Acute Medicine & Surgery最新文献

Prehospital Variability of Pediatric Emergency Acuity Assessment Criteria in Japan: A Nationwide Analysis of Fire Department Protocols. 日本儿科急诊视力评估标准院前变异性：全国消防部门协议分析。

IF 1.3 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2026-02-23 eCollection Date: 2026-01-01 DOI: 10.1002/ams2.70124

Sakura Minami, Chiaki Toida, Naoki Yogo, Noriyuki Kaku, Takeru Abe, Takashi Moriya

Introduction: In pediatric emergency care, acuity assessment is required based on age-specific physiological characteristics. However, in Japan, prehospital pediatric acuity d protocols vary regionally in the assessment tools and vital sign criteria used. This study aimed to clarify the differences in assessment tools and vital sign criteria currently used for pediatric acuity determination in Japan.

Methods: This study used data from a nationwide survey conducted in August 2024 by the Pediatric Emergency Committee, Japanese Society for Emergency Medicine, which targeted emergency medical services supervisors at all 720 fire departments across Japan regarding the presence and content of pediatric acuity determination protocols. Collected protocols were compared and analyzed for differences in assessment tools, vital sign thresholds, and age categorizations.

Results: Responses were obtained from 561 departments (77.9%). After consolidation of duplicate prefecture-level protocols, 32 unique pediatric acuity determination protocols were included in the final analysis. Only one protocol fully adhered to the Fire and Disaster Management Agency (FDMA) framework, whereas most protocols were based on the Foundation for Ambulance Service Development (FASD) criteria. The upper and lower limits of vital signs varied, with apparent differences in younger age groups. Age categorizations ranged from three broad divisions to detailed subdivisions.

Conclusion: Japan's prehospital pediatric acuity determination shows substantial regional variability, reflected in the identification of multiple distinct protocols and limited real-world adherence to FDMA-based criteria. Nationwide standardization and implementation of FDMA-based criteria should be prioritized before developing new systems, followed by validation in real-world practice to ensure feasibility, equity, and clinical effectiveness.

简介：在儿科急诊护理中，需要根据年龄特定的生理特征进行视力评估。然而，在日本，院前儿科敏锐度协议在使用的评估工具和生命体征标准方面因地区而异。本研究旨在澄清日本目前用于儿科锐度测定的评估工具和生命体征标准的差异。方法：本研究使用了日本急诊医学学会儿科急诊委员会于2024年8月进行的一项全国性调查的数据，该调查针对日本所有720个消防部门的急诊医疗服务主管，调查了儿童敏锐度测定方案的存在和内容。收集的方案比较和分析评估工具、生命体征阈值和年龄分类的差异。结果：共获得561个科室的反馈，占77.9%。在合并重复的地级方案后，最终分析了32个独特的儿科锐度计测定方案。只有一个协议完全遵守消防和灾害管理局（FDMA）框架，而大多数协议都是基于救护车服务发展基金会（FASD）标准。生命体征的上下限各不相同，在低龄组差异明显。年龄分类范围从三个大的分类到详细的细分。结论：日本的院前儿科锐度测定显示出很大的地区差异，这反映在多种不同方案的识别和基于fdma标准的有限现实依从性上。在开发新系统之前，应优先考虑全国范围内基于fdma标准的标准化和实施，然后在实际实践中进行验证，以确保可行性、公平性和临床有效性。

{"title":"Prehospital Variability of Pediatric Emergency Acuity Assessment Criteria in Japan: A Nationwide Analysis of Fire Department Protocols.","authors":"Sakura Minami, Chiaki Toida, Naoki Yogo, Noriyuki Kaku, Takeru Abe, Takashi Moriya","doi":"10.1002/ams2.70124","DOIUrl":"https://doi.org/10.1002/ams2.70124","url":null,"abstract":"<p><strong>Introduction: </strong>In pediatric emergency care, acuity assessment is required based on age-specific physiological characteristics. However, in Japan, prehospital pediatric acuity d protocols vary regionally in the assessment tools and vital sign criteria used. This study aimed to clarify the differences in assessment tools and vital sign criteria currently used for pediatric acuity determination in Japan.</p><p><strong>Methods: </strong>This study used data from a nationwide survey conducted in August 2024 by the Pediatric Emergency Committee, Japanese Society for Emergency Medicine, which targeted emergency medical services supervisors at all 720 fire departments across Japan regarding the presence and content of pediatric acuity determination protocols. Collected protocols were compared and analyzed for differences in assessment tools, vital sign thresholds, and age categorizations.</p><p><strong>Results: </strong>Responses were obtained from 561 departments (77.9%). After consolidation of duplicate prefecture-level protocols, 32 unique pediatric acuity determination protocols were included in the final analysis. Only one protocol fully adhered to the Fire and Disaster Management Agency (FDMA) framework, whereas most protocols were based on the Foundation for Ambulance Service Development (FASD) criteria. The upper and lower limits of vital signs varied, with apparent differences in younger age groups. Age categorizations ranged from three broad divisions to detailed subdivisions.</p><p><strong>Conclusion: </strong>Japan's prehospital pediatric acuity determination shows substantial regional variability, reflected in the identification of multiple distinct protocols and limited real-world adherence to FDMA-based criteria. Nationwide standardization and implementation of FDMA-based criteria should be prioritized before developing new systems, followed by validation in real-world practice to ensure feasibility, equity, and clinical effectiveness.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":"e70124"},"PeriodicalIF":1.3,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12929648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147289079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Predicting Reduced Left Ventricular Ejection Fraction in Patients With ST-Elevation Myocardial Infarction: Role of the Quick Forrester Classification 预测st段抬高型心肌梗死患者左室射血分数降低：快速Forrester分类的作用

IF 1.3 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2026-02-20 DOI: 10.1002/ams2.70120

Yosuke Matsumoto, Shoji Kawakami, Hidenobu Koga, Eigo Nawata, Yoshihiro Ota, Hikaru Sasamoto, Masato Takei, Chikako Tamura, Kenichi Kitahara, Tetsuhisa Yamada, Jun-Ichiro Nishi

Introduction

Cardiogenic shock, heart failure, and reduced left ventricular ejection fraction (LVEF) are major determinants of poor prognosis in patients with ST-elevation myocardial infarction (STEMI). Rapid identification of high-risk patients and subsequent provision of multidisciplinary care are critical. However, traditional risk scores mainly rely on infarct size, age, and hemodynamics, which may offer limited discriminatory ability at the time of hospital arrival. We developed a quick Forrester classification (QFC) using the respiratory rate (RR) and serum lactate levels upon hospital arrival and investigated its association with a reduced LVEF of patients with STEMI.

Methods

This retrospective cohort study included consecutive patients with STEMI from 2018 to 2023. Patients were divided into four QFC classes: Class-1 (RR < 20 per minute and lactate < 2.0 mmol/L), Class-2 (RR ≥ 20 per minute and lactate < 2.0 mmol/L), Class-3 (RR < 20 per minute and lactate ≥ 2.0 mmol/L), and Class-4 (RR ≥ 20 per minute and lactate ≥ 2.0 mmol/L). The primary endpoint was the LVEF < 45% measured by transthoracic echocardiography before discharge.

Results

Among 569 patients with STEMI (Class-1: 118; Class-2: 146; Class-3: 92; Class-4: 213), the QFC Class-4 demonstrated the highest proportions of reduced LVEF (26%) and mechanical circulatory support use (13%). In multivariable logistic analysis, Class-4 was independently associated with reduced LVEF compared with Class-1 (odds ratio 2.47).

Conclusion

The QFC, based solely on RR and lactate levels, was significantly associated with reduced LVEF in STEMI. This simple bedside tool may support rapid identification of high-risk patients on arrival and complement existing risk stratification strategies to facilitate timely multidisciplinary management. Clinical Trial Registration: Aso Iizuka Hospital/approval ID: 21068.

心源性休克、心力衰竭和左心室射血分数（LVEF）降低是st段抬高型心肌梗死（STEMI）患者预后不良的主要决定因素。快速识别高危患者和随后提供多学科护理至关重要。然而，传统的风险评分主要依赖于梗死面积、年龄和血流动力学，这可能在到达医院时提供有限的区分能力。我们开发了一种快速的福瑞斯特分类（QFC），使用到达医院时的呼吸频率（RR）和血清乳酸水平，并研究其与STEMI患者LVEF降低的关系。方法：本回顾性队列研究纳入2018年至2023年连续STEMI患者。结果：在569例STEMI患者中（1类：118例；2类：146例；3类：92例；4类：213例），QFC 4类患者LVEF降低比例最高（26%），机械循环支持使用比例最高（13%）。在多变量logistic分析中，与1级相比，4级与LVEF降低独立相关（优势比2.47）。结论：仅基于RR和乳酸水平的QFC与STEMI患者LVEF降低显著相关。这个简单的床边工具可以支持在到达时快速识别高风险患者，并补充现有的风险分层策略，以促进及时的多学科管理。临床试验注册：Aso Iizuka医院/批准号：21068。

{"title":"Predicting Reduced Left Ventricular Ejection Fraction in Patients With ST-Elevation Myocardial Infarction: Role of the Quick Forrester Classification","authors":"Yosuke Matsumoto, Shoji Kawakami, Hidenobu Koga, Eigo Nawata, Yoshihiro Ota, Hikaru Sasamoto, Masato Takei, Chikako Tamura, Kenichi Kitahara, Tetsuhisa Yamada, Jun-Ichiro Nishi","doi":"10.1002/ams2.70120","DOIUrl":"10.1002/ams2.70120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cardiogenic shock, heart failure, and reduced left ventricular ejection fraction (LVEF) are major determinants of poor prognosis in patients with ST-elevation myocardial infarction (STEMI). Rapid identification of high-risk patients and subsequent provision of multidisciplinary care are critical. However, traditional risk scores mainly rely on infarct size, age, and hemodynamics, which may offer limited discriminatory ability at the time of hospital arrival. We developed a quick Forrester classification (QFC) using the respiratory rate (RR) and serum lactate levels upon hospital arrival and investigated its association with a reduced LVEF of patients with STEMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included consecutive patients with STEMI from 2018 to 2023. Patients were divided into four QFC classes: Class-1 (RR < 20 per minute and lactate < 2.0 mmol/L), Class-2 (RR ≥ 20 per minute and lactate < 2.0 mmol/L), Class-3 (RR < 20 per minute and lactate ≥ 2.0 mmol/L), and Class-4 (RR ≥ 20 per minute and lactate ≥ 2.0 mmol/L). The primary endpoint was the LVEF < 45% measured by transthoracic echocardiography before discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 569 patients with STEMI (Class-1: 118; Class-2: 146; Class-3: 92; Class-4: 213), the QFC Class-4 demonstrated the highest proportions of reduced LVEF (26%) and mechanical circulatory support use (13%). In multivariable logistic analysis, Class-4 was independently associated with reduced LVEF compared with Class-1 (odds ratio 2.47).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The QFC, based solely on RR and lactate levels, was significantly associated with reduced LVEF in STEMI. This simple bedside tool may support rapid identification of high-risk patients on arrival and complement existing risk stratification strategies to facilitate timely multidisciplinary management. <b>Clinical Trial Registration:</b> Aso Iizuka Hospital/approval ID: 21068.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147281636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Case of Paroxysmal Sympathetic Hyperactivity due to Cardiogenic Shock 心源性休克致阵发性交感神经亢进1例。

IF 1.3 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2026-02-18 DOI: 10.1002/ams2.70123

Takahito Katsuyama, Chiaki Toida, Yasuaki Maeda, Masao Hattori, Akiko Kameyama, Hiroshi Kamijo, Hiroshi Miyama, Yuichiro Kashima, Hiroshi Imamura

Background

Paroxysmal sympathetic hyperactivity (PSH) is characterized by excessive autonomic activation typically seen after severe brain injury. PSH has not previously been reported in association with cardiogenic shock. Here, we report a case of PSH during the treatment of cardiogenic shock with dilated cardiomyopathy.

Case Presentation

A 60-year-old man with cardiogenic shock and dilated cardiomyopathy was transferred to our hospital. He was intubated and received an Impella support. On Day 4 post-admission, paroxysmal fever, tachycardia, tachypnea, and abnormal muscle tone were observed in the extremities. Antiepileptic drugs and broad-spectrum antibiotics were ineffective, and the seizure pattern suggested PSH; therefore, gabapentin was started on Day 27 post-admission. The seizures gradually resolved and eventually resolved.

Conclusion

This case suggests that PSH may be triggered by functional disturbances in cerebral perfusion and autonomic regulation associated with cardiogenic shock, even in the absence of irreversible brain injury. When patients with cardiogenic shock present with paroxysmal tachycardia, tachypnea, and fever, PSH should be considered in the differential diagnosis. Early recognition of PSH may facilitate timely treatment and contribute to improved clinical outcomes.

背景：阵发性交感神经亢进（PSH）以过度的自主神经激活为特征，通常在严重脑损伤后出现。PSH与心源性休克的相关性此前未见报道。在这里，我们报告一例PSH在治疗心源性休克扩张型心肌病。病例介绍：一位60岁男性心源性休克合并扩张性心肌病转送我院。他接受了气管插管和穿刺支持。入院后第4天，患者四肢出现阵发性发热、心动过速、呼吸急促、肌张力异常。抗癫痫药物及广谱抗生素无效，癫痫发作模式提示PSH；因此，加巴喷丁在入院后第27天开始使用。癫痫发作逐渐消退，最终痊愈。结论：本病例提示PSH可能由与心源性休克相关的脑灌注和自主神经调节功能障碍引发，即使在没有不可逆脑损伤的情况下。当心源性休克患者出现阵发性心动过速、呼吸急促和发热时，应考虑PSH作为鉴别诊断的依据。早期识别PSH可能有助于及时治疗，并有助于改善临床结果。

{"title":"A Case of Paroxysmal Sympathetic Hyperactivity due to Cardiogenic Shock","authors":"Takahito Katsuyama, Chiaki Toida, Yasuaki Maeda, Masao Hattori, Akiko Kameyama, Hiroshi Kamijo, Hiroshi Miyama, Yuichiro Kashima, Hiroshi Imamura","doi":"10.1002/ams2.70123","DOIUrl":"10.1002/ams2.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Paroxysmal sympathetic hyperactivity (PSH) is characterized by excessive autonomic activation typically seen after severe brain injury. PSH has not previously been reported in association with cardiogenic shock. Here, we report a case of PSH during the treatment of cardiogenic shock with dilated cardiomyopathy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 60-year-old man with cardiogenic shock and dilated cardiomyopathy was transferred to our hospital. He was intubated and received an Impella support. On Day 4 post-admission, paroxysmal fever, tachycardia, tachypnea, and abnormal muscle tone were observed in the extremities. Antiepileptic drugs and broad-spectrum antibiotics were ineffective, and the seizure pattern suggested PSH; therefore, gabapentin was started on Day 27 post-admission. The seizures gradually resolved and eventually resolved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case suggests that PSH may be triggered by functional disturbances in cerebral perfusion and autonomic regulation associated with cardiogenic shock, even in the absence of irreversible brain injury. When patients with cardiogenic shock present with paroxysmal tachycardia, tachypnea, and fever, PSH should be considered in the differential diagnosis. Early recognition of PSH may facilitate timely treatment and contribute to improved clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12916243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association of Level 3 Personal Protective Equipment With Intubation Success in the Emergency Department 三级个人防护装备与急诊插管成功率的关系

IF 1.3 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2026-02-17 DOI: 10.1002/ams2.70121

Haruka Tsuji, Takashi Shiga, Takuyo Chiba, Yoshiki Fujishima, Yusuke Hagiwara, Hiroshi Okamoto, Hiroko Watase, Jin Takahashi, Takao Ono, Sakina Kadomatsu, Kohei Hasegawa, Tadahiro Goto

Introduction

Tracheal intubation is an aerosol-generating procedure that poses a high risk of infection for healthcare workers. While Level 3 personal protective equipment (PPE) is recommended, its effect on procedural performance remains uncertain. The objective of this study was to evaluate the association among Level 3 PPE use, first-pass success, and adverse events during emergency department (ED) intubation.

Methods

We analyzed data from the Japanese Emergency Airway Network-V, a multicenter prospective registry of 12 EDs in Japan. Adult patients, aged ≥ 18 years, who underwent emergency intubation between 2020 and 2022 were included. Level 3 PPE included disposable gloves, fluid-repellent gowns or coveralls, filtering face piece 3 respirators, and eye protection. The primary outcome was first-pass success, while secondary outcomes included major and minor adverse events, including hypotension, hypoxemia, cardiac arrest, and airway injury. Logistic regression with stabilized inverse probability of treatment weighting was performed to adjust for confounding variables.

Results

Of the 2431 patients, 1159 (47.7%) were intubated with Level 3 PPE. The unadjusted first-pass success rate was higher with PPE (83.4% vs. 79.6%; p = 0.02); however, adjusted first-pass success did not differ significantly (risk difference−0.4%, 95% CI–6.3 to 5.5; p = 0.88). After adjustment, major (0.8%, 95% CI–7.1 to 8.7) and minor (0.5%, 95% CI–2.2 to 3.2) adverse events showed no significant differences.

Conclusions

The use of Level 3 PPE was not associated with decreased success or increased adverse events, supporting its safe use during high-risk procedures.

简介：气管插管是一种产生气溶胶的程序，对医护人员造成了很高的感染风险。虽然建议使用3级个人防护装备（PPE），但其对程序性能的影响仍不确定。本研究的目的是评估三级PPE使用、首次通过成功率和急诊插管期间不良事件之间的关系。方法：我们分析了来自日本紧急气道网络- v的数据，这是一个多中心前瞻性登记的日本12名急诊科医生。纳入了在2020年至2022年期间接受紧急插管的年龄≥18岁的成年患者。3级个人防护装备包括一次性手套、防液体长袍或工作服、过滤式3号口罩和护眼设备。主要结局是首次通过成功，次要结局包括主要和次要不良事件，包括低血压、低氧血症、心脏骤停和气道损伤。采用稳定的处理权重逆概率Logistic回归来调整混杂变量。结果：2431例患者中，1159例（47.7%）采用3级PPE插管。PPE组未调整的首次通过成功率更高（83.4%比79.6%,p = 0.02）；然而，调整后的首次通过成功率没有显著差异（风险差异-0.4%,95% CI-6.3至5.5;p = 0.88）。调整后，严重不良事件（0.8%,95% CI-7.1 ~ 8.7）和轻微不良事件（0.5%,95% CI-2.2 ~ 3.2）差异无统计学意义。结论：使用3级PPE与成功率降低或不良事件增加无关，支持在高风险手术中安全使用。

{"title":"Association of Level 3 Personal Protective Equipment With Intubation Success in the Emergency Department","authors":"Haruka Tsuji, Takashi Shiga, Takuyo Chiba, Yoshiki Fujishima, Yusuke Hagiwara, Hiroshi Okamoto, Hiroko Watase, Jin Takahashi, Takao Ono, Sakina Kadomatsu, Kohei Hasegawa, Tadahiro Goto","doi":"10.1002/ams2.70121","DOIUrl":"10.1002/ams2.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Tracheal intubation is an aerosol-generating procedure that poses a high risk of infection for healthcare workers. While Level 3 personal protective equipment (PPE) is recommended, its effect on procedural performance remains uncertain. The objective of this study was to evaluate the association among Level 3 PPE use, first-pass success, and adverse events during emergency department (ED) intubation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the Japanese Emergency Airway Network-V, a multicenter prospective registry of 12 EDs in Japan. Adult patients, aged ≥ 18 years, who underwent emergency intubation between 2020 and 2022 were included. Level 3 PPE included disposable gloves, fluid-repellent gowns or coveralls, filtering face piece 3 respirators, and eye protection. The primary outcome was first-pass success, while secondary outcomes included major and minor adverse events, including hypotension, hypoxemia, cardiac arrest, and airway injury. Logistic regression with stabilized inverse probability of treatment weighting was performed to adjust for confounding variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 2431 patients, 1159 (47.7%) were intubated with Level 3 PPE. The unadjusted first-pass success rate was higher with PPE (83.4% vs. 79.6%; <i>p</i> = 0.02); however, adjusted first-pass success did not differ significantly (risk difference−0.4%, 95% CI–6.3 to 5.5; <i>p</i> = 0.88). After adjustment, major (0.8%, 95% CI–7.1 to 8.7) and minor (0.5%, 95% CI–2.2 to 3.2) adverse events showed no significant differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The use of Level 3 PPE was not associated with decreased success or increased adverse events, supporting its safe use during high-risk procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12913705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146224782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comment on “Fulminant Myocarditis in Immune-Mediated Thrombotic Thrombocytopenic Purpura: A Case Report” 《免疫介导的血栓性血小板减少性紫癜并发暴发性心肌炎1例》评论

IF 1.3 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2026-02-17 DOI: 10.1002/ams2.70122

Prajnasini Satapathy, Rachana Mehta, Ranjana Sah

We commented on a recent case report of fulminant myocarditis in immune-mediated thrombotic thrombocytopenic purpura (iTTP). While the authors attributed cardiac dysfunction to myocarditis, we caution that microvascular ischemia remains a plausible mechanism, given the clinical context and nonspecific imaging. Diagnostic clarity is essential because therapeutic strategies may differ from one another. We advocated for a rigorous cardiac evaluation in patients with iTTP to inform appropriate management.

我们评论了最近的一个病例报告暴发性心肌炎在免疫介导的血栓性血小板减少性紫癜（iTTP）。虽然作者将心功能障碍归因于心肌炎，但我们提醒，鉴于临床背景和非特异性影像学，微血管缺血仍然是一个合理的机制。诊断清晰是必要的，因为治疗策略可能彼此不同。我们提倡对iTTP患者进行严格的心脏评估，以告知适当的管理。

引用次数: 0

Validation of the PECARN Abdominal Rule and FAST-AST/ALT Criteria in Pediatric Blunt Abdominal Trauma: A Retrospective Cohort Study PECARN腹部规则和FAST-AST/ALT标准在儿童钝性腹部创伤中的验证：一项回顾性队列研究。

IF 1.3 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2026-02-17 DOI: 10.1002/ams2.70116

Ryo Kamidani, Takashi Araki, Yoshihiro Tada, Ikuya Ueta

Aims

Rapid and accurate diagnosis of intra-abdominal injuries (IAIs) is crucial for pediatric patients with blunt abdominal trauma. However, clinical assessments can be challenging in children. We evaluated several clinical decision instruments (CDIs) designed to identify children with low risk of IAI who required acute intervention (IAI-I) at a Japanese pediatric hospital.

Methods

This retrospective cohort study was conducted between April 2021 and March 2024 and included 259 pediatric patients with torso trauma. We used clinical and imaging data to compare the Pediatric Emergency Care Applied Research Network (PECARN) abdominal rule with a combination of focused assessment with sonography in trauma (FAST) with elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels rule.

Results

Of the 259 pediatric patients assessed, 20 (7.7%) developed IAI. Of these, one required intervention. The PECARN abdominal rule had a sensitivity of 100% and a specificity of 65.1% for identifying IAI-I, whereas FAST with elevated AST/ALT had a sensitivity of 100% and a specificity of 82.2%. For IAI, the PECARN abdominal rule had a sensitivity of 90% and a specificity of 69.5%, whereas FAST with elevated AST/ALT had a sensitivity of 65.0% and a specificity of 88.7%.

Conclusions

The PECARN abdominal rule had high sensitivity but moderate specificity for identifying IAI, whereas FAST with elevated AST/ALT had a higher specificity. These findings suggest that CDIs can minimize unnecessary computed tomography scans in this context. Further validation of these findings in other healthcare settings and patient populations is warranted.

目的：快速准确的诊断腹内损伤（IAIs）对儿童钝性腹部创伤患者至关重要。然而，对儿童的临床评估可能具有挑战性。我们评估了几种临床决策工具（cdi），这些工具旨在识别日本儿科医院需要急性干预（IAI- i）的低风险IAI儿童。方法：本回顾性队列研究于2021年4月至2024年3月进行，包括259例躯干创伤的儿科患者。我们使用临床和影像学数据来比较儿科急诊应用研究网络（PECARN）腹部规则与创伤超声集中评估结合（FAST）与升高的天冬氨酸转氨酶（AST）或丙氨酸转氨酶（ALT）水平规则。结果：在评估的259例儿科患者中，20例（7.7%）发生IAI。其中一项需要干预。PECARN腹检法鉴别iai - 1的敏感性为100%，特异性为65.1%，而AST/ALT升高的FAST的敏感性为100%，特异性为82.2%。对于IAI， PECARN腹部诊断法的敏感性为90%，特异性为69.5%，而AST/ALT升高的FAST的敏感性为65.0%，特异性为88.7%。结论：PECARN腹检法鉴别IAI具有高敏感性和中等特异性，而AST/ALT升高的FAST具有更高的特异性。这些发现表明，在这种情况下，cdi可以减少不必要的计算机断层扫描。有必要在其他医疗机构和患者群体中进一步验证这些发现。

{"title":"Validation of the PECARN Abdominal Rule and FAST-AST/ALT Criteria in Pediatric Blunt Abdominal Trauma: A Retrospective Cohort Study","authors":"Ryo Kamidani, Takashi Araki, Yoshihiro Tada, Ikuya Ueta","doi":"10.1002/ams2.70116","DOIUrl":"10.1002/ams2.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Rapid and accurate diagnosis of intra-abdominal injuries (IAIs) is crucial for pediatric patients with blunt abdominal trauma. However, clinical assessments can be challenging in children. We evaluated several clinical decision instruments (CDIs) designed to identify children with low risk of IAI who required acute intervention (IAI-I) at a Japanese pediatric hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study was conducted between April 2021 and March 2024 and included 259 pediatric patients with torso trauma. We used clinical and imaging data to compare the Pediatric Emergency Care Applied Research Network (PECARN) abdominal rule with a combination of focused assessment with sonography in trauma (FAST) with elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels rule.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 259 pediatric patients assessed, 20 (7.7%) developed IAI. Of these, one required intervention. The PECARN abdominal rule had a sensitivity of 100% and a specificity of 65.1% for identifying IAI-I, whereas FAST with elevated AST/ALT had a sensitivity of 100% and a specificity of 82.2%. For IAI, the PECARN abdominal rule had a sensitivity of 90% and a specificity of 69.5%, whereas FAST with elevated AST/ALT had a sensitivity of 65.0% and a specificity of 88.7%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The PECARN abdominal rule had high sensitivity but moderate specificity for identifying IAI, whereas FAST with elevated AST/ALT had a higher specificity. These findings suggest that CDIs can minimize unnecessary computed tomography scans in this context. Further validation of these findings in other healthcare settings and patient populations is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

RE: Utility of Plasma Myostatin as a Predictive Biomarker for Post-Intensive Care Syndrome in Patients With Sepsis 血浆肌生长抑制素作为脓毒症患者重症监护后综合征的预测性生物标志物的应用。

IF 1.3 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2026-02-16 DOI: 10.1002/ams2.70119

Hinpetch Daungsupawong, Viroj Wiwanitkit

<p>The publication on “Utility of Plasma Myostatin as a Predictive Biomarker for Post-Intensive Care Syndrome in Patients With Sepsis [<span>1</span>]” is interesting. The intriguing hypothesis that plasma myostatin levels may be a predictor of Post-Intensive Care Syndrome (PICS) in patients with severe sepsis is brought up by this study. However, there are a number of limitations to the study that need to be taken into account. First, given the high mean patient age of 71 years, it is a single-center prospective study, which restricts extrapolation to other groups. Confounding variables that have not been sufficiently controlled could include frailty or sarcopenia. Additionally, there is a considerable danger of statistical instability and large confidence intervals due to the small sample size of 77 patients, especially in logistic regression. This could result in “significant” results that are less definite than claimed.</p><p>In terms of statistics, even though multivariable logistic regression was employed, no information was given on control variables such baseline muscle mass, nutritional status, inflammation indicators, the severity of delirium, or drugs that impact the system. Neuromuscular levels are significant confounders of PICS results as well as myostatin dynamics. Additionally, even though the AUC values of 0.70 and 0.76 indicate “fair discrimination” prediction abilities, they are not yet appropriate for use as clinical biomarkers, particularly as the biomarker to be utilized should have an AUC of ≥ 0.80 or higher for dependability. Additionally, the sample was only measured three times, which might not accurately represent the sepsis response's myostatin kinetics, which exhibit a more complicated pattern than a linear change over a single day.</p><p>From a discussion standpoint, a number of issues need extensive discussion such as (1) Do lower myostatin levels indicate muscle catabolism or an adaptive response of the inflammatory–metabolic axis? (2) are the links shown to be causative or just epiphenomena of the severity of the disease? (3) for years, there has been discussion in the literature on whether myostatin measures can actually be differentiated from structurally identical proteins, such as GDF-11, and (4) whether a more potent multibiomarker panel can be produced by combining myostatin with other biomarkers such as IL-6, NGAL, or neurofilament light chain.</p><p>In the future, generalizability will be confirmed by multicenter trials with a variety of sample groups, especially in younger patients or those without sarcopenia. The biological consequences will also be clarified by longitudinal studies that monitor myostatin trajectories on a daily basis or connect them to imaging-based muscle measurements like CT or ultrasound muscle mass. To improve predictive power, myostatin data could be combined with other variables using machine learning models. In order to translate biomarkers into specific intervention paths, it wi

《血浆肌生长抑制素作为脓毒症患者重症监护后综合征的预测性生物标志物的应用》这篇文章很有趣。该研究提出了一个有趣的假设，即血浆肌生长抑制素水平可能是严重脓毒症患者重症监护后综合征（PICS）的预测因子。然而，这项研究也有一些局限性需要考虑。首先，考虑到患者平均年龄71岁，这是一项单中心前瞻性研究，这限制了外推到其他组。尚未得到充分控制的混杂变量可能包括虚弱或肌肉减少症。此外，由于77例患者的小样本量，特别是在逻辑回归中，存在相当大的统计不稳定性和大置信区间的危险。这可能会导致“重要”的结果不像声称的那样明确。在统计方面，即使采用了多变量logistic回归，也没有给出控制变量的信息，如基线肌肉量、营养状况、炎症指标、谵妄的严重程度或影响系统的药物。神经肌肉水平是PICS结果和肌肉生成抑制素动力学的重要混杂因素。此外，尽管AUC值为0.70和0.76表明具有“公平区分”的预测能力，但它们尚不适合用作临床生物标志物，特别是用于可靠性的生物标志物应具有≥0.80或更高的AUC。此外，样品只测量了三次，这可能不能准确地代表败血症反应的肌肉生长抑制素动力学，这比一天内的线性变化表现出更复杂的模式。从讨论的角度来看，许多问题需要广泛讨论，例如(1)较低的肌肉生长抑制素水平是否表明肌肉分解代谢或炎症代谢轴的适应性反应？(2)这些联系是致病的还是仅仅是疾病严重程度的副现象？(3)多年来，文献中一直在讨论肌生长抑制素措施是否真的可以与结构相同的蛋白质（如GDF-11）区分，以及(4)是否可以通过将肌生长抑制素与其他生物标志物（如IL-6、NGAL或神经丝轻链）结合产生更有效的多生物标志物。在未来，可推广性将通过多中心试验在各种样本组中得到证实，特别是在年轻患者或没有肌肉减少症的患者中。通过纵向研究，每天监测肌肉生长抑制素轨迹，或将其与基于成像的肌肉测量（如CT或超声肌肉质量）联系起来，生物学后果也将得到澄清。为了提高预测能力，可以使用机器学习模型将肌肉生长抑制素数据与其他变量结合起来。为了将生物标志物转化为特定的干预途径，研究恢复肌肉生长抑制素水平（通过饮食治疗或康复）是否能真正降低PICS的风险将是至关重要的。作者没有什么可报告的。作者没有什么可报告的。作者没有什么可报告的。作者声明无利益冲突。

{"title":"RE: Utility of Plasma Myostatin as a Predictive Biomarker for Post-Intensive Care Syndrome in Patients With Sepsis","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1002/ams2.70119","DOIUrl":"10.1002/ams2.70119","url":null,"abstract":"<p>The publication on “Utility of Plasma Myostatin as a Predictive Biomarker for Post-Intensive Care Syndrome in Patients With Sepsis [<span>1</span>]” is interesting. The intriguing hypothesis that plasma myostatin levels may be a predictor of Post-Intensive Care Syndrome (PICS) in patients with severe sepsis is brought up by this study. However, there are a number of limitations to the study that need to be taken into account. First, given the high mean patient age of 71 years, it is a single-center prospective study, which restricts extrapolation to other groups. Confounding variables that have not been sufficiently controlled could include frailty or sarcopenia. Additionally, there is a considerable danger of statistical instability and large confidence intervals due to the small sample size of 77 patients, especially in logistic regression. This could result in “significant” results that are less definite than claimed.</p><p>In terms of statistics, even though multivariable logistic regression was employed, no information was given on control variables such baseline muscle mass, nutritional status, inflammation indicators, the severity of delirium, or drugs that impact the system. Neuromuscular levels are significant confounders of PICS results as well as myostatin dynamics. Additionally, even though the AUC values of 0.70 and 0.76 indicate “fair discrimination” prediction abilities, they are not yet appropriate for use as clinical biomarkers, particularly as the biomarker to be utilized should have an AUC of ≥ 0.80 or higher for dependability. Additionally, the sample was only measured three times, which might not accurately represent the sepsis response's myostatin kinetics, which exhibit a more complicated pattern than a linear change over a single day.</p><p>From a discussion standpoint, a number of issues need extensive discussion such as (1) Do lower myostatin levels indicate muscle catabolism or an adaptive response of the inflammatory–metabolic axis? (2) are the links shown to be causative or just epiphenomena of the severity of the disease? (3) for years, there has been discussion in the literature on whether myostatin measures can actually be differentiated from structurally identical proteins, such as GDF-11, and (4) whether a more potent multibiomarker panel can be produced by combining myostatin with other biomarkers such as IL-6, NGAL, or neurofilament light chain.</p><p>In the future, generalizability will be confirmed by multicenter trials with a variety of sample groups, especially in younger patients or those without sarcopenia. The biological consequences will also be clarified by longitudinal studies that monitor myostatin trajectories on a daily basis or connect them to imaging-based muscle measurements like CT or ultrasound muscle mass. To improve predictive power, myostatin data could be combined with other variables using machine learning models. In order to translate biomarkers into specific intervention paths, it wi","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12908191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146211927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Response to “RE: Utility of Plasma Myostatin as a Predictive Biomarker for Post Intensive Care Syndrome in Patients With Sepsis” 对“RE：血浆肌生长抑制素作为脓毒症患者重症监护后综合征的预测性生物标志物”的回应。

IF 1.3 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2026-02-15 DOI: 10.1002/ams2.70118

Ayaki Shirahata, Nobuto Nakanishi, Yuko Ono, Shigeaki Inoue, Joji Kotani

<p>We sincerely thank Drs. Daungsupawong and Wiwanitkit for their thoughtful and constructive comments on our article, “Utility of Plasma Myostatin as a Predictive Biomarker for Post-Intensive Care Syndrome (PICS) in Patients with Sepsis.” Their insights provide an important opportunity to clarify several aspects of our study.</p><p>First, we acknowledge that this was a single-center, exploratory study that predominantly included elderly patients. As stated in the manuscript, our findings should be regarded as hypothesis-generating, and confirmation in larger, multicenter cohorts is necessary. Major limitations include the small sample size, potential selection bias, and limited adjustment for confounding variables.</p><p>Second, regarding the assessment of sarcopenia, skeletal muscle mass was evaluated using the psoas muscle index at the third lumbar vertebral level on computed tomography. Previous studies have demonstrated that computed tomography-derived psoas muscle index correlates with whole-body skeletal muscle mass and serves as a reasonable surrogate marker for sarcopenia in critically ill patients [<span>1</span>]. Sarcopenia was included as a covariate in our multivariable model, and lower plasma myostatin levels remained independently associated with long-term functional impairment. Because of the retrospective study design, muscle assessment was limited to a single time point. Future prospective studies should incorporate longitudinal muscle evaluation using ultrasound, which has been shown to detect low muscularity at ICU admission [<span>1</span>]. Serial ultrasound measurements combined with myostatin kinetics may better capture dynamic muscle changes after sepsis.</p><p>Third, the predictive performance of plasma myostatin, with area-under-the-curve values ranging from 0.70 to 0.76, indicates fair discrimination. According to commonly accepted criteria, an AUC of 0.70–0.79 reflects fair accuracy, 0.80–0.89 good accuracy, and ≥ 0.90 excellent accuracy [<span>2</span>]. Therefore, although statistically significant, our findings should be interpreted cautiously and require external validation before clinical application.</p><p>Finally, low plasma myostatin levels may reflect enhanced muscle catabolism or compensatory adaptation within the inflammatory–metabolic axis. In critically ill populations, lower circulating myostatin has been associated with systemic inflammation and unfavorable outcomes [<span>3</span>]. Experimental studies suggest that interleukin-6 may modulate myostatin expression via the JAK/STAT3 signaling pathway, providing a mechanistic link between inflammation and muscle atrophy. Although myostatin (GDF-8) and GDF-11 share substantial sequence homology, they are distinct gene products with different tissue distributions. Myostatin is primarily expressed in skeletal muscle and the central nervous system, whereas GDF-11 is more prominent in neural and cardiovascular tissues [<span>4</span>]. This difference may par

我们衷心感谢dr。Daungsupawong和Wiwanitkit对我们的文章《血浆肌生长抑制素作为脓毒症患者重症监护后综合征（PICS）的预测性生物标志物的应用》进行了深思熟虑和建设性的评论。他们的见解为澄清我们研究的几个方面提供了重要的机会。首先，我们承认这是一项单中心探索性研究，主要包括老年患者。如文中所述，我们的发现应被视为假设产生，并且需要在更大的多中心队列中进行确认。主要的限制包括样本量小，潜在的选择偏差，以及对混杂变量的有限调整。其次，关于肌肉减少症的评估，骨骼肌质量是通过计算机断层扫描在第三腰椎水平的腰肌指数来评估的。先前的研究表明，计算机断层扫描得出的腰肌指数与全身骨骼肌质量相关，可作为危重患者肌肉减少症的合理替代指标。在我们的多变量模型中，肌肉减少症被作为协变量纳入，血浆肌生成抑制素水平降低与长期功能损害仍然独立相关。由于回顾性研究设计，肌肉评估仅限于单一时间点。未来的前瞻性研究应纳入使用超声的纵向肌肉评估，这已被证明可以在ICU入院时发现低肌肉。连续超声测量结合肌肉生长抑制素动力学可以更好地捕捉脓毒症后肌肉的动态变化。第三，血浆肌生长抑制素的预测性能，曲线下面积值在0.70到0.76之间，表明公平的歧视。根据普遍接受的标准，AUC为0.70-0.79，为一般准确度，0.80-0.89为良好准确度，≥0.90为优良准确度[2]。因此，尽管我们的研究结果具有统计学意义，但在临床应用前应谨慎解释并需要外部验证。最后，低血浆肌生长抑制素水平可能反映了肌肉分解代谢增强或炎症代谢轴内的代偿性适应。在危重患者中，低循环肌生长抑制素与全身性炎症和不良结局有关。实验研究表明，白细胞介素-6可能通过JAK/STAT3信号通路调节肌肉生长抑制素的表达，在炎症和肌肉萎缩之间提供了机制联系。尽管肌肉生长抑制素（GDF-8）和GDF-11具有大量的序列同源性，但它们是不同的基因产物，具有不同的组织分布。肌生长抑制素主要表达于骨骼肌和中枢神经系统，而GDF-11在神经和心血管组织中更为突出。这种差异可能部分解释了肌肉生长抑制素和PICS之间更强的关联。最近的纵向研究进一步支持多标志物方法，包括炎症、神经肌肉和代谢生物标志物[5]。因此，将血浆肌生长抑制素与IL-6和神经丝轻链等标志物结合可能为PICS的早期识别提供更全面的框架。我们很高兴有机会对这些评论做出回应，并进一步阐明我们研究结果的临床和机制意义。本文得到了JSPS KAKENHI基金号JP24K19491的支持。获得神户大学医院临床研究机构审查委员会的伦理批准(批准号：B210116)。作者声明无利益冲突。

{"title":"Response to “RE: Utility of Plasma Myostatin as a Predictive Biomarker for Post Intensive Care Syndrome in Patients With Sepsis”","authors":"Ayaki Shirahata, Nobuto Nakanishi, Yuko Ono, Shigeaki Inoue, Joji Kotani","doi":"10.1002/ams2.70118","DOIUrl":"10.1002/ams2.70118","url":null,"abstract":"<p>We sincerely thank Drs. Daungsupawong and Wiwanitkit for their thoughtful and constructive comments on our article, “Utility of Plasma Myostatin as a Predictive Biomarker for Post-Intensive Care Syndrome (PICS) in Patients with Sepsis.” Their insights provide an important opportunity to clarify several aspects of our study.</p><p>First, we acknowledge that this was a single-center, exploratory study that predominantly included elderly patients. As stated in the manuscript, our findings should be regarded as hypothesis-generating, and confirmation in larger, multicenter cohorts is necessary. Major limitations include the small sample size, potential selection bias, and limited adjustment for confounding variables.</p><p>Second, regarding the assessment of sarcopenia, skeletal muscle mass was evaluated using the psoas muscle index at the third lumbar vertebral level on computed tomography. Previous studies have demonstrated that computed tomography-derived psoas muscle index correlates with whole-body skeletal muscle mass and serves as a reasonable surrogate marker for sarcopenia in critically ill patients [<span>1</span>]. Sarcopenia was included as a covariate in our multivariable model, and lower plasma myostatin levels remained independently associated with long-term functional impairment. Because of the retrospective study design, muscle assessment was limited to a single time point. Future prospective studies should incorporate longitudinal muscle evaluation using ultrasound, which has been shown to detect low muscularity at ICU admission [<span>1</span>]. Serial ultrasound measurements combined with myostatin kinetics may better capture dynamic muscle changes after sepsis.</p><p>Third, the predictive performance of plasma myostatin, with area-under-the-curve values ranging from 0.70 to 0.76, indicates fair discrimination. According to commonly accepted criteria, an AUC of 0.70–0.79 reflects fair accuracy, 0.80–0.89 good accuracy, and ≥ 0.90 excellent accuracy [<span>2</span>]. Therefore, although statistically significant, our findings should be interpreted cautiously and require external validation before clinical application.</p><p>Finally, low plasma myostatin levels may reflect enhanced muscle catabolism or compensatory adaptation within the inflammatory–metabolic axis. In critically ill populations, lower circulating myostatin has been associated with systemic inflammation and unfavorable outcomes [<span>3</span>]. Experimental studies suggest that interleukin-6 may modulate myostatin expression via the JAK/STAT3 signaling pathway, providing a mechanistic link between inflammation and muscle atrophy. Although myostatin (GDF-8) and GDF-11 share substantial sequence homology, they are distinct gene products with different tissue distributions. Myostatin is primarily expressed in skeletal muscle and the central nervous system, whereas GDF-11 is more prominent in neural and cardiovascular tissues [<span>4</span>]. This difference may par","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12907249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146211905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pediatric ECPR as Bridge to Surgery: Successful Management of Refractory Cardiac Arrest in High-Risk ICD Lead Extraction 儿科ECPR作为手术的桥梁：高危ICD拔铅中难治性心脏骤停的成功管理。

IF 1.3 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2026-02-15 DOI: 10.1002/ams2.70117

Jessy Steve Masso-Bueso, Gian Manuel Jiménez-Rodríguez, Kevin Alexis Fierros-Chablé, David Jacobo Sánchez-Amaya, Gustavo Rojas-Velasco, Daniel Manzur-Sandoval

Background

Refractory cardiac arrest remains a major challenge in children, with poor survival despite advances in cardiopulmonary resuscitation (CPR). Extracorporeal cardiopulmonary resuscitation (ECPR), defined as rapid deployment of extracorporeal membrane oxygenation (ECMO) during ongoing CPR, provides circulatory and respiratory support and can serve as a bridge to definitive interventions. While increasingly reported in adults, pediatric use remains limited due to anatomical and physiological challenges, with evidence largely restricted to case reports and small series.

Case Presentation

A 14-year-old female with dilated cardiomyopathy, severe left ventricular dysfunction (LVEF 12.5%), and prior implantable cardioverter-defibrillator placement underwent elective lead extraction and generator replacement. During the procedure, pericardial effusion with hemodynamic collapse occurred, requiring emergent pericardiocentesis. Despite transient return of spontaneous circulation, refractory cardiac arrest developed after 24 min of CPR. ECPR was initiated via percutaneous femoral veno-arterial ECMO, restoring systemic perfusion. Transesophageal echocardiography revealed right atrial perforation, which was surgically repaired. Hemodynamic stability was achieved with combined ECMO and intra-aortic balloon pump support. The patient was successfully decannulated on postoperative Day 1, extubated on Day 4 without neurological deficits, and discharged to a heart transplant program.

Conclusion

This case highlights the pivotal role of ECPR as a bridge to definitive repair in pediatric patients experiencing refractory arrest during high-risk interventions. Early initiation, skilled cannulation, and multidisciplinary coordination were critical for survival. Pediatric experiences such as these are essential to refine selection criteria, inform procedural planning, and expand the limited evidence supporting ECPR as a transformative strategy in resuscitation for this vulnerable population.

背景：难治性心脏骤停仍然是儿童面临的主要挑战，尽管心肺复苏（CPR）有所进展，但儿童的生存率很低。体外心肺复苏（ECPR）被定义为在正在进行的心肺复苏术中快速部署体外膜氧合（ECMO），提供循环和呼吸支持，可以作为最终干预措施的桥梁。虽然越来越多的成人报道，但由于解剖学和生理学方面的挑战，儿科使用仍然有限，证据主要局限于病例报告和小系列。病例介绍：一名14岁女性扩张型心肌病，严重左心室功能障碍（LVEF 12.5%），既往植入式心律转复除颤器放置，择期取铅和更换发生器。手术过程中出现心包积液伴血流动力学塌陷，需要紧急心包穿刺。尽管短暂的自发循环恢复，但心肺复苏术24分钟后出现难治性心脏骤停。ECPR通过经皮股静脉-动脉ECMO启动，恢复全身灌注。经食管超声心动图显示右心房穿孔，手术修复。联合ECMO和主动脉内球囊泵支持实现了血流动力学稳定性。患者在术后第1天成功脱管，第4天拔管，无神经功能缺损，出院进行心脏移植。结论：本病例强调了ECPR作为高危干预期间顽固性骤停患儿最终修复的桥梁的关键作用。早期启动，熟练的插管和多学科协调是生存的关键。诸如此类的儿科经验对于完善选择标准，为程序规划提供信息，并扩大支持ECPR作为这一弱势群体复苏变革策略的有限证据至关重要。

{"title":"Pediatric ECPR as Bridge to Surgery: Successful Management of Refractory Cardiac Arrest in High-Risk ICD Lead Extraction","authors":"Jessy Steve Masso-Bueso, Gian Manuel Jiménez-Rodríguez, Kevin Alexis Fierros-Chablé, David Jacobo Sánchez-Amaya, Gustavo Rojas-Velasco, Daniel Manzur-Sandoval","doi":"10.1002/ams2.70117","DOIUrl":"10.1002/ams2.70117","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Refractory cardiac arrest remains a major challenge in children, with poor survival despite advances in cardiopulmonary resuscitation (CPR). Extracorporeal cardiopulmonary resuscitation (ECPR), defined as rapid deployment of extracorporeal membrane oxygenation (ECMO) during ongoing CPR, provides circulatory and respiratory support and can serve as a bridge to definitive interventions. While increasingly reported in adults, pediatric use remains limited due to anatomical and physiological challenges, with evidence largely restricted to case reports and small series.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 14-year-old female with dilated cardiomyopathy, severe left ventricular dysfunction (LVEF 12.5%), and prior implantable cardioverter-defibrillator placement underwent elective lead extraction and generator replacement. During the procedure, pericardial effusion with hemodynamic collapse occurred, requiring emergent pericardiocentesis. Despite transient return of spontaneous circulation, refractory cardiac arrest developed after 24 min of CPR. ECPR was initiated via percutaneous femoral veno-arterial ECMO, restoring systemic perfusion. Transesophageal echocardiography revealed right atrial perforation, which was surgically repaired. Hemodynamic stability was achieved with combined ECMO and intra-aortic balloon pump support. The patient was successfully decannulated on postoperative Day 1, extubated on Day 4 without neurological deficits, and discharged to a heart transplant program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case highlights the pivotal role of ECPR as a bridge to definitive repair in pediatric patients experiencing refractory arrest during high-risk interventions. Early initiation, skilled cannulation, and multidisciplinary coordination were critical for survival. Pediatric experiences such as these are essential to refine selection criteria, inform procedural planning, and expand the limited evidence supporting ECPR as a transformative strategy in resuscitation for this vulnerable population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12907257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146211914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating the Efficacy of Hyperbaric Oxygen Therapy for Acute Carbon Monoxide Poisoning: A Systematic Review and Meta-Analysis 评价高压氧治疗急性一氧化碳中毒的疗效：一项系统回顾和荟萃分析。

IF 1.3 Q2 MEDICINE, GENERAL & INTERNAL

Acute Medicine & Surgery

Pub Date : 2026-01-28 DOI: 10.1002/ams2.70114

Motoki Fujita, Masaki Todani, Yasuhiko Ajimi, Tomoaki Yatabe, Shoji Yokobori, Manabu Araki, Norio Chihara, Masao Nagayama, Tetsuya Samkamoto, Ryosuke Tsuruta, the Japan Resuscitation Council (JRC) Neuroresuscitation Task Force and the Guidelines Editorial Committee

Aim

To reassess the efficacy of hyperbaric oxygen (HBO) therapy for acute carbon monoxide (CO) poisoning through a systematic review and meta-analysis, including a subgroup analysis of treatment pressures exceeding 2.5 atm absolute (ATA).

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating HBO therapy for acute CO poisoning. A literature search was performed in MEDLINE, CENTRAL, and Ichushi-Web databases, focusing on RCTs published up to June 2024. Only adult patients (≥ 18 years) were included, and studies were screened following PRISMA guidelines. Data extraction and quality assessment were conducted by two independent reviewers using the Cochrane risk of bias tool and the GRADE approach. Statistical analysis used a random effects model, with outcomes expressed as odds ratios (OR) and 95% confidence intervals (CI).

Results

Six studies were included, and no significant benefit of HBO therapy was observed in terms of reducing mortality or improving neurological outcomes. The subgroup analysis of HBO at ≥ 2.5 ATA also showed no significant advantage over control treatments. Moderate to significant heterogeneity was found across included studies, and the quality of evidence was rated as low to very low.

Conclusions

The efficacy of HBO therapy, even at ≥ 2.5 ATA, for improving outcomes in acute CO poisoning remains unproven. Despite these findings, HBO therapy may still hold potential benefits that require further exploration. High-quality, multicenter RCTs are necessary to better define its role in the treatment of CO poisoning.

Trial Registration

UMIN Clinical Trials Registry: UMIN000054641

目的：通过系统回顾和荟萃分析，包括治疗压力超过2.5 atm （ATA）的亚组分析，重新评估高压氧（HBO）治疗急性一氧化碳（CO）中毒的疗效。方法：我们对评价HBO治疗急性一氧化碳中毒的随机对照试验（rct）进行了系统回顾和荟萃分析。在MEDLINE、CENTRAL和Ichushi-Web数据库中进行文献检索，重点检索截至2024年6月发表的随机对照试验。仅纳入成年患者（≥18岁），并根据PRISMA指南筛选研究。数据提取和质量评估由两名独立审稿人使用Cochrane偏倚风险工具和GRADE方法进行。统计分析采用随机效应模型，结果以比值比（OR）和95%置信区间（CI）表示。结果：纳入6项研究，HBO治疗在降低死亡率或改善神经预后方面未观察到显著益处。≥2.5 ATA的HBO亚组分析也显示与对照治疗相比没有显著优势。在纳入的研究中发现了中度至显著的异质性，证据质量被评为低至极低。结论：HBO治疗的疗效，即使在≥2.5 ATA，改善急性一氧化碳中毒的预后仍未得到证实。尽管有这些发现，HBO疗法可能仍有潜在的益处，需要进一步探索。为了更好地确定其在一氧化碳中毒治疗中的作用，需要高质量的多中心随机对照试验。试验注册：UMIN临床试验注册：UMIN000054641。

{"title":"Evaluating the Efficacy of Hyperbaric Oxygen Therapy for Acute Carbon Monoxide Poisoning: A Systematic Review and Meta-Analysis","authors":"Motoki Fujita, Masaki Todani, Yasuhiko Ajimi, Tomoaki Yatabe, Shoji Yokobori, Manabu Araki, Norio Chihara, Masao Nagayama, Tetsuya Samkamoto, Ryosuke Tsuruta, the Japan Resuscitation Council (JRC) Neuroresuscitation Task Force and the Guidelines Editorial Committee","doi":"10.1002/ams2.70114","DOIUrl":"10.1002/ams2.70114","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To reassess the efficacy of hyperbaric oxygen (HBO) therapy for acute carbon monoxide (CO) poisoning through a systematic review and meta-analysis, including a subgroup analysis of treatment pressures exceeding 2.5 atm absolute (ATA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating HBO therapy for acute CO poisoning. A literature search was performed in MEDLINE, CENTRAL, and Ichushi-Web databases, focusing on RCTs published up to June 2024. Only adult patients (≥ 18 years) were included, and studies were screened following PRISMA guidelines. Data extraction and quality assessment were conducted by two independent reviewers using the Cochrane risk of bias tool and the GRADE approach. Statistical analysis used a random effects model, with outcomes expressed as odds ratios (OR) and 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six studies were included, and no significant benefit of HBO therapy was observed in terms of reducing mortality or improving neurological outcomes. The subgroup analysis of HBO at ≥ 2.5 ATA also showed no significant advantage over control treatments. Moderate to significant heterogeneity was found across included studies, and the quality of evidence was rated as low to very low.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The efficacy of HBO therapy, even at ≥ 2.5 ATA, for improving outcomes in acute CO poisoning remains unproven. Despite these findings, HBO therapy may still hold potential benefits that require further exploration. High-quality, multicenter RCTs are necessary to better define its role in the treatment of CO poisoning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>UMIN Clinical Trials Registry: UMIN000054641</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0