Search

There is insufficient evidence supporting the theory that mechanical ventilation can replace the manual ventilation method during CPR. Is using automatic mechanical ventilation (MV) feasible and comparable to the manual ventilation method during CPR? This pilot randomized controlled trial compared MV and manual bag ventilation (BV) during CPR after out-of-hospital cardiac arrest (OHCA). Patients with medical OHCA arriving at the ED were randomly assigned to two groups: an MV group using a mechanical ventilator and a BV group using a bag valve mask. Primary outcome was any return of spontaneous circulation (ROSC). Secondary outcomes were changes of arterial blood gas analysis results during CPR. Tidal volume, minute volume, and peak airway pressure were also analyzed. A total of 60 patients were enrolled, and 30 patients were randomly assigned to each group. There were no statistically significant differences in basic characteristics of OHCA patients between the two groups. The rate of any return of spontaneous circulation was 56.7% in the MV group and 43.3% in the BV group, indicating no significant (P =.439) difference between the two groups. There were also no statistically significant differences in changes of PH, P co 2 , P o 2 , bicarbonate, or lactate levels during CPR between the two groups (P values =.798, 0.249,.515,.876, and.878, respectively). Significantly lower tidal volume (P <.001) and minute volume (P =.009) were observed in the MV group. In this pilot trial, the use of MV instead of BV during CPR was feasible and could serve as a viable alternative. A multicenter randomized controlled trial is needed to create sufficient evidence for ventilation guidelines during CPR. ClinicalTrials.gov ; No.: NCT05550454; URL: www.clinicaltrials.gov. [Display omitted] [ABSTRACT FROM AUTHOR]

Extracorporeal life support (ECLS) for out-of-hospital cardiac arrest (OHCA) is increasing. There is little evidence identifying the association between hospital ECLS case volumes and outcomes in different populations receiving ECLS or conventional cardiopulmonary resuscitation (CPR). The goal of this investigation was to identify the association between ECLS case volumes and clinical outcomes of OHCA patients. This cross-sectional observational study used the National OHCA Registry for adult OHCA cases in Seoul, Korea between January 2015 and December 2019. If the ECLS volume during the study period was >20, the institution was defined as a high-volume ECLS center. Others were defined as low-volume ECLS centers. Outcomes were good neurologic recovery (cerebral performance category 1 or 2) and survival to discharge. We performed multivariate logistic regression and interaction analyses to assess the association between case volume and clinical outcome. Of the 17,248 OHCA cases, 3,731 were transported to high-volume centers. Among the patients who underwent ECLS, those at high-volume centers had a higher neurologic recovery rate than those at low-volume centers (17.0% vs. 12.0%), and the adjusted OR for good neurologic recovery was 2.22 (95% confidence interval (CI): 1.15–4.28) in high-volume centers compared to low-volume centers. For patients who received conventional CPR, high-volume centers also showed higher survival-to-discharge rates (adjusted OR of 1.16, 95%CI: 1.01–1.34). High-volume ECLS centers showed better neurological recovery in patients who underwent ECLS. High-volume centers also had better survival-to-discharge rates than low-volume centers for patients not receiving ECLS. [ABSTRACT FROM AUTHOR]

Early diagnosis and intervention by visiting the emergency department (ED) are important for traumatic brain injury (TBI). We evaluate the factors associated with delayed ED visits in patients with intracranial TBI. A retrospective multicenter observational study using the ED-based injury in-depth surveillance database (EDIIS) was designed. Patients with intracranial TBI with an alert mentality at ED presentation from 2014 to 2019 were enrolled. Patients were categorized into four groups according to ED visit time after injury (<1 h, 1–3 h, 3–12 h, and >12 h). ED visits after 12 h were defined as delayed ED visits. The factors associated with delayed ED visits were identified using multivariable logistic regression analysis. Among 15,620 patients with TBI enrolled in the final analysis, 2,190 (14.0%) visited the ED 12 h after injury. Multivariable analysis identified the following factors as independent predictors for delayed ED visit such as unintentionally struck by or against an object or unintentional fall as a trauma mechanism, injury during ordinary activities, indoor injury, injury during nighttime, winter season, combined subdural hemorrhage and epidural hemorrhage. In patients with intracranial TBI with an alert mentality, multiple factors related to patient demographics and injury characteristics were associated with the time interval from injury to ED visit. [ABSTRACT FROM AUTHOR]

Serum zinc levels in the acute stages after traumatic brain injury (TBI) may be capable of predicting cinical and functional prognoses. This study aimed to evaluate the association between serum zinc levels and long-term survival and neurological outcomes in TBI patients with intracranial injury. This multicenter prospective cohort study enrolled adult TBI patients with intracranial injury who visited emergency departments between December 2018 and June 2020. Serum zinc levels drawn within 24 h after injury were categorized into four groups: low (<80.0 mcg/dL), low–normal (80.0–100.0 mcg/dL), high–normal (100.1–120.0 mcg/dL), and high (>120.0 mcg/dL). The study outcomes were 6-month mortality and disability (Glasgow Outcome Scale, 1–3). A multilevel multivariable logistic regression analysis was conducted to estimate associations between serum zinc and study outcomes. From the eligible TBI patients (N = 487), the median (interquartile range) serum zinc level was 112.0 mcg/dL (95.0–142.0). Six-month mortality and disability were 21.1% (103/487) and 29.6% (144/487), respectively. Compared to the high–normal zinc group, there were significant associations with 6-month mortality and disability observed in the low zinc group (aORs (95% CIs): 1.91 (1.60–2.28) and 1.95 (1.62–2.36) for the low group; 1.14 (0.67–1.94) and 1.15 (0.91–1.46) for the low–normal group; and 0.72 (0.44–1.16) and 0.88 (0.61–1.27) for the high group, respectively). Among the 122 TBI patients with diabetes mellitus, the low zinc group showed a higher incidence of 6-month mortality (aOR (95% CI): 9.13 (4.01–20.81)) compared to the high–normal zinc group. Moreover, the low and low–normal groups had higher odds for 6-month disability (aORs (95% CIs): 6.63 (3.61–12.15) for the low group and 2.37 (1.38–4.07) for the low–normal group). Serum zinc deficiency is associated with a higher incidence of 6-month mortality and disability after injury for TBI patients with intracranial injury. [ABSTRACT FROM AUTHOR]