When the initial rhythm of cardiac arrest is non-shockable, resuscitation outcomes tend to be unfavorable. However, signs of life (gasping, pupillary light reaction, or any form of body movement) have been suggested as favorable prognostic factors for patients with refractory cardiac arrest who are undergoing extracorporeal cardiopulmonary resuscitation (ECPR). This study determined whether signs of life are favorable neurological prognostic factors for patients undergoing ECPR post non-shockable cardiac arrest.
Methods and results
This single-center retrospective study included 227 refractory out-of-hospital cardiac-arrest patients who had undergone ECPR, divided into four groups according to shockability of initial cardiac rhythms and presence of signs of life. Initial cardiac rhythms were shockable in 154 patients (67.8 %) and non-shockable in 73 (32.2). Favorable neurological outcomes were observed in 4.1 %, 48.2 %, 0.0 %, and 38.7 % of patients with shockable rhythm without signs of life, shockable rhythm with signs of life, non-shockable rhythm without signs of life, and non-shockable rhythm with signs of life, respectively, with significant differences. Multivariate logistic regression analysis showed an independent association of signs of life during resuscitation with favorable neurological outcomes. The adjusted odds ratios for patients with shockable and non-shockable rhythm with signs of life were 34.33 and 96.51, respectively, compared with those without signs of life.
Conclusions
Signs of life during resuscitation were favorable prognostic factors in patients with refractory cardiac arrest and non-shockable rhythm. When these patients are considered for ECPR, the status of signs of life during resuscitation may facilitate the decision to perform ECPR.
{"title":"Signs of life as a favorable predictor for non-shockable cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation post non-shockable cardiac arrest","authors":"Naofumi Bunya MD, PhD , Hirofumi Ohnishi MD, PhD , Takehiko Kasai MD , Ryo Nishikawa MD , Keigo Sawamoto MD , Shuji Uemura MD, PhD , Narimatsu Eichi MD, PhD","doi":"10.1016/j.ajem.2024.10.046","DOIUrl":"10.1016/j.ajem.2024.10.046","url":null,"abstract":"<div><h3>Background</h3><div>When the initial rhythm of cardiac arrest is non-shockable, resuscitation outcomes tend to be unfavorable. However, signs of life (gasping, pupillary light reaction, or any form of body movement) have been suggested as favorable prognostic factors for patients with refractory cardiac arrest who are undergoing extracorporeal cardiopulmonary resuscitation (ECPR). This study determined whether signs of life are favorable neurological prognostic factors for patients undergoing ECPR post non-shockable cardiac arrest.</div></div><div><h3>Methods and results</h3><div>This single-center retrospective study included 227 refractory out-of-hospital cardiac-arrest patients who had undergone ECPR, divided into four groups according to shockability of initial cardiac rhythms and presence of signs of life. Initial cardiac rhythms were shockable in 154 patients (67.8 %) and non-shockable in 73 (32.2). Favorable neurological outcomes were observed in 4.1 %, 48.2 %, 0.0 %, and 38.7 % of patients with shockable rhythm without signs of life, shockable rhythm with signs of life, non-shockable rhythm without signs of life, and non-shockable rhythm with signs of life, respectively, with significant differences. Multivariate logistic regression analysis showed an independent association of signs of life during resuscitation with favorable neurological outcomes. The adjusted odds ratios for patients with shockable and non-shockable rhythm with signs of life were 34.33 and 96.51, respectively, compared with those without signs of life.</div></div><div><h3>Conclusions</h3><div>Signs of life during resuscitation were favorable prognostic factors in patients with refractory cardiac arrest and non-shockable rhythm. When these patients are considered for ECPR, the status of signs of life during resuscitation may facilitate the decision to perform ECPR.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"87 ","pages":"Pages 95-104"},"PeriodicalIF":2.7,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-02DOI: 10.1016/j.ajem.2024.11.001
Jing Wang M.D , Han Zhang M.D , Tianlong Wang M.D, Gang Liu M.D, Yuan Teng M.D, Jian Wang M.D, Qiaoni Zhang M.D, Ph.D, Shujie Yan M.D, Ph.D, Bingyang Ji M.D, Ph.D
Background
The optimal temperature control strategy in extracorporeal cardiopulmonary resuscitation (ECPR) patients is unknown, and several trials have reported conflicting results regarding its effectiveness. We aimed to conduct a systemic review and network meta-analysis (NMA) to assess the efficacy of temperature control in ECPR patients.
Methods
Database searching of studies reporting data on temperature control strategy during ECPR in MEDLINE, EMBASE, Scopus, and Cochrane Library was performed. Primary outcomes were overall survival and neurological outcome. Pairwise meta-analysis and Bayesian NMA were performed on studies comparing outcomes among groups of moderate hypothermia (32–34 °C), mild hypothermia (34.1–36 °C) and normothermia (36.1–37.5 °C).
Results
Nineteen retrospective studies were included (5622 patients). Statistically significant differences in good neurological outcome were observed in the direct comparison of moderate hypothermia and mild hypothermia (OR, 1.73; 95 % CI: 1.07–2.81) as well as moderate hypothermia and normothermia (OR, 2.14; 95 % CI: 1.24–3.67), but no significant differences were found in the NMA result. There was no difference in either survival outcome or the incidence of bleeding complications among any groups according to direct or indirect analysis.
Conclusions
Direct evidence suggests that moderate hypothermia might be associated with improved neurological outcomes in ECPR patients. However, no significant differences in survival outcomes were observed in either the direct or NMA results. Given the lower level of the evidence, interpretation should be made with caution.
{"title":"What’s the optimal temperature control strategy in patients receiving ECPR after cardiac arrest? A network meta-analysis","authors":"Jing Wang M.D , Han Zhang M.D , Tianlong Wang M.D, Gang Liu M.D, Yuan Teng M.D, Jian Wang M.D, Qiaoni Zhang M.D, Ph.D, Shujie Yan M.D, Ph.D, Bingyang Ji M.D, Ph.D","doi":"10.1016/j.ajem.2024.11.001","DOIUrl":"10.1016/j.ajem.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>The optimal temperature control strategy in extracorporeal cardiopulmonary resuscitation (ECPR) patients is unknown, and several trials have reported conflicting results regarding its effectiveness. We aimed to conduct a systemic review and network meta-analysis (NMA) to assess the efficacy of temperature control in ECPR patients.</div></div><div><h3>Methods</h3><div>Database searching of studies reporting data on temperature control strategy during ECPR in MEDLINE, EMBASE, Scopus, and Cochrane Library was performed. Primary outcomes were overall survival and neurological outcome. Pairwise meta-analysis and Bayesian NMA were performed on studies comparing outcomes among groups of moderate hypothermia (32–34 °C), mild hypothermia (34.1–36 °C) and normothermia (36.1–37.5 °C).</div></div><div><h3>Results</h3><div>Nineteen retrospective studies were included (5622 patients). Statistically significant differences in good neurological outcome were observed in the direct comparison of moderate hypothermia and mild hypothermia (OR, 1.73; 95 % CI: 1.07–2.81) as well as moderate hypothermia and normothermia (OR, 2.14; 95 % CI: 1.24–3.67), but no significant differences were found in the NMA result. There was no difference in either survival outcome or the incidence of bleeding complications among any groups according to direct or indirect analysis.</div></div><div><h3>Conclusions</h3><div>Direct evidence suggests that moderate hypothermia might be associated with improved neurological outcomes in ECPR patients. However, no significant differences in survival outcomes were observed in either the direct or NMA results. Given the lower level of the evidence, interpretation should be made with caution.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"87 ","pages":"Pages 74-81"},"PeriodicalIF":2.7,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-02DOI: 10.1016/j.ajem.2024.10.050
Samia Farooqi, Timothy Montrief, Alex Koyfman, Brit Long
Introduction: Bariatric surgery complications carry a high rate of morbidity and mortality.
Objective: This review highlights the pearls and pitfalls of bariatric surgery complications, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
Discussion: Bariatric surgeries include restrictive procedures (e.g., adjustable gastric banding, endoscopic gastric balloon insertion, and sleeve gastrectomy) and mixed restrictive and malabsorptive procedures (e.g., roux-en-y gastric bypass and duodenal switch-biliopancreatic diversion). Several complications may occur, which may be associated with severe morbidity and mortality. These complications include anastomotic/staple line leaks, small bowel obstruction and internal hernia, marginal ulceration, biliary disease, and device-specific issues. History concerning the type of surgery, when and where it was performed, prior complications, changes in weight, and systemic symptoms is essential. Many signs and symptoms are subtle, but fever, tachycardia, and persistent vomiting are concerning for a severe complication. If there is concern for a complication, emergent consultation with the bariatric surgeon is recommended (preferably the patient's surgeon). Imaging studies can assist in the evaluation, including computed tomography with oral and intravenous contrast. Resuscitation in the ED and early intervention by a bariatric surgeon provide the best opportunity to reduce morbidity and mortality for patients with intra-abdominal pathology.
Conclusion: Understanding bariatric surgery complications can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
{"title":"High risk and low incidence diseases: Bariatric surgery complications.","authors":"Samia Farooqi, Timothy Montrief, Alex Koyfman, Brit Long","doi":"10.1016/j.ajem.2024.10.050","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.050","url":null,"abstract":"<p><strong>Introduction: </strong>Bariatric surgery complications carry a high rate of morbidity and mortality.</p><p><strong>Objective: </strong>This review highlights the pearls and pitfalls of bariatric surgery complications, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.</p><p><strong>Discussion: </strong>Bariatric surgeries include restrictive procedures (e.g., adjustable gastric banding, endoscopic gastric balloon insertion, and sleeve gastrectomy) and mixed restrictive and malabsorptive procedures (e.g., roux-en-y gastric bypass and duodenal switch-biliopancreatic diversion). Several complications may occur, which may be associated with severe morbidity and mortality. These complications include anastomotic/staple line leaks, small bowel obstruction and internal hernia, marginal ulceration, biliary disease, and device-specific issues. History concerning the type of surgery, when and where it was performed, prior complications, changes in weight, and systemic symptoms is essential. Many signs and symptoms are subtle, but fever, tachycardia, and persistent vomiting are concerning for a severe complication. If there is concern for a complication, emergent consultation with the bariatric surgeon is recommended (preferably the patient's surgeon). Imaging studies can assist in the evaluation, including computed tomography with oral and intravenous contrast. Resuscitation in the ED and early intervention by a bariatric surgeon provide the best opportunity to reduce morbidity and mortality for patients with intra-abdominal pathology.</p><p><strong>Conclusion: </strong>Understanding bariatric surgery complications can assist emergency clinicians in diagnosing and managing this potentially deadly disease.</p>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"87 ","pages":"113-122"},"PeriodicalIF":2.7,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-02DOI: 10.1016/j.ajem.2024.11.002
Saamia I. Masoom MD , Gina Aloisio MD PhD , Elizabeth A. Camp PhD , James J. Dunn PhD , Sarah D. Meskill MD MS
<div><h3>Background</h3><div>Following the onset of the COVID-19 pandemic, RSV infections deviated from a previously reliable epidemiologic pattern of presentation. To investigate whether this change in RSV seasonality resulted in a change in frequency and severity of RSV infections, this single center retrospective study compares demographic and hospital factors during RSV seasons before and after the onset of the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>Included were patients under age 5 years who tested positive for RSV only by RT-PCR in our pediatric emergency departments during the last three RSV seasons before the onset of the COVID-19 pandemic in spring 2020, as compared to the first three seasons after the pandemic started. RSV seasonality was defined as periods in which greater than 10 % of all RSV RT-PCR tests sent resulted positive. Patients with tracheostomies were excluded, as were duplicate tests performed in the same patient within 1 day. Demographic data obtained included patient age, sex, and weight. Hospital factors obtained were inpatient admission and length of stay (LOS), intensive care unit (ICU) admission and LOS, respiratory support during the encounter, and mortality. A planned subgroup analysis isolating the first RSV season after the pandemic's onset was performed. Mann-Whitney and Pearson Chi-Square testing were used for comparison of continuous and categorical variables, respectively. Significance was set at <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>RSV seasons were identified with 7592 cases meeting study criteria (2770 cases before the pandemic's onset and 4822 cases after). While there were more RSV cases identified per season after the onset of COVID-19, testing also increased in this period. RSV positive patients in seasons after the onset of COVID-19 were significantly older than those in seasons before (0.83 years vs. 0.56 years, <em>p</em> < 0.001). They were admitted to the hospital significantly less (46.8 % vs. 54.9 %, p < 0.001), though ICU admission rates did not change significantly (32.9 % vs. 31.1 %, <em>p</em> = 0.25). Both inpatient LOS (64 h vs. 60 h, <em>p</em> = 0.01) and ICU LOS (68 h vs. 88.5 h, <em>p</em> < 0.001) decreased significantly. RSV positive inpatients in seasons after the onset of COVID-19 were significantly more likely to require respiratory support (89.0 % vs. 86.5 %, <em>p</em> = 0.02), with more requiring BIPAP (11.3 % vs. 8.1 %, <em>p</em> = 0.003) and fewer requiring intubation (9.6 % vs. 13.8 %, p < 0.001).</div></div><div><h3>Conclusions</h3><div>During the first three RSV seasons after the onset of the COVID-19 pandemic, our pediatric emergency departments saw more RSV positive patients than in the last three seasons beforehand. These patients were significantly older and less likely to be admitted, which may be partly due to increased respiratory viral testing during the pandemic. However, shorter LOS and decreased intubations des
{"title":"Characterizing respiratory syncytial virus (RSV) infections before and during the COVID-19 pandemic","authors":"Saamia I. Masoom MD , Gina Aloisio MD PhD , Elizabeth A. Camp PhD , James J. Dunn PhD , Sarah D. Meskill MD MS","doi":"10.1016/j.ajem.2024.11.002","DOIUrl":"10.1016/j.ajem.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Following the onset of the COVID-19 pandemic, RSV infections deviated from a previously reliable epidemiologic pattern of presentation. To investigate whether this change in RSV seasonality resulted in a change in frequency and severity of RSV infections, this single center retrospective study compares demographic and hospital factors during RSV seasons before and after the onset of the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>Included were patients under age 5 years who tested positive for RSV only by RT-PCR in our pediatric emergency departments during the last three RSV seasons before the onset of the COVID-19 pandemic in spring 2020, as compared to the first three seasons after the pandemic started. RSV seasonality was defined as periods in which greater than 10 % of all RSV RT-PCR tests sent resulted positive. Patients with tracheostomies were excluded, as were duplicate tests performed in the same patient within 1 day. Demographic data obtained included patient age, sex, and weight. Hospital factors obtained were inpatient admission and length of stay (LOS), intensive care unit (ICU) admission and LOS, respiratory support during the encounter, and mortality. A planned subgroup analysis isolating the first RSV season after the pandemic's onset was performed. Mann-Whitney and Pearson Chi-Square testing were used for comparison of continuous and categorical variables, respectively. Significance was set at <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>RSV seasons were identified with 7592 cases meeting study criteria (2770 cases before the pandemic's onset and 4822 cases after). While there were more RSV cases identified per season after the onset of COVID-19, testing also increased in this period. RSV positive patients in seasons after the onset of COVID-19 were significantly older than those in seasons before (0.83 years vs. 0.56 years, <em>p</em> < 0.001). They were admitted to the hospital significantly less (46.8 % vs. 54.9 %, p < 0.001), though ICU admission rates did not change significantly (32.9 % vs. 31.1 %, <em>p</em> = 0.25). Both inpatient LOS (64 h vs. 60 h, <em>p</em> = 0.01) and ICU LOS (68 h vs. 88.5 h, <em>p</em> < 0.001) decreased significantly. RSV positive inpatients in seasons after the onset of COVID-19 were significantly more likely to require respiratory support (89.0 % vs. 86.5 %, <em>p</em> = 0.02), with more requiring BIPAP (11.3 % vs. 8.1 %, <em>p</em> = 0.003) and fewer requiring intubation (9.6 % vs. 13.8 %, p < 0.001).</div></div><div><h3>Conclusions</h3><div>During the first three RSV seasons after the onset of the COVID-19 pandemic, our pediatric emergency departments saw more RSV positive patients than in the last three seasons beforehand. These patients were significantly older and less likely to be admitted, which may be partly due to increased respiratory viral testing during the pandemic. However, shorter LOS and decreased intubations des","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"87 ","pages":"Pages 108-112"},"PeriodicalIF":2.7,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1016/S0735-6757(24)00501-1
{"title":"Info for authors","authors":"","doi":"10.1016/S0735-6757(24)00501-1","DOIUrl":"10.1016/S0735-6757(24)00501-1","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"85 ","pages":"Page A8"},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1016/j.ajem.2024.10.039
Ziyi He, Chenxi Wang, Huichuan Tian
{"title":"Regarding the measurement of left atrial size as a predictor of severity of illness in sickle cell disease.","authors":"Ziyi He, Chenxi Wang, Huichuan Tian","doi":"10.1016/j.ajem.2024.10.039","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.039","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1016/j.ajem.2024.10.044
Katherine Bradley PharmD, Elizabeth A. Feldman PharmD, Joshua Schrader PharmD, Gregory Meola PharmD, Christopher D. Miller Pharm D, William Darko PharmD, Robert Seabury PharmD
Introduction
This study sought to assess the cardiorespiratory safety of parenteral olanzapine and benzodiazepine combination treatment compared to parenteral droperidol or haloperidol and benzodiazepine combination treatment.
Materials and methods
This was a retrospective chart review conducted in adult emergency department patients who received intramuscular (IM) or intravenous (IV) droperidol, haloperidol, or olanzapine within one hour of IM or IV benzodiazepine. Patients were stratified into groups based on whether they received either olanzapine in combination with a benzodiazepine (n = 48) or droperidol or haloperidol in combination with a benzodiazepine (n = 48).
Results
Patients in each group had a decrease in their systolic blood pressure (SBP) after IM/IV olanzapine and IM/IV droperidol or haloperidol when used in combination with an IM/IV benzodiazepine ((Olanzapine + benzodiazepine (mmHg), median (IQR): Pre-SBP: 132 (117–151) vs. Post-SBP: 117 (99–131), p < 0.01) (Droperidol or haloperidol + benzodiazepine (mmHg), median (IQR): Pre-SBP: 138 (122–149) vs. Post-SBP: 106 (98–127), p < 0.01)). Both groups had similar percent SBP decreases post-combination treatment (Olanzapine + benzodiazepine (15.6 %) vs. Droperidol or haloperidol + benzodiazepine (15.2 %); p = 0.55). We did not observe any statistically significant between group differences for hypotension (Olanzapine + benzodiazepine: 1/48, 2.1 % vs. Droperidol or haloperidol + benzodiazepine: 3/48, 6.3 %; p = 0.62)), escalation in oxygen requirements (Olanzapine + benzodiazepine: 7/48, 14.6 %) vs. Droperidol or haloperidol + benzodiazepine: 5/48, 10.4 %; p = 0.76)), or intubation due to cardiorespiratory depression (Olanzapine + benzodiazepine: 0/0, 0 % vs. Droperidol or haloperidol + benzodiazepine: 0/0, 0 %; p = 1.00)).
Conclusion
This study found decreases in SBP after administering parenteral olanzapine and parenteral droperidol or haloperidol in combination with a parenteral benzodiazepine. The percent change in SBP and the frequency of hypotensive episodes post-combination treatment were not different between groups. There were also no differences between groups in need of increased oxygen requirements post-combination treatment or need for intubation due to cardiorespiratory depression. This study suggests parenteral olanzapine in combination with a parenteral benzodiazepine may have comparable cardiorespiratory safety versus parenteral droperidol or haloperidol in combination with a parenteral benzodiazepine when treating agitation in the adult ED.
{"title":"Comparing the cardiorespiratory safety of parenteral olanzapine and benzodiazepines to parenteral haloperidol/droperidol and benzodiazepines in emergency department patients","authors":"Katherine Bradley PharmD, Elizabeth A. Feldman PharmD, Joshua Schrader PharmD, Gregory Meola PharmD, Christopher D. Miller Pharm D, William Darko PharmD, Robert Seabury PharmD","doi":"10.1016/j.ajem.2024.10.044","DOIUrl":"10.1016/j.ajem.2024.10.044","url":null,"abstract":"<div><h3>Introduction</h3><div>This study sought to assess the cardiorespiratory safety of parenteral olanzapine and benzodiazepine combination treatment compared to parenteral droperidol or haloperidol and benzodiazepine combination treatment.</div></div><div><h3>Materials and methods</h3><div>This was a retrospective chart review conducted in adult emergency department patients who received intramuscular (IM) or intravenous (IV) droperidol, haloperidol, or olanzapine within one hour of IM or IV benzodiazepine. Patients were stratified into groups based on whether they received either olanzapine in combination with a benzodiazepine (<em>n</em> = 48) or droperidol or haloperidol in combination with a benzodiazepine (n = 48).</div></div><div><h3>Results</h3><div>Patients in each group had a decrease in their systolic blood pressure (SBP) after IM/IV olanzapine and IM/IV droperidol or haloperidol when used in combination with an IM/IV benzodiazepine ((Olanzapine + benzodiazepine (mmHg), median (IQR): Pre-SBP: 132 (117–151) vs. Post-SBP: 117 (99–131), <em>p</em> < 0.01) (Droperidol or haloperidol + benzodiazepine (mmHg), median (IQR): Pre-SBP: 138 (122–149) vs. Post-SBP: 106 (98–127), <em>p</em> < 0.01)). Both groups had similar percent SBP decreases post-combination treatment (Olanzapine + benzodiazepine (15.6 %) vs. Droperidol or haloperidol + benzodiazepine (15.2 %); <em>p</em> = 0.55). We did not observe any statistically significant between group differences for hypotension (Olanzapine + benzodiazepine: 1/48, 2.1 % vs. Droperidol or haloperidol + benzodiazepine: 3/48, 6.3 %; <em>p</em> = 0.62)), escalation in oxygen requirements (Olanzapine + benzodiazepine: 7/48, 14.6 %) vs. Droperidol or haloperidol + benzodiazepine: 5/48, 10.4 %; <em>p</em> = 0.76)), or intubation due to cardiorespiratory depression (Olanzapine + benzodiazepine: 0/0, 0 % vs. Droperidol or haloperidol + benzodiazepine: 0/0, 0 %; <em>p</em> = 1.00)).</div></div><div><h3>Conclusion</h3><div>This study found decreases in SBP after administering parenteral olanzapine and parenteral droperidol or haloperidol in combination with a parenteral benzodiazepine. The percent change in SBP and the frequency of hypotensive episodes post-combination treatment were not different between groups. There were also no differences between groups in need of increased oxygen requirements post-combination treatment or need for intubation due to cardiorespiratory depression. This study suggests parenteral olanzapine in combination with a parenteral benzodiazepine may have comparable cardiorespiratory safety versus parenteral droperidol or haloperidol in combination with a parenteral benzodiazepine when treating agitation in the adult ED.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"87 ","pages":"Pages 51-56"},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1016/j.ajem.2024.10.048
Kayla Vanderkooi, Peter Richman, Joshua White, Laura Sample, K Tom Xu, Michael Miller
{"title":"A prospective single-blinded randomized field-based trial to evaluate the prophylactic treatment of oral prochlorperazine for acute mountain sickness.","authors":"Kayla Vanderkooi, Peter Richman, Joshua White, Laura Sample, K Tom Xu, Michael Miller","doi":"10.1016/j.ajem.2024.10.048","DOIUrl":"https://doi.org/10.1016/j.ajem.2024.10.048","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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