Pub Date : 2024-06-14DOI: 10.3389/femer.2024.1374291
A. Papanikolaou, D. Chlorogiannis, A. Apostolos, Theodoros Mavridis, G. Tsigkas
Cardiogenic Shock represents a life-threatening condition characterized by high mortality and a spectrum of clinical presentations, complicating ~5%−10% of patients presenting with Acute Coronary Syndromes. Despite advances in interventional cardiology and emergency medicine, mortality rates remain extremely high and evidence concerning its management is scarce. Consequently, the decision making relies heavily on a single operator's experience. This comprehensive review aims to provide a thorough update on the latest proof regarding mechanical circulatory support devices of the left ventricle and examines the role of the classification scores on the selection of the appropriate patient and timing for the initiation of the device. The five necessary steps to a successful mechanical circulatory support device's insertion. The picture was made by Pixlr AI Image Generator.
心源性休克是一种危及生命的疾病，其特点是死亡率高，临床表现多种多样，约有 5%-10% 的急性冠状动脉综合征患者会并发心源性休克。尽管介入心脏病学和急诊医学取得了进步，但死亡率仍然极高，有关其治疗的证据也很少。因此，决策在很大程度上依赖于单个操作者的经验。本综述旨在全面更新有关左心室机械循环支持装置的最新证据，并探讨分类评分对选择合适患者和启动装置时机的作用。成功植入机械循环支持装置的五个必要步骤。图片由 Pixlr AI 图像生成器制作。
{"title":"Advances and challenges in mechanical support for cardiogenic shock complicating acute myocardial infarct: a comprehensive review of the latest data","authors":"A. Papanikolaou, D. Chlorogiannis, A. Apostolos, Theodoros Mavridis, G. Tsigkas","doi":"10.3389/femer.2024.1374291","DOIUrl":"https://doi.org/10.3389/femer.2024.1374291","url":null,"abstract":"Cardiogenic Shock represents a life-threatening condition characterized by high mortality and a spectrum of clinical presentations, complicating ~5%−10% of patients presenting with Acute Coronary Syndromes. Despite advances in interventional cardiology and emergency medicine, mortality rates remain extremely high and evidence concerning its management is scarce. Consequently, the decision making relies heavily on a single operator's experience. This comprehensive review aims to provide a thorough update on the latest proof regarding mechanical circulatory support devices of the left ventricle and examines the role of the classification scores on the selection of the appropriate patient and timing for the initiation of the device. The five necessary steps to a successful mechanical circulatory support device's insertion. The picture was made by Pixlr AI Image Generator.","PeriodicalId":502453,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":"14 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141341388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Early rehabilitation during disasters such as earthquakes is an important but often undervalued responsibility of medical teams. Both the development of simple tools for assessing the life functioning of evacuees and the standardization of intervention methods are urgent issues in disaster rehabilitation. The Japanese Rehabilitation Assistance Team (JRAT), an officially recognized organization consisting of 10 suborganisations, was established after gaining important experience with disaster rehabilitation in the aftermath of the Great East Japan Earthquake. We, the Hiroshima JRAT, were dispatched to the Monzen area of Wajima City to support disaster recovery after the 2024 Noto Peninsula Earthquake. Since disaster rehabilitation assistance was not well established in the Monzen area of Wajima City, the medical team consulted JRAT for guidance on triaging evacuees based on their life functioning. We developed a rehabilitation triage algorithm that classifies evacuees into four triage tags based on their ability to perform three simple movements: sitting up, standing up from the floor, and one-leg standing. In our triage algorithm, an inability to sit up is classified as a red tag (difficulty living in a shelter without assistance), an inability to stand up from the floor is classified as a yellow tag (individual intervention: introduction of beds and handrails), one-leg standing for < 2 s is classified as a green tag (group intervention: installation of toilets and bath rails and use of walkers to prevent falls), and standing on one leg for more than 2 s is classified as a white tag (independent in ADLs). We worked with medical teams to triage 922 evacuees in 27 evacuation centers, resulting in the extraction of four red and eight yellow evacuees in 1 day. Our rehabilitation triage system has the potential to be a simple assessment tool for classifying the life functioning of disaster victims and linking them to appropriate supports.
{"title":"Development and implementation of a rehabilitation triage algorithm for disasters in the subacute phase: an experience from the 2024 Noto peninsula earthquake","authors":"Shigehito Shiota, Naoya Orita, Yuma Tsubakita, Masaya Ichimoto, Noboru Shimada, Naoya Goto, Tomohiro Hirota, Shunsuke Taito, Kazuhiko Hirata, Yukio Mikami","doi":"10.3389/femer.2024.1387704","DOIUrl":"https://doi.org/10.3389/femer.2024.1387704","url":null,"abstract":"Early rehabilitation during disasters such as earthquakes is an important but often undervalued responsibility of medical teams. Both the development of simple tools for assessing the life functioning of evacuees and the standardization of intervention methods are urgent issues in disaster rehabilitation. The Japanese Rehabilitation Assistance Team (JRAT), an officially recognized organization consisting of 10 suborganisations, was established after gaining important experience with disaster rehabilitation in the aftermath of the Great East Japan Earthquake. We, the Hiroshima JRAT, were dispatched to the Monzen area of Wajima City to support disaster recovery after the 2024 Noto Peninsula Earthquake. Since disaster rehabilitation assistance was not well established in the Monzen area of Wajima City, the medical team consulted JRAT for guidance on triaging evacuees based on their life functioning. We developed a rehabilitation triage algorithm that classifies evacuees into four triage tags based on their ability to perform three simple movements: sitting up, standing up from the floor, and one-leg standing. In our triage algorithm, an inability to sit up is classified as a red tag (difficulty living in a shelter without assistance), an inability to stand up from the floor is classified as a yellow tag (individual intervention: introduction of beds and handrails), one-leg standing for < 2 s is classified as a green tag (group intervention: installation of toilets and bath rails and use of walkers to prevent falls), and standing on one leg for more than 2 s is classified as a white tag (independent in ADLs). We worked with medical teams to triage 922 evacuees in 27 evacuation centers, resulting in the extraction of four red and eight yellow evacuees in 1 day. Our rehabilitation triage system has the potential to be a simple assessment tool for classifying the life functioning of disaster victims and linking them to appropriate supports.","PeriodicalId":502453,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":"93 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141352728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Japanese Disaster Medical Assistance Teams (DMATs) are pivotal in disaster response, especially during nuclear crises. The objective of this study was to identify factors associated with anxiety among Japanese DMAT personnel when handling contaminated patients during nuclear disasters.In this cross-sectional study, 609 Japanese DMAT members from Kyushu and Okinawa, Japan, were surveyed. Multivariate binomial logistic regression was used to determine anxiety predictors.Of the 276 respondents, 77.2% expressed anxiety about managing contaminated patients. Women and younger team members expressed the highest level of anxiety associated with handling contaminated patients during nuclear disasters.This study revealed heightened anxiety among female and younger Japanese DMAT personnel regarding the handling of contaminated patients during nuclear disasters. Targeted training addressing these concerns is essential for effective disaster response.
{"title":"Factors associated with anxiety about handling contaminated patients during a nuclear disaster among disaster medical assistant teams in Japan: a cross-sectional study","authors":"Hisami Shibata, Takumi Yamaguchi, Yumiko Yamada, Tetsuko Shinkawa, H. Urata, Yuko Matsunari","doi":"10.3389/femer.2024.1361236","DOIUrl":"https://doi.org/10.3389/femer.2024.1361236","url":null,"abstract":"Japanese Disaster Medical Assistance Teams (DMATs) are pivotal in disaster response, especially during nuclear crises. The objective of this study was to identify factors associated with anxiety among Japanese DMAT personnel when handling contaminated patients during nuclear disasters.In this cross-sectional study, 609 Japanese DMAT members from Kyushu and Okinawa, Japan, were surveyed. Multivariate binomial logistic regression was used to determine anxiety predictors.Of the 276 respondents, 77.2% expressed anxiety about managing contaminated patients. Women and younger team members expressed the highest level of anxiety associated with handling contaminated patients during nuclear disasters.This study revealed heightened anxiety among female and younger Japanese DMAT personnel regarding the handling of contaminated patients during nuclear disasters. Targeted training addressing these concerns is essential for effective disaster response.","PeriodicalId":502453,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":" 71","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140692256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-22DOI: 10.3389/femer.2024.1328502
Loreta Kavaliukaite, Anca-Isabela Diaconescu, Doris Eis, K. Slankamenac
Current guidelines suggest considering extracorporeal cardiopulmonary resuscitation (ECPR) in refractory cardiac arrest and provide some guidance for favorable prognostic factors. However, inclusion and exclusion criteria are not strictly defined. We describe a 60-year-old male who underwent extracorporeal life support (ECLS) following refractory out-of-hospital cardiac arrest and made a full neurological recovery despite severe metabolic derangements, including a pH of 6.6 and lactate of 29 mmol/l. The aim is to present a favorable neurological outcome after ECPR despite severe significant physiologic derangements and put relative contraindications for ECPR into perspective.
{"title":"Case report: Successful extracorporeal cardiopulmonary resuscitation despite severe metabolic acidosis after refractory out-of-hospital cardiac arrest","authors":"Loreta Kavaliukaite, Anca-Isabela Diaconescu, Doris Eis, K. Slankamenac","doi":"10.3389/femer.2024.1328502","DOIUrl":"https://doi.org/10.3389/femer.2024.1328502","url":null,"abstract":"Current guidelines suggest considering extracorporeal cardiopulmonary resuscitation (ECPR) in refractory cardiac arrest and provide some guidance for favorable prognostic factors. However, inclusion and exclusion criteria are not strictly defined. We describe a 60-year-old male who underwent extracorporeal life support (ECLS) following refractory out-of-hospital cardiac arrest and made a full neurological recovery despite severe metabolic derangements, including a pH of 6.6 and lactate of 29 mmol/l. The aim is to present a favorable neurological outcome after ECPR despite severe significant physiologic derangements and put relative contraindications for ECPR into perspective.","PeriodicalId":502453,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":"16 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139609479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-08DOI: 10.3389/femer.2023.1339798
Andrew P. Reimer, Wei Dai, N. Schiltz, Jiayang Sun, S. Koroukian
To identify the factors that predict mortality post-transfer and develop a comprehensive mortality prediction model capable of supporting pre-transfer decision making.Electronic health record data from the Medical Transport Data Repository of a large health system hospital in Northeast Ohio that consists of a main campus and 11 affiliated medical centers. We retrospectively analyzed patient data from the referring hospital encounter prior to interhospital transfer. All patient data including diagnoses, laboratory results, medication, and medical and social history were analyzed to predict in-hospital mortality post-transfer. We employed a multi-method approach including logistic regression, gradient boosting, and multiple correspondence analysis to identify significant predictors of mortality as well as variables that are clinically useful to inform clinical decision support development. We identified all patients aged 21 and older that underwent critical care transfer in the health system between 2010 and 2017.We found that age, laboratory results (albumin, INR, platelets, BUN, leukocyte, hemoglobin, glucose), vital signs (temperature, respirations, pulse, systolic blood pressure, pulse oximetry), and ventilator usage are the most predictive variables of post-interhospital transfer mortality. Using structured data from the EHR we achieved the same performance as APACHE IV within our health system (0.85 vs. 0.85). Lastly, mode of transport alone was not a significant predictor for the general population in any of the outcome models.Our findings provide a foundation for the development of decision support tools to guide transport referrals and identified the need for further inquiry to discern the role of mode of transport to enable future inclusion in decision support approaches. Further inquiry is needed to identify factors that differentiate patients not triaged as time-sensitive transfers but still require helicopter intervention to maintain or improve post-interhospital transfer morbidity and mortality.
我们从俄亥俄州东北部一家大型医疗系统医院的医疗转运数据存储库中获取了电子健康记录数据，该医院由一个主校区和 11 个附属医疗中心组成。我们回顾性地分析了院际转运前转诊医院的患者数据。我们分析了所有患者数据，包括诊断、化验结果、用药、病史和社会史，以预测转院后的院内死亡率。我们采用了多种方法，包括逻辑回归、梯度提升和多重对应分析，以确定死亡率的重要预测因素以及对临床有用的变量，为临床决策支持的开发提供信息。我们发现，年龄、实验室结果（白蛋白、INR、血小板、BUN、白细胞、血红蛋白、葡萄糖）、生命体征（体温、呼吸、脉搏、收缩压、脉搏血氧饱和度）和呼吸机使用情况是院内转运后死亡率的最大预测变量。通过使用电子病历中的结构化数据，我们的医疗系统实现了与 APACHE IV 相同的性能（0.85 vs. 0.85）。我们的研究结果为开发决策支持工具以指导转运提供了基础，并确定了进一步调查的必要性，以确定转运方式的作用，以便将来纳入决策支持方法。我们还需要进一步研究，以确定哪些因素可以区分未被分流为时间敏感转运但仍需要直升机干预的患者，从而维持或改善院内转运后的发病率和死亡率。
{"title":"Patient factors associated with survival after critical care interhospital transfer","authors":"Andrew P. Reimer, Wei Dai, N. Schiltz, Jiayang Sun, S. Koroukian","doi":"10.3389/femer.2023.1339798","DOIUrl":"https://doi.org/10.3389/femer.2023.1339798","url":null,"abstract":"To identify the factors that predict mortality post-transfer and develop a comprehensive mortality prediction model capable of supporting pre-transfer decision making.Electronic health record data from the Medical Transport Data Repository of a large health system hospital in Northeast Ohio that consists of a main campus and 11 affiliated medical centers. We retrospectively analyzed patient data from the referring hospital encounter prior to interhospital transfer. All patient data including diagnoses, laboratory results, medication, and medical and social history were analyzed to predict in-hospital mortality post-transfer. We employed a multi-method approach including logistic regression, gradient boosting, and multiple correspondence analysis to identify significant predictors of mortality as well as variables that are clinically useful to inform clinical decision support development. We identified all patients aged 21 and older that underwent critical care transfer in the health system between 2010 and 2017.We found that age, laboratory results (albumin, INR, platelets, BUN, leukocyte, hemoglobin, glucose), vital signs (temperature, respirations, pulse, systolic blood pressure, pulse oximetry), and ventilator usage are the most predictive variables of post-interhospital transfer mortality. Using structured data from the EHR we achieved the same performance as APACHE IV within our health system (0.85 vs. 0.85). Lastly, mode of transport alone was not a significant predictor for the general population in any of the outcome models.Our findings provide a foundation for the development of decision support tools to guide transport referrals and identified the need for further inquiry to discern the role of mode of transport to enable future inclusion in decision support approaches. Further inquiry is needed to identify factors that differentiate patients not triaged as time-sensitive transfers but still require helicopter intervention to maintain or improve post-interhospital transfer morbidity and mortality.","PeriodicalId":502453,"journal":{"name":"Frontiers in Disaster and Emergency Medicine","volume":"48 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139448115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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