Results: A total of 649 patients were enrolled in this study. Before matching, the clinical outcomes and pneumothorax incidence did not differ between the MV and BV groups. After 1:1 matching between the two groups using propensity scores, 522 patients (261 MV and 261 BV) were analyzed. Propensity score matching yielded an adequate balance (standardized mean difference <0.10) for all covariates. The estimated odds ratio (OR) for ROSC was 1.23 (95% confidence interval [CI]: 0.85-1.77; P=0.267), for survival at hospital admission was 1.02 (95%CI: 0.68-1.53; P=0.918), for survival at hospital discharge was 2.31 (95%CI: 1.10-5.20; P=0.033), and for good neurologic outcome was 2.56 (95%CI: 0.84-9.43; P= 0.116).

Conclusion: In patients with OHCA admitted to the emergency department, MV ventilation during CPR showed clinical outcomes similar to those of BV ventilation in most measures. However, survival at hospital discharge was significantly higher in the MV group, suggesting potential benefits of MV use in selected patients.

Background: The lack of a stable, easy-to-operate animal model for severe trauma has hindered the research progress. The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of severe trauma, providing a reliable research tool.

Methods: Male C57BL/6J mice (aged 8-10 weeks and weighting approximately 20 g) were used to establish the severe trauma model. Under anesthesia, a midshaft femoral fracture was created and packed with sterile cotton. A midline incision was made from the inguinal region to the sternum, exposing the abdominal organs for 30 min. The right femoral artery was cannulated to induce controlled blood loss at 30%, 35%, 40%, and 50% of the total blood volume. Survival rates were monitored for 24 h post-induction. In the mice that experienced 30% blood loss, the mean arterial pressure, body temperature, blood gas parameters, peripheral blood inflammatory markers, and major organ pathological changes were assessed.

Results: Mice with femoral fractures, soft tissue injuries, abdominal organ exposure, and 30% blood loss exhibited stable survival rates. Increased blood loss significantly reduced survival rates. Mean arterial pressure decreased initially, recovering within 0-15 min and returning to baseline by 50 min. Similarly, the body temperature decreased initially and gradually recovered to baseline within 50 min. Levels of peripheral blood inflammatory markers remained elevated for 12 h post-injury. Distant organs, including intestines, lungs, liver, spleen and kidneys, displayed varying degrees of injury.

Conclusion: The established mouse model replicates the pathophysiological responses to severe trauma, indicating stability and reproducibility, which could be an useful tool for further trauma research.