American Journal of Emergency Medicine最新文献_第7页

Remote real-time ambulatory ECG monitoring of the longest RR interval and corresponding arrhythmias during altitude ascent 海拔上升时最长RR间期及相应心律失常的远程实时动态心电图监测

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-16 DOI: 10.1016/j.ajem.2026.01.020

Li-Hong Zheng, Yan Wang, Xue-Wen Huang, Miao Li, Hai-Ying Xian, Chun-Xia Guo, Zi-Yang He, Lin Ma

Objective

The aim of this study is to characterize the longest RR intervals and associated arrhythmias during the early phase of rapid ascent to high altitude environments using ambulatory electrocardiography (AECG), with the aim of informing strategies to prevent acute high-altitude illness and cardiovascular adverse events.

Methods

Participants residing at low altitude underwent rapid ascent to high-altitude locations at 3060 m, 3460 m, and 4014 m. Beginning on the first day at altitude, AECG monitoring was conducted for more than 24 h using a Model 401 wearable ECG monitor, enabling remote, real-time data transmission via a 4G network and immediate clinical response to high-risk arrhythmias. Cloud-based storage and analytic platforms facilitated statistical evaluation of the longest RR intervals and corresponding rhythm types.

Results

(1) The longest RR intervals and associated arrhythmias were primarily observed during nighttime sleep. (2) Statistically significant differences (p < 0.05) were found among the three altitude groups in the incidence of the longest RR intervals <1.00 s, abnormal rhythms associated with the longest RR intervals, premature beats corresponding to the longest RR intervals, and sinus pause episodes. (3) The primary arrhythmias associated with the longest RR intervals included ventricular premature beats, second-degree type II atrioventricular block, high-degree atrioventricular block, sinus pause, and atrial fibrillation.

Conclusion

Clinically significant bradyarrhythmia may occur during rapid ascent to altitudes between 3060 m and 4014 m, particularly during nocturnal hours. These findings highlight the need to consider targeted preventive attention during nighttime exposure, given the high prevalence of nocturnal bradyarrhythmias. Remote real-time AECG monitoring may serve as a useful tool for early detection and intervention in populations at risk of altitude-related cardiac rhythm disturbances.

目的本研究的目的是利用动态心电图（AECG）表征快速上升到高海拔环境早期最长RR间期和相关心律失常，目的是为预防急性高原疾病和心血管不良事件的策略提供信息。方法居住在低海拔地区的参与者在海拔3060米、3460米和4014米的地方快速上升。从高海拔第一天开始，使用401型可穿戴心电监护仪进行AECG监测24小时以上，通过4G网络远程实时传输数据，对高危心律失常及时做出临床反应。基于云的存储和分析平台促进了最长RR间隔和相应节律类型的统计评估。结果(1)最长RR间期及相关心律失常主要见于夜间睡眠。(2) 3个海拔组最长RR间期1.00 s、最长RR间期相关的异常节律、最长RR间期对应的早搏、窦性暂停发作的发生率差异有统计学意义（p < 0.05）。(3)与最长RR间期相关的原发性心律失常包括室性早搏、二度房室传导阻滞、高度房室传导阻滞、窦性暂停和心房颤动。结论在海拔3060 ~ 4014 m的快速上升过程中可能发生临床意义上的缓慢性心律失常，尤其是在夜间。这些发现强调了在夜间暴露时考虑有针对性的预防注意的必要性，考虑到夜间缓慢性心律失常的高患病率。远程实时AECG监测可作为一种有用的工具，用于早期发现和干预有海拔相关心律紊乱风险的人群。

{"title":"Remote real-time ambulatory ECG monitoring of the longest RR interval and corresponding arrhythmias during altitude ascent","authors":"Li-Hong Zheng, Yan Wang, Xue-Wen Huang, Miao Li, Hai-Ying Xian, Chun-Xia Guo, Zi-Yang He, Lin Ma","doi":"10.1016/j.ajem.2026.01.020","DOIUrl":"10.1016/j.ajem.2026.01.020","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to characterize the longest RR intervals and associated arrhythmias during the early phase of rapid ascent to high altitude environments using ambulatory electrocardiography (AECG), with the aim of informing strategies to prevent acute high-altitude illness and cardiovascular adverse events.</div></div><div><h3>Methods</h3><div>Participants residing at low altitude underwent rapid ascent to high-altitude locations at 3060 m, 3460 m, and 4014 m. Beginning on the first day at altitude, AECG monitoring was conducted for more than 24 h using a Model 401 wearable ECG monitor, enabling remote, real-time data transmission via a 4G network and immediate clinical response to high-risk arrhythmias. Cloud-based storage and analytic platforms facilitated statistical evaluation of the longest RR intervals and corresponding rhythm types.</div></div><div><h3>Results</h3><div>(1) The longest RR intervals and associated arrhythmias were primarily observed during nighttime sleep. (2) Statistically significant differences (<em>p</em> < 0.05) were found among the three altitude groups in the incidence of the longest RR intervals <1.00 s, abnormal rhythms associated with the longest RR intervals, premature beats corresponding to the longest RR intervals, and sinus pause episodes. (3) The primary arrhythmias associated with the longest RR intervals included ventricular premature beats, second-degree type II atrioventricular block, high-degree atrioventricular block, sinus pause, and atrial fibrillation.</div></div><div><h3>Conclusion</h3><div>Clinically significant bradyarrhythmia may occur during rapid ascent to altitudes between 3060 m and 4014 m, particularly during nocturnal hours. These findings highlight the need to consider targeted preventive attention during nighttime exposure, given the high prevalence of nocturnal bradyarrhythmias. Remote real-time AECG monitoring may serve as a useful tool for early detection and intervention in populations at risk of altitude-related cardiac rhythm disturbances.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 98-103"},"PeriodicalIF":2.2,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039487","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}

引用次数: 0

Pulmonary hypertension in cardiac tamponade: An observational cohort study of in-hospital mortality and echocardiographic findings 心包填塞导致肺动脉高压：一项住院死亡率和超声心动图结果的观察性队列研究。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-14 DOI: 10.1016/j.ajem.2026.01.013

Robert James Adrian MD , Onyinyechi F. Eke MD, MPH , Nour Al Jalbout MD , Moustafa Al Hariri PhD , Kristofer Montoya MD , Patricia Hernandez MD , Hamid Shokoohi MD, MPH

Background

Patients with pulmonary hypertension (PHTN) (i.e., chronic PHTN) have right ventricular hypertrophy, elevated right-sided heart pressures, and frequently have pericardial effusions. When evaluating these patients for cardiac tamponade, the hypertrophy and elevated pressure in right heart may be protective from tamponade by counteracting the pressure from the pericardial effusion. However, these patients may be harmed if echocardiographic signs of tamponade (e.g., right ventricular diastolic collapse) are obscured.

Study objective

The effect of PHTN on patients with cardiac tamponade remains unclear. We aimed (1) to evaluate whether PHTN influences the echocardiographic findings of tamponade, and (2) to examine whether PHTN is associated with in-hospital mortality among patients undergoing pericardial drainage primarily for cardiac tamponade.

Methods

We conducted a retrospective observational study of adult patients who underwent pericardial drainage within 48 h of emergency department presentation at two academic centers. PHTN probability was classified using the 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines. We classified patients in four categories: no PHTN, low probability, intermediate probability, and high probability of PHTN. PHTN parameters were manually extracted from cardiologist-interpreted echocardiography reports. The primary outcome was in-hospital mortality. Secondary outcomes included the prevalence of echocardiographic findings of cardiac tamponade and their associations with mortality.

Results

A total of 249 patients met the inclusion criteria. In-hospital mortality did not significantly differ across PHTN probability categories: no PHTN (63.8%), low probability (9.3%), intermediate probability (20.9%), and high probability (5.3%) (p-values all >0.2). Among patients who died, 50.0% were in the no PHTN group compared to 7.1% in the high probability group (p = 0.222). The echocardiographic impression of cardiac tamponade was significantly lower among patients with high PHTN probability compared to those with no PHTN (64.3% vs. 85.4%, p = 0.041), with a weak negative correlation (r = −0.493) between increasing PHTN probability and tamponade impression.

Conclusions

In this cohort of patients undergoing pericardial drainage primarily for cardiac tamponade, PHTN was not significantly associated with in-hospital mortality. However, patients with a high probability of PHTN showed fewer echocardiographic signs of tamponade, suggesting that PHTN may obscure typical sonographic findings of tamponade.

背景：肺动脉高压（PHTN）患者（即慢性PHTN）右心室肥厚，右侧心压升高，常有心包积液。在评估这些患者的心包填塞时，右心肥厚和血压升高可能通过抵消心包积液的压力来保护心包填塞。然而，如果心包填塞的超声心动图征象（如右心室舒张性塌陷）被掩盖，这些患者可能会受到伤害。研究目的：PHTN对心包填塞的影响尚不清楚。我们的目的是(1)评估PHTN是否影响心包填塞的超声心动图表现；(2)研究PHTN是否与主要因心包填塞而行心包引流的患者的住院死亡率相关。方法：我们对两个学术中心急诊就诊后48小时内行心包引流术的成年患者进行了回顾性观察研究。根据2022年欧洲心脏病学会/欧洲呼吸学会（ESC/ERS）指南对PHTN概率进行分类。我们将患者分为无PHTN、低概率、中概率和高概率四类。从心脏病专家解释的超声心动图报告中手动提取PHTN参数。主要终点是住院死亡率。次要结局包括超声心动图发现心脏填塞的流行程度及其与死亡率的关系。结果：249例患者符合纳入标准。住院死亡率在PHTN概率类别之间没有显著差异：无PHTN（63.8%）、低概率（9.3%）、中概率（20.9%）和高概率（5.3%）（p值均为bb0 0.2）。在死亡患者中，无PHTN组为50.0%，而高概率组为7.1% （p = 0.222）。PHTN概率高的患者超声心动图对心包填塞的印象明显低于无PHTN的患者（64.3% vs. 85.4%, p = 0.041）， PHTN概率增加与心包填塞印象呈弱负相关（r = -0.493）。结论：在这组主要因心包填塞而接受心包引流的患者中，PHTN与住院死亡率无显著相关性。然而，PHTN高概率的患者表现出较少的心包填塞的超声心动图征象，提示PHTN可能掩盖了典型的心包填塞的超声表现。

{"title":"Pulmonary hypertension in cardiac tamponade: An observational cohort study of in-hospital mortality and echocardiographic findings","authors":"Robert James Adrian MD , Onyinyechi F. Eke MD, MPH , Nour Al Jalbout MD , Moustafa Al Hariri PhD , Kristofer Montoya MD , Patricia Hernandez MD , Hamid Shokoohi MD, MPH","doi":"10.1016/j.ajem.2026.01.013","DOIUrl":"10.1016/j.ajem.2026.01.013","url":null,"abstract":"<div><h3>Background</h3><div>Patients with pulmonary hypertension (PHTN) (i.e., chronic PHTN) have right ventricular hypertrophy, elevated right-sided heart pressures, and frequently have pericardial effusions. When evaluating these patients for cardiac tamponade, the hypertrophy and elevated pressure in right heart may be protective from tamponade by counteracting the pressure from the pericardial effusion. However, these patients may be harmed if echocardiographic signs of tamponade (e.g., right ventricular diastolic collapse) are obscured.</div></div><div><h3>Study objective</h3><div>The effect of PHTN on patients with cardiac tamponade remains unclear. We aimed (1) to evaluate whether PHTN influences the echocardiographic findings of tamponade, and (2) to examine whether PHTN is associated with in-hospital mortality among patients undergoing pericardial drainage primarily for cardiac tamponade.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study of adult patients who underwent pericardial drainage within 48 h of emergency department presentation at two academic centers. PHTN probability was classified using the 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines. We classified patients in four categories: no PHTN, low probability, intermediate probability, and high probability of PHTN. PHTN parameters were manually extracted from cardiologist-interpreted echocardiography reports. The primary outcome was in-hospital mortality. Secondary outcomes included the prevalence of echocardiographic findings of cardiac tamponade and their associations with mortality.</div></div><div><h3>Results</h3><div>A total of 249 patients met the inclusion criteria. In-hospital mortality did not significantly differ across PHTN probability categories: no PHTN (63.8%), low probability (9.3%), intermediate probability (20.9%), and high probability (5.3%) (<em>p</em>-values all >0.2). Among patients who died, 50.0% were in the no PHTN group compared to 7.1% in the high probability group (<em>p</em> = 0.222). The echocardiographic impression of cardiac tamponade was significantly lower among patients with high PHTN probability compared to those with no PHTN (64.3% vs. 85.4%, <em>p</em> = 0.041), with a weak negative correlation (<em>r</em> = −0.493) between increasing PHTN probability and tamponade impression.</div></div><div><h3>Conclusions</h3><div>In this cohort of patients undergoing pericardial drainage primarily for cardiac tamponade, PHTN was not significantly associated with in-hospital mortality. However, patients with a high probability of PHTN showed fewer echocardiographic signs of tamponade, suggesting that PHTN may obscure typical sonographic findings of tamponade.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 55-61"},"PeriodicalIF":2.2,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031711","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}

引用次数: 0

Large academic enterprise load balancing: ED patient transfers to regional hospitals. 大型学术企业负载均衡：急诊科患者转移到地区医院。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-14 DOI: 10.1016/j.ajem.2026.01.015

Mehul Shah, Ethan Fargo, Nicole M Acquisto, Aekta Miglani

引用次数: 0

Lightweight interpretable AI model using multiple blood parameters for emergency diagnosis of acute appendicitis 基于多种血液参数的轻量级可解释人工智能模型用于急性阑尾炎的急诊诊断。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-12 DOI: 10.1016/j.ajem.2026.01.006

Shun Liao , Yan Li , Haoran Tang , Zixiong Li , Tianqi Xu , Zongfang Ren

Background: Acute appendicitis poses diagnostic challenges due to symptom overlap with other abdominal conditions, often leading to misdiagnosis or missed diagnosis. This study aimed to develop and validate an interpretable machine learning model based on routine hematological indicators to facilitate rapid diagnosis. Methods: A retrospective analysis was conducted on 408 patients with acute abdominal pain, including both adult and pediatric patients. The median age of patients in the appendicitis group was 37.5 years (IQR: 26.5 years). Univariate logistic regression revealed significant group differences in hematological indicators (all P < 0.001). Three feature selection methods—LASSO, ElasticNet, and Random Forest—were applied, with neutrophil percentage (NE%) and eosinophil percentage (EO%) consistently identified across all methods, and red blood cell (RBC) and white blood cell (WBC) repeatedly selected by at least two methods. Eleven commonly used machine learning classifiers were developed and evaluated on an independent test set. Results: The support vector machine with a radial basis function kernel (SVM-RBF) using LASSO-selected features achieved the best performance, with an AUC (area under the curve) of 0.903 (95% CI: 0.84–0.96), accuracy of 90.2%, sensitivity of 80.3%, and specificity of 100%. The average precision exceeded 0.92, and the calibration curve demonstrated good agreement (Brier score: 0.092). Interpretability analyses with SHAP (Shapley additive explanations) and LIME (local interpretable model-agnostic explanations) applied to the LightGBM (Light Gradient Boosting Machine) model confirmed EO%, RBC, and WBC as the most influential predictors. Conclusion:This parsimonious and interpretable model, relying solely on routine blood indicators, may enable timely and accurate diagnosis of acute appendicitis while providing additional insights, particularly in resource-limited settings.

背景：急性阑尾炎由于症状与其他腹部疾病重叠，给诊断带来挑战，经常导致误诊或漏诊。本研究旨在开发和验证基于常规血液学指标的可解释机器学习模型，以促进快速诊断。方法：对408例急性腹痛患者进行回顾性分析，包括成人和儿童患者。阑尾炎组患者中位年龄为37.5岁（IQR: 26.5岁）。结果：采用lasso选择特征的径向基函数核支持向量机（SVM-RBF）表现最佳，曲线下面积（AUC）为0.903 (95% CI: 0.84-0.96)，准确率为90.2%，灵敏度为80.3%，特异性为100%。平均精密度超过0.92，校准曲线一致性较好（Brier评分为0.092）。应用于光梯度增强机（LightGBM）模型的SHAP （Shapley加性解释）和LIME（局部可解释模型不可知解释）的可解释性分析证实EO%、RBC和WBC是最具影响力的预测因子。结论：这种简单且可解释的模型，仅依靠常规血液指标，可以及时准确地诊断急性阑尾炎，同时提供额外的见解，特别是在资源有限的情况下。

{"title":"Lightweight interpretable AI model using multiple blood parameters for emergency diagnosis of acute appendicitis","authors":"Shun Liao , Yan Li , Haoran Tang , Zixiong Li , Tianqi Xu , Zongfang Ren","doi":"10.1016/j.ajem.2026.01.006","DOIUrl":"10.1016/j.ajem.2026.01.006","url":null,"abstract":"<div><div>Background: Acute appendicitis poses diagnostic challenges due to symptom overlap with other abdominal conditions, often leading to misdiagnosis or missed diagnosis. This study aimed to develop and validate an interpretable machine learning model based on routine hematological indicators to facilitate rapid diagnosis. Methods: A retrospective analysis was conducted on 408 patients with acute abdominal pain, including both adult and pediatric patients. The median age of patients in the appendicitis group was 37.5 years (IQR: 26.5 years). Univariate logistic regression revealed significant group differences in hematological indicators (all <em>P</em> < 0.001). Three feature selection methods—LASSO, ElasticNet, and Random Forest—were applied, with neutrophil percentage (NE%) and eosinophil percentage (EO%) consistently identified across all methods, and red blood cell (RBC) and white blood cell (WBC) repeatedly selected by at least two methods. Eleven commonly used machine learning classifiers were developed and evaluated on an independent test set. Results: The support vector machine with a radial basis function kernel (SVM-RBF) using LASSO-selected features achieved the best performance, with an AUC (area under the curve) of 0.903 (95% CI: 0.84–0.96), accuracy of 90.2%, sensitivity of 80.3%, and specificity of 100%. The average precision exceeded 0.92, and the calibration curve demonstrated good agreement (Brier score: 0.092). Interpretability analyses with SHAP (Shapley additive explanations) and LIME (local interpretable model-agnostic explanations) applied to the LightGBM (Light Gradient Boosting Machine) model confirmed EO%, RBC, and WBC as the most influential predictors. Conclusion:This parsimonious and interpretable model, relying solely on routine blood indicators, may enable timely and accurate diagnosis of acute appendicitis while providing additional insights, particularly in resource-limited settings.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 39-48"},"PeriodicalIF":2.2,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031718","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}

引用次数: 0

Practice changing articles: Efficacy of albuterol-budesonide inhaler compared with albuterol alone in mild asthma. 实践变更文章：沙丁胺醇-布地奈德吸入器与单独沙丁胺醇治疗轻度哮喘的疗效比较。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-10 DOI: 10.1016/j.ajem.2026.01.010

Rachel E Bridwell, Ali Pourmand, Michael Gottlieb, Brit Long

引用次数: 0

Exertional and classic heat stroke: A narrative review 劳累和经典中暑：叙述回顾。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-10 DOI: 10.1016/j.ajem.2026.01.008

Rosie I. Perez , Maria J. Londono , Bryan Everitt , Douglas Young , R. Lyle Hood , Robert A. De Lorenzo , Brendon P. McDermott

Exertional (EHS) and classic heat stroke (CHS) share similarities in pathophysiology, progression, and potential sequelae. Further, quick recognition and management demonstrate favorable outcomes. Limited publications have examined parallels between types of heat stroke. Therefore, the purpose of this review was to search available literature and critically outline current evidence-informed clinical management of heat stroke. Our result was a thorough search and analysis of related literature that answers questions related to heat stroke. The pathophysiology of heat stroke is similar between EHS and CHS, with the only difference being onset predisposition and typical affected population. The main driver toward EHS includes exercise intensity inconsistent with environmental demands. CHS often presents in geriatric or pediatric populations and in patients with predisposing thermoregulatory limitations. Although debate continues in diagnostic criteria, both EHS and CHS are diagnosed with concomitant hyperpyrexia and central nervous system dysfunction. Following initial onset, the progression of cell death, tissue and organ failure, and potentially fatal outcome remains consistent between EHS and CHS. Emergency management of EHS has resulted in 100% survival when prompt diagnosis and effective treatment are administered. Results are not as favorable with CHS, albeit with a lack of robust data. The available evidence suggests similar management protocols would potentially improve outcomes with CHS. A potential addition to successful cooling may include hemodynamic support. Lastly, recommendations for enhanced data and documentation for heat stroke in emergency management could help foster consistent, updated clinical guidelines.

劳役性中暑（EHS）和典型中暑（CHS）在病理生理、进展和潜在的后遗症方面有相似之处。此外，快速识别和管理显示出良好的效果。有限的出版物研究了中暑类型之间的相似之处。因此，本综述的目的是检索现有文献，并批判性地概述当前中暑的循证临床管理。我们的结果是对相关文献进行了彻底的搜索和分析，回答了与中暑有关的问题。中暑的病理生理在EHS和CHS之间是相似的，唯一的区别是发病易感性和典型的影响人群。与环境要求不一致的运动强度是诱发EHS的主要因素。CHS通常出现在老年或儿科人群以及易患体温调节限制的患者中。尽管诊断标准仍有争议，但EHS和CHS都被诊断为伴有高热和中枢神经系统功能障碍。在初始发病后，EHS和CHS的细胞死亡、组织和器官衰竭以及潜在致命结局的进展保持一致。在及时诊断和有效治疗的情况下，EHS的应急管理导致100%的生存率。尽管缺乏可靠的数据，但CHS的结果并不那么有利。现有证据表明，类似的管理方案可能会改善CHS的预后。成功降温的潜在补充可能包括血流动力学支持。最后，建议在应急管理中加强中暑的数据和文件，有助于促进一致的、更新的临床指南。

{"title":"Exertional and classic heat stroke: A narrative review","authors":"Rosie I. Perez , Maria J. Londono , Bryan Everitt , Douglas Young , R. Lyle Hood , Robert A. De Lorenzo , Brendon P. McDermott","doi":"10.1016/j.ajem.2026.01.008","DOIUrl":"10.1016/j.ajem.2026.01.008","url":null,"abstract":"<div><div>Exertional (EHS) and classic heat stroke (CHS) share similarities in pathophysiology, progression, and potential sequelae. Further, quick recognition and management demonstrate favorable outcomes. Limited publications have examined parallels between types of heat stroke. Therefore, the purpose of this review was to search available literature and critically outline current evidence-informed clinical management of heat stroke. Our result was a thorough search and analysis of related literature that answers questions related to heat stroke. The pathophysiology of heat stroke is similar between EHS and CHS, with the only difference being onset predisposition and typical affected population. The main driver toward EHS includes exercise intensity inconsistent with environmental demands. CHS often presents in geriatric or pediatric populations and in patients with predisposing thermoregulatory limitations. Although debate continues in diagnostic criteria, both EHS and CHS are diagnosed with concomitant hyperpyrexia and central nervous system dysfunction. Following initial onset, the progression of cell death, tissue and organ failure, and potentially fatal outcome remains consistent between EHS and CHS. Emergency management of EHS has resulted in 100% survival when prompt diagnosis and effective treatment are administered. Results are not as favorable with CHS, albeit with a lack of robust data. The available evidence suggests similar management protocols would potentially improve outcomes with CHS. A potential addition to successful cooling may include hemodynamic support. Lastly, recommendations for enhanced data and documentation for heat stroke in emergency management could help foster consistent, updated clinical guidelines.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 49-54"},"PeriodicalIF":2.2,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031731","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}

引用次数: 0

Evaluation of the prehospital characteristics of traumatic amputation cases: A retrospective observational study 外伤性截肢病例院前特征的评价：一项回顾性观察研究。

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-10 DOI: 10.1016/j.ajem.2026.01.003

Mehmet Yılmaz MD , Burak Bekgöz MD , İshak Şan MD

Objective

This study aimed to comprehensively assess the epidemiological, etiological, and operational characteristics of prehospital traumatic amputations with a specific focus on demographic patterns, injury mechanisms, anatomical distribution, and emergency medical services (EMS) response intervals and distances.

Methods

This retrospective observational study initially assessed 1704 suspected traumatic amputation cases recorded in the Ankara Ambulance Service Operations System between January 2018 and December 2023. After applying the exclusion criteria of on-scene death (n = 60), interfacility transfer (n = 556), and non-amputation trauma (n = 72), a total of 1016 eligible cases were included in the final analysis. Extracted variables included patient demographics, injury etiology, extremity involvement (upper vs. lower), urban vs. rural location, prehospital vital signs, and operational metrics (dispatch-to-arrival, on-scene, and scene-to-hospital times and corresponding distances). Statistical analyses entailed chi-square or Fisher exact tests for categorical variables, t-tests or Mann–Whitney U tests for continuous variables, and Bonferroni corrections for multiple comparisons.

Results

The median age of the patients was 32 years (IQR: 21–47) and 75.8% were male. Upper extremity amputations predominated (79.5%), particularly in cases of occupational (86.5%) and domestic (86.1%) injuries, while lower extremity amputations were more frequent in traffic accidents (34.9%). Occupational accidents were significantly more common among men and domestic accidents among women (p < 0.001, Bonferroni-adjusted). Rural patients had significantly longer call-to-arrival times (median: 15.0 vs. 8.0 min), scene-to-hospital times (21.0 vs. 13.0 min), and total distances (median 45.0 vs. 17.0 km) than urban patients (all p < 0.001). Traffic accidents had the longest on-scene times (median: 10.8 min) compared to occupational (9.0 min) and domestic (8.8 min) injuries (p < 0.001). Vital signs showed no significant differences between upper and lower extremity cases.

Conclusion

Prehospital traumatic amputations in this large cohort displayed clear demographic and etiological trends, with upper extremity injuries predominating and distinct sex- and mechanism-specific patterns. Rural–urban disparities in prehospital times and distances were pronounced and traffic-related amputations required longer on-scene management. These findings highlight the need for targeted prevention strategies, EMS workflow optimization, and the strengthening of rural trauma systems to improve survival and limb salvage outcomes.

目的：本研究旨在全面评估院前创伤性截肢的流行病学、病因学和手术特征，特别关注人口统计学模式、损伤机制、解剖分布和紧急医疗服务（EMS）响应间隔和距离。方法：本回顾性观察研究初步评估了2018年1月至2023年12月期间安卡拉救护车服务运营系统记录的1704例疑似创伤性截肢病例。采用现场死亡（n = 60）、机构间转移（n = 556）和非截肢创伤（n = 72）的排除标准，最终纳入1016例符合条件的病例。提取的变量包括患者人口统计学、损伤病因、四肢受累（上肢与下肢）、城市与农村位置、院前生命体征和操作指标（从调度到到达、现场和现场到医院的时间及相应距离）。统计分析需要对分类变量进行卡方检验或Fisher精确检验，对连续变量进行t检验或Mann-Whitney U检验，对多重比较进行Bonferroni修正。结果：患者中位年龄32岁（IQR: 21 ~ 47），男性占75.8%。上肢截肢占多数（79.5%），尤其是职业（86.5%）和家庭（86.1%）伤害，而下肢截肢在交通事故中更为常见（34.9%）。职业事故在男性中更常见，而家庭事故在女性中更常见(p结论：在这一大型队列中，院前创伤性截肢显示出明确的人口统计学和病因学趋势，上肢损伤占主导地位，并有明显的性别和机制特异性模式。城乡在院前时间和距离上存在明显差异，与交通有关的截肢需要更长的现场处理时间。这些发现强调了有针对性的预防策略、EMS工作流程优化和加强农村创伤系统以提高生存率和肢体保留结果的必要性。

{"title":"Evaluation of the prehospital characteristics of traumatic amputation cases: A retrospective observational study","authors":"Mehmet Yılmaz MD , Burak Bekgöz MD , İshak Şan MD","doi":"10.1016/j.ajem.2026.01.003","DOIUrl":"10.1016/j.ajem.2026.01.003","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to comprehensively assess the epidemiological, etiological, and operational characteristics of prehospital traumatic amputations with a specific focus on demographic patterns, injury mechanisms, anatomical distribution, and emergency medical services (EMS) response intervals and distances.</div></div><div><h3>Methods</h3><div>This retrospective observational study initially assessed 1704 suspected traumatic amputation cases recorded in the Ankara Ambulance Service Operations System between January 2018 and December 2023. After applying the exclusion criteria of on-scene death (<em>n</em> = 60), interfacility transfer (<em>n</em> = 556), and non-amputation trauma (<em>n</em> = 72), a total of 1016 eligible cases were included in the final analysis. Extracted variables included patient demographics, injury etiology, extremity involvement (upper vs. lower), urban vs. rural location, prehospital vital signs, and operational metrics (dispatch-to-arrival, on-scene, and scene-to-hospital times and corresponding distances). Statistical analyses entailed chi-square or Fisher exact tests for categorical variables, <em>t</em>-tests or Mann–Whitney <em>U</em> tests for continuous variables, and Bonferroni corrections for multiple comparisons.</div></div><div><h3>Results</h3><div>The median age of the patients was 32 years (IQR: 21–47) and 75.8% were male. Upper extremity amputations predominated (79.5%), particularly in cases of occupational (86.5%) and domestic (86.1%) injuries, while lower extremity amputations were more frequent in traffic accidents (34.9%). Occupational accidents were significantly more common among men and domestic accidents among women (<em>p</em> < 0.001, Bonferroni-adjusted). Rural patients had significantly longer call-to-arrival times (median: 15.0 vs. 8.0 min), scene-to-hospital times (21.0 vs. 13.0 min), and total distances (median 45.0 vs. 17.0 km) than urban patients (all <em>p</em> < 0.001). Traffic accidents had the longest on-scene times (median: 10.8 min) compared to occupational (9.0 min) and domestic (8.8 min) injuries (p < 0.001). Vital signs showed no significant differences between upper and lower extremity cases.</div></div><div><h3>Conclusion</h3><div>Prehospital traumatic amputations in this large cohort displayed clear demographic and etiological trends, with upper extremity injuries predominating and distinct sex- and mechanism-specific patterns. Rural–urban disparities in prehospital times and distances were pronounced and traffic-related amputations required longer on-scene management. These findings highlight the need for targeted prevention strategies, EMS workflow optimization, and the strengthening of rural trauma systems to improve survival and limb salvage outcomes.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 126-130"},"PeriodicalIF":2.2,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068798","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}

引用次数: 0

Protocolized trauma team activations improve trauma patient outcomes and decrease decision-making intervals 程序化的创伤小组激活改善了创伤患者的预后，缩短了决策间隔

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-09 DOI: 10.1016/j.ajem.2026.01.011

Yau-Ren Chang , Hu-Lin Christina Wang , Chien Wu , Po-Cheng Chen , Keng-Li Lin , Chih-Yuan Fu , Heng-Fu Lin

Introduction

Trauma team activation (TTA) is widely recognized to improve outcomes in trauma care; however, few studies have examined its long-term maturation and the effects of protocolized implementation. This study aimed to evaluate the impact of a comprehensive trauma team protocol introduced in 2012 in a single institution and to identify factors associated with patient outcomes.

Methods

We conducted a retrospective cohort study of trauma patients who underwent TTA between 2006 and 2023 at a single medical center in Taiwan. The generalized protocol was implemented in 2012 for trauma patients who fulfilled the TTA criteria. Patients <18 years old, who were dead or had unknown vital signs on arrival at the emergency department (ED) or had been transferred from other institutions were excluded. The primary outcomes were the patient clinical outcomes; the time intervals to critical decision-making points after TTA were evaluated as secondary outcomes. Logistic regression was performed to identify independent risk factors.

Results

The study included 3002 patients. Compared with patients in the pre-protocolized stage (n = 518), patients in the protocolized stage (n = 2484) had a higher survival rate (90.5% vs. 79.7%, p < 0.001), lower morbidity (0.8% vs. 10.6%, p < 0.001), a higher success rate of nonoperative management (NOM) (39.0% vs. 27.2%, p < 0.001), and shorter ED-to-computed tomography (CT) times (39.0 vs. 52.6 min, p = 0.001). Multivariate analysis identified age, Trauma Score and Injury Severity Score (TRISS), Glasgow Coma Scale (GCS) score, and treatment stage as independent predictors of survival. In addition, timely ED-to-CT (≤60 min) was more frequent in the protocolized stage.

Conclusion

Implementing a protocolized TTA system is feasible and can enhance the quality of trauma care, both in processes and outcomes. The treatment stage itself, independent of patient condition, serves as a determinant of clinical results. Tertiary trauma centers should consider adopting a standardized TTA protocol to improve patient outcomes.

创伤小组激活（TTA）被广泛认为可以改善创伤护理的结果；然而，很少有研究考察其长期成熟度和协议化实施的影响。本研究旨在评估2012年在单一机构引入的综合创伤团队协议的影响，并确定与患者预后相关的因素。方法对2006年至2023年间在台湾某医疗中心接受TTA治疗的创伤患者进行回顾性队列研究。2012年对符合TTA标准的创伤患者实施了通用方案。18岁、到达急诊科（ED）时死亡或有未知生命体征或从其他机构转来的患者被排除在外。主要结局是患者的临床结局；TTA后到达关键决策点的时间间隔被评价为次要结果。采用Logistic回归分析确定独立危险因素。结果纳入3002例患者。与方案前阶段（n = 518）的患者相比，方案期（n = 2484）的患者生存率更高（90.5%对79.7%,p < 0.001），发病率更低（0.8%对10.6%,p < 0.001），非手术治疗成功率更高（39.0%对27.2%,p < 0.001）， ed - CT （CT）时间更短（39.0对52.6分钟，p = 0.001）。多变量分析发现，年龄、创伤评分和损伤严重程度评分（TRISS）、格拉斯哥昏迷量表（GCS）评分和治疗分期是独立的生存预测因素。此外，在协议阶段，及时的ED-to-CT（≤60 min）更为常见。结论实施协议化的TTA系统是可行的，可以从过程和结果两方面提高创伤护理质量。治疗阶段本身，独立于患者病情，是临床结果的决定因素。三级创伤中心应考虑采用标准化的TTA方案来改善患者的预后。

{"title":"Protocolized trauma team activations improve trauma patient outcomes and decrease decision-making intervals","authors":"Yau-Ren Chang , Hu-Lin Christina Wang , Chien Wu , Po-Cheng Chen , Keng-Li Lin , Chih-Yuan Fu , Heng-Fu Lin","doi":"10.1016/j.ajem.2026.01.011","DOIUrl":"10.1016/j.ajem.2026.01.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma team activation (TTA) is widely recognized to improve outcomes in trauma care; however, few studies have examined its long-term maturation and the effects of protocolized implementation. This study aimed to evaluate the impact of a comprehensive trauma team protocol introduced in 2012 in a single institution and to identify factors associated with patient outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of trauma patients who underwent TTA between 2006 and 2023 at a single medical center in Taiwan. The generalized protocol was implemented in 2012 for trauma patients who fulfilled the TTA criteria. Patients <18 years old, who were dead or had unknown vital signs on arrival at the emergency department (ED) or had been transferred from other institutions were excluded. The primary outcomes were the patient clinical outcomes; the time intervals to critical decision-making points after TTA were evaluated as secondary outcomes. Logistic regression was performed to identify independent risk factors.</div></div><div><h3>Results</h3><div>The study included 3002 patients. Compared with patients in the pre-protocolized stage (<em>n</em> = 518), patients in the protocolized stage (<em>n</em> = 2484) had a higher survival rate (90.5% vs. 79.7%, <em>p</em> < 0.001), lower morbidity (0.8% vs. 10.6%, p < 0.001), a higher success rate of nonoperative management (NOM) (39.0% vs. 27.2%, p < 0.001), and shorter ED-to-computed tomography (CT) times (39.0 vs. 52.6 min, <em>p</em> = 0.001). Multivariate analysis identified age, Trauma Score and Injury Severity Score (TRISS), Glasgow Coma Scale (GCS) score, and treatment stage as independent predictors of survival. In addition, timely ED-to-CT (≤60 min) was more frequent in the protocolized stage.</div></div><div><h3>Conclusion</h3><div>Implementing a protocolized TTA system is feasible and can enhance the quality of trauma care, both in processes and outcomes. The treatment stage itself, independent of patient condition, serves as a determinant of clinical results. Tertiary trauma centers should consider adopting a standardized TTA protocol to improve patient outcomes.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 1-7"},"PeriodicalIF":2.2,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963138","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}

引用次数: 0

New world screwworm: A focused review for the emergency medicine clinician 新的世界螺旋蝇：急诊医学临床医师的重点综述

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-08 DOI: 10.1016/j.ajem.2026.01.007

Brit Long MD , Anissa Finley DO , Stephen Y. Liang MD, MPHS , Heather A. Heaton MD

Introduction

New World Screwworm (NWS), or Cochliomyia hominivorax, is a potentially fatal disease due to severe larvae infestation and tissue destruction. A resurgence has been reported.

Objective

This narrative review provides a focused overview of NWS for the emergency clinician, including the epidemiology, presentation, diagnosis, and management of the disease.

Discussion

NWS is endemic to tropical and subtropical America. While previously eradicated in the U.S., several human cases have been recently reported. This insect primarily infests livestock but may also affect humans. Female flies are attracted to mucosal surfaces and wounds and lay hundreds of eggs. Once hatching, larvae burrow into these surfaces and cause extensive damage by ingesting live tissue. Humans at risk include those with significant immunocompromise, open wounds, and those around animals. Infested patients present with severe swelling, bleeding, pain, and open, malodorous wounds. Larvae are usually visible in the wound. Bacterial superinfections may also occur. Suspected cases should be reported to the local or state public health department and the Centers for Disease Control and Prevention. Diagnosis includes morphologic identification of larvae removed from a wound. Larvae should be placed in a leak-proof container with 70% ethanol. Serum laboratory testing may also be needed in patients with evidence of bacterial superinfection and sepsis. Treatment includes removal of all larvae and often extensive debridement. Reevaluation of the wound within 48 h is recommended. Antibiotics are necessary for those with bacterial superinfection.

Conclusion

Emergency clinicians should be aware of the presentation, diagnosis, evaluation, and management of NWS to ensure optimal outcomes.

新世界螺旋虫（new World Screwworm，简称NWS）是一种具有潜在致命性的疾病，其幼虫严重侵染并破坏组织。据报道，这种情况又开始抬头。目的本综述为急诊临床医生提供了NWS的重点概述，包括该病的流行病学、表现、诊断和治疗。nws是热带和亚热带美洲特有的疾病。虽然以前在美国被根除，但最近报告了几例人类病例。这种昆虫主要侵害牲畜，但也可能影响人类。雌性苍蝇被粘膜表面和伤口吸引，产卵数百个。一旦孵化，幼虫就会钻入这些表面，并通过摄入活组织造成广泛的损害。有风险的人包括免疫功能明显低下的人、开放性伤口和动物周围的人。受感染的患者表现为严重的肿胀、出血、疼痛和开放性、有恶臭的伤口。伤口上通常可以看到幼虫。细菌重复感染也可能发生。疑似病例应报告给当地或州公共卫生部门和疾病控制与预防中心。诊断包括从伤口取出的幼虫的形态学鉴定。幼虫应放置在含有70%乙醇的防漏容器中。有细菌重复感染和败血症证据的患者也可能需要进行血清实验室检测。治疗包括清除所有幼虫和通常广泛的清创。建议在48小时内重新评估伤口。抗生素对于细菌重复感染是必需的。结论急诊临床医生应了解NWS的表现、诊断、评估和管理，以确保最佳结果。

{"title":"New world screwworm: A focused review for the emergency medicine clinician","authors":"Brit Long MD , Anissa Finley DO , Stephen Y. Liang MD, MPHS , Heather A. Heaton MD","doi":"10.1016/j.ajem.2026.01.007","DOIUrl":"10.1016/j.ajem.2026.01.007","url":null,"abstract":"<div><h3>Introduction</h3><div>New World Screwworm (NWS), or <em>Cochliomyia hominivorax</em>, is a potentially fatal disease due to severe larvae infestation and tissue destruction. A resurgence has been reported.</div></div><div><h3>Objective</h3><div>This narrative review provides a focused overview of NWS for the emergency clinician, including the epidemiology, presentation, diagnosis, and management of the disease.</div></div><div><h3>Discussion</h3><div>NWS is endemic to tropical and subtropical America. While previously eradicated in the U.S., several human cases have been recently reported. This insect primarily infests livestock but may also affect humans. Female flies are attracted to mucosal surfaces and wounds and lay hundreds of eggs. Once hatching, larvae burrow into these surfaces and cause extensive damage by ingesting live tissue. Humans at risk include those with significant immunocompromise, open wounds, and those around animals. Infested patients present with severe swelling, bleeding, pain, and open, malodorous wounds. Larvae are usually visible in the wound. Bacterial superinfections may also occur. Suspected cases should be reported to the local or state public health department and the Centers for Disease Control and Prevention. Diagnosis includes morphologic identification of larvae removed from a wound. Larvae should be placed in a leak-proof container with 70% ethanol. Serum laboratory testing may also be needed in patients with evidence of bacterial superinfection and sepsis. Treatment includes removal of all larvae and often extensive debridement. Reevaluation of the wound within 48 h is recommended. Antibiotics are necessary for those with bacterial superinfection.</div></div><div><h3>Conclusion</h3><div>Emergency clinicians should be aware of the presentation, diagnosis, evaluation, and management of NWS to ensure optimal outcomes.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 8-12"},"PeriodicalIF":2.2,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963173","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}

引用次数: 0

Achieved blood pressure during the first 12 h and clinical outcomes in patients with out-of-hospital cardiac arrest 院外心脏骤停患者前12小时的血压及临床结果

IF 2.2 3区医学 Q1 EMERGENCY MEDICINE

American Journal of Emergency Medicine

Pub Date : 2026-01-08 DOI: 10.1016/j.ajem.2026.01.009

Chen-Hsi Chang M.D. , Shih-Neng Lin M.D. , Hao-Wei Lee M.D. , Ming-Jen Kuo M.D. , Pai-Feng Hsu M.D., Ph.D. , I-Hsin Lee M.D. , Teh-Fu Hsu M.D. , Chorng-Kuang How M.D. , Yenn-Jiang Lin M.D., Ph.D. , Chin-Chou Huang M.D., Ph.D.

Purpose

There is a significant correlation between mean arterial pressure (MAP) levels after the return of spontaneous circulation (ROSC) and the outcomes of out-of-hospital cardiac arrest (OHCA) patients. This study investigates the impact of MAP regulation within 12 h post-ROSC on OHCA outcomes.

Methods

This retrospective, single-center cohort study included non-traumatic OHCA patients who achieved ROSC at a medical center in Taiwan between January 1, 2017, and December 31, 2022. The primary outcomes were 30-day mortality and neurological status assessed by the Cerebral Performance Category (CPC) score.

Results

A total of 231 OHCA survivors were included in the analysis. Patients were stratified into three tertiles based on MAP distribution, with each group consisting of 77 patients, as follows: MAP < 80 mmHg, 80 ≤ MAP <95 mmHg, and MAP ≥ 95 mmHg, based on measurements taken within the first 12 h post-ROSC. No significant differences were observed in mortality or CPC scores between the 80 ≤ MAP < 95 mmHg and ≥ 95 mmHg groups. However, MAP levels below 80 mmHg were correlated with significantly higher 30-day mortality (hazard ratio [HR] = 1.760, 95% confidence interval [CI] = 1.130–2.760, P = 0.013) and worse neurological outcomes (HR = 1.560, 95% CI = 1.060–2.300, P = 0.023).

Conclusion

MAP <80 mmHg within the first 12 h post-ROSC is a strong predictor of poor clinical outcomes in OHCA patients, while a higher MAP target (≥ 95 mmHg) is not associated with additional benefit in the early post-arrest period.

目的探讨院外心脏骤停（OHCA）患者自发循环恢复（ROSC）后平均动脉压（MAP）水平与预后的相关性。本研究探讨rosc后12小时内MAP调节对OHCA结果的影响。方法本研究为回顾性单中心队列研究，纳入2017年1月1日至2022年12月31日在台湾某医疗中心完成ROSC的非创伤性OHCA患者。主要结局是30天死亡率和脑功能分类（CPC）评分评估的神经系统状态。结果共有231例OHCA幸存者纳入分析。根据MAP分布将患者分为三组，每组77例患者，根据rosc后前12小时内的测量结果分为MAP <； 80 mmHg, 80≤MAP <；95 mmHg和MAP≥95 mmHg。80≤MAP <； 95 mmHg组和≥95 mmHg组的死亡率或CPC评分无显著差异。然而，MAP水平低于80 mmHg与较高的30天死亡率（风险比[HR] = 1.760, 95%可信区间[CI] = 1.130-2.760, P = 0.013）和较差的神经预后（HR = 1.560, 95% CI = 1.060-2.300, P = 0.023）相关。结论：rosc后12小时内MAP = 80 mmHg是OHCA患者临床预后不良的有力预测指标，而较高的MAP目标（≥95 mmHg）与骤停后早期的额外获益无关。

{"title":"Achieved blood pressure during the first 12 h and clinical outcomes in patients with out-of-hospital cardiac arrest","authors":"Chen-Hsi Chang M.D. , Shih-Neng Lin M.D. , Hao-Wei Lee M.D. , Ming-Jen Kuo M.D. , Pai-Feng Hsu M.D., Ph.D. , I-Hsin Lee M.D. , Teh-Fu Hsu M.D. , Chorng-Kuang How M.D. , Yenn-Jiang Lin M.D., Ph.D. , Chin-Chou Huang M.D., Ph.D.","doi":"10.1016/j.ajem.2026.01.009","DOIUrl":"10.1016/j.ajem.2026.01.009","url":null,"abstract":"<div><h3>Purpose</h3><div>There is a significant correlation between mean arterial pressure (MAP) levels after the return of spontaneous circulation (ROSC) and the outcomes of out-of-hospital cardiac arrest (OHCA) patients. This study investigates the impact of MAP regulation within 12 h post-ROSC on OHCA outcomes.</div></div><div><h3>Methods</h3><div>This retrospective, single-center cohort study included non-traumatic OHCA patients who achieved ROSC at a medical center in Taiwan between January 1, 2017, and December 31, 2022. The primary outcomes were 30-day mortality and neurological status assessed by the Cerebral Performance Category (CPC) score.</div></div><div><h3>Results</h3><div>A total of 231 OHCA survivors were included in the analysis. Patients were stratified into three tertiles based on MAP distribution, with each group consisting of 77 patients, as follows: MAP < 80 mmHg, 80 ≤ MAP <95 mmHg, and MAP ≥ 95 mmHg, based on measurements taken within the first 12 h post-ROSC. No significant differences were observed in mortality or CPC scores between the 80 ≤ MAP < 95 mmHg and ≥ 95 mmHg groups. However, MAP levels below 80 mmHg were correlated with significantly higher 30-day mortality (hazard ratio [HR] = 1.760, 95% confidence interval [CI] = 1.130–2.760, <em>P</em> = 0.013) and worse neurological outcomes (HR = 1.560, 95% CI = 1.060–2.300, <em>P</em> = 0.023).</div></div><div><h3>Conclusion</h3><div>MAP <80 mmHg within the first 12 h post-ROSC is a strong predictor of poor clinical outcomes in OHCA patients, while a higher MAP target (≥ 95 mmHg) is not associated with additional benefit in the early post-arrest period.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"102 ","pages":"Pages 13-20"},"PeriodicalIF":2.2,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963139","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}

引用次数: 0