Extracorporeal cardiopulmonary resuscitation (ECPR) followed by targeted temperature management has been demonstrated to significantly improve the outcomes of out-of-hospital cardiac arrest (OHCA) in ...adult patients. Although recent narrative and systematic reviews on extracorporeal life support in the emergency department are available in the literature, they are focused on the efficacy of ECPR, and no comprehensively summarized review on ECPR for OHCA in adult patients is available. In this review, we aimed to clarify the prevalence, pathophysiology, predictors, management, and details of the complications of ECPR for OHCA, all of which have not been reviewed in previous literature, with the aim of facilitating understanding among acute care physicians. The leading countries in the field of ECPR are those in East Asia followed by those in Europe and the United States. ECPR may reduce the risks of reperfusion injury and deterioration to secondary brain injury. Unlike conventional cardiopulmonary resuscitation, however, no clear prognostic markers have been identified for ECPR for OHCA. Bleeding was identified as the most common complication of ECPR in patients with OHCA. Future studies should combine ECPR with intra-aortic balloon pump, extracorporeal membrane oxygenation flow, target blood pressure, and seizure management in ECPR.
Background:Although bystanders’ performance is important to improve outcomes of patients after cardiac arrests, few studies have investigated the barriers of bystanders, including those who could not ...perform cardiopulmonary resuscitation or any other rescue actions in emergency situations. This study aimed to assess the relationship between the psychological barriers of laypersons who encountered emergency situations and their rescue actions.Methods and Results:A questionnaire survey was conducted and this included laypersons who had encountered emergency situations during the last 5 years. Six questions were about the psychological barriers and 8 questions were about the laypersons’ rescue actions. The primary outcome was any rescue actions performed by laypersons in an actual emergency situation. Overall, 7,827 (92.8%) of 8,430 laypersons responded; of them, 1,361 (16.1%) had encountered emergency situations during the last 5 years, and 1,220 (14.5%) were eligible for inclusion in the analyses. Of the 6 psychological barriers, “fear of approaching a collapsed person” (adjusted odds ratio AOR 0.50; 95% confidence interval 95% CI 0.32–0.79) and “difficulties in judging whether to perform any rescue action” (AOR 0.63; 95% CI 0.40–0.99) were significantly associated with performing any rescue actions.Conclusions:The fear of approaching a collapsed person and difficulties in judging whether to take any actions were identified as the psychological barriers in performing any rescue actions by laypersons who encountered emergency situations.
Extracorporeal cardiopulmonary resuscitation (ECPR) is rapidly becoming a common treatment strategy for patients with refractory cardiac arrest. Despite its benefits, ECPR raises a variety of ethical ...concerns when the treatment is discontinued. There is little information about the decision to withhold/withdraw life-sustaining therapy (WLST) for out-of-hospital cardiac arrest (OHCA) patients after ECPR.
We conducted a secondary analysis of data from the SAVE-J II study, a retrospective, multicenter study of ECPR in Japan. Adult patients who underwent ECPR for OHCA with medical causes were included. The prevalence, reasons, and timing of WLST decisions were recorded. Outcomes of patients with or without WLST decisions were compared. Further, factors associated with WLST decisions were examined.
We included 1660 patients in the analysis; 510 (30.7%) had WLST decisions. The number of WLST decisions was the highest on the first day and WSLT decisions were made a median of two days after ICU admission. Reasons for WLST were perceived unfavorable neurological prognosis (300/510 58.8%), perceived unfavorable cardiac/pulmonary prognosis (105/510 20.5%), inability to maintain extracorporeal cardiopulmonary support (71/510 13.9%), complications (10/510 1.9%), exacerbation of comorbidity before cardiac arrest (7/510 1.3%), and others. Patients with WLST had lower 30-day survival (WLST vs. no-WLST: 36/506 7.1% vs. 386/1140 33.8%, p < 0.001). Primary cerebral disorders as cause of cardiac arrest and higher severity of illness at intensive care unit admission were associated with WLST decisions.
For approximately one-third of ECPR/OHCA patients, WLST was decided during admission, mainly because of perceived unfavorable neurological prognoses. Decisions and neurological assessments for ECPR/OHCA patients need further analysis.
High reactivity of H2O vapor on GaN surfaces Sumiya, Masatomo; Sumita, Masato; Tsuda, Yasutaka ...
Science and technology of advanced materials,
12/2022, Letnik:
23, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Understanding the process of oxidation on the surface of GaN is important for improving metal-oxide-semiconductor (MOS) devices. Real-time X-ray photoelectron spectroscopy was used to observe the ...dynamic adsorption behavior of GaN surfaces upon irradiation of H
2
O, O
2
, N
2
O, and NO gases. It was found that H
2
O vapor has the highest reactivity on the surface despite its lower oxidation power. The adsorption behavior of H
2
O was explained by the density functional molecular dynamic calculation including the spin state of the surfaces. Two types of adsorbed H
2
O molecules were present on the (0001) (+c) surface: non-dissociatively adsorbed H
2
O (physisorption), and dissociatively adsorbed H
2
O (chemisorption) molecules that were dissociated with OH and H adsorbed on Ga atoms. H
2
O molecules attacked the back side of three-fold Ga atoms on the (0001̅) (−c) GaN surface, and the bond length between the Ga and N was broken. The chemisorption on the (101̅0) m-plane of GaN, which is the channel of a trench-type GaN MOS power transistor, was dominant, and a stable Ga-O bond was formed due to the elongated bond length of Ga on the surface. In the atomic layer deposition process of the Al
2
O
3
layer using H
2
O vapor, the reactions caused at the interface were more remarkable for p-GaN. If unintentional oxidation can be resulted in the generation of the defects at the MOS interface, these results suggest that oxidant gases other than H
2
O and O
2
should be used to avoid uncontrollable oxidation on GaN surfaces.
Body cooling is recommended for patients with heat stroke and heat exhaustion. However, differences in the outcomes of patients who do or do not receive active cooling therapy have not been ...determined. The best available evidence supporting active cooling is based on a case series without comparison groups; thus, the effectiveness of this method in improving patient prognoses cannot be appropriately quantified. Therefore, we compared the outcomes of heat stroke patients receiving active cooling with those of patients receiving rehydration-only therapy. This prospective observational multicenter registry-based study of heat stroke and heat exhaustion patients was conducted in Japan from 2010 to 2019. The patients were stratified into the "severe" group or the "mild-to-moderate" group, per clinical findings on admission. After conducting multivariate logistic regression analyses, we compared the prognoses between patients who received "active cooling + rehydration" and patients who received "rehydration only," with in-hospital death as the endpoint. Sex, age, onset situation (i.e., exertional or non-exertional), core body temperature, liver damage, renal dysfunction, and disseminated intravascular coagulation were considered potential covariates. Among those who received active cooling and rehydration-only therapy, the in-hospital mortality rates were 21.5% and 35.5%, respectively, for severe patients (n = 231) and 3.9% and 5.7%, respectively, for mild-to-moderate patients (n = 578). Rehydration-only therapy was associated with a higher in-hospital mortality in patients with severe heat illness (adjusted odds ratio aOR, 3.29; 95% confidence interval CI, 1.21-8.90), whereas the cooling methods were not associated with lower in-hospital mortality in patients with mild-to-moderate heat illness (aOR, 2.22; 95% CI, 0.92-5.84). Active cooling was associated with lower in-hospital mortality only in the severe group. Our results indicated that active cooling should be recommended as an adjunct to rehydration-only therapy for patients with severe heat illness.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Curved periacetabular osteotomy (CPO) is one of the periacetabular osteotomies for the treatment of acetabular dysplasia. Several complications have been described after CPO, however, there have been ...no reports on the leg length change (LLC). This study aimed to investigate the LLC after CPO and its impact on the clinical outcomes.
This study was a retrospective review of 70 consecutive hips in 67 patients with symptomatic acetabular dysplasia who underwent CPO between March 2016 and April 2019. Preoperative and postoperative leg lengths were measured using anteroposterior radiographs, and the clinical outcomes were evaluated based on the Harris hip score (HHS) and Medical Outcomes Survey 36-item Short Form Health Survey (SF-36).
The mean LLC (and standard deviation) after CPO was −0.08 ± 3.10 mm. The mean HHS significantly improved from 73.5 points to 91.9 points (P < .001). The physical component and role component scores of SF-36 significantly improved from 35.1 to 46.1 (P < .001) and from 39.5 to 47.0 (P < .001), respectively. No significant differences were found between the preoperative and postoperative mental component scores of SF-36. In addition, among 70 hips, 35 hips exhibited leg length elongation (0 to plus 6.82 mm) after CPO, whereas 35 hips exhibited leg length shortening (0 to minus 6.23 mm). No significant differences were found in HHS and SF-36 between the leg elongation group and leg shortening group.
The mean LLC after CPO was −0.08 ± 3.10 mm, and this change does not affect the postoperative clinical outcomes.
Extracorporeal life support (ECLS) describes the use of blood perfusion devices to provide advanced cardiac or respiratory support. Advances in percutaneous vascular cannula insertion, centrifugal ...pump technologies, and the miniaturization of extracorporeal devices have simplified ECLS. The intention of this discussion is to review the role of ECLS as a potential rescue method for emergency department (ED) clinicians in critical clinical scenarios and to focus on the prerequisites for managing an ECLS program in an ED setting.
Possible indications for ECLS cannulation in the ED include ongoing circulatory arrest, shock or refractory hypoxemia and pulmonary embolism with refractory shock. Severe trauma, foreign body obstruction, hypothermia and near drowning are situations in which patients may potentially benefit from ECLS. Early stabilization in the ED can provide a time window for a diagnostic workup and/or urgent procedures, including percutaneous coronary intervention, rewarming or damage control surgery in trauma. The use of ECLS is resource intensive and can be associated with a high risk of complications, especially when performed without previous training. Therefore, ECLS should only be used when the underlying problem is potentially reversible, and the resources are available to address the etiology of organ dysfunction.
Emergent ECLS has a role in the ED for selected indications in the face of life-threatening conditions. ECLS provides a bridge to recovery, definitive therapy, intervention or surgery. ECLS program requires an appropriately trained staff (physicians, nurses and ECLS specialists), equipment resources and logistical planning.
Femoral nerve palsy is an uncommon but serious complication during the anterolateral approach for total hip arthroplasty. One of the reported reasons for femoral nerve palsy is retractor-induced ...intraoperative damage after retractor placement on the anterior wall of the acetabulum. The present study aimed to clarify the femoral nerve status during anterolateral approach total hip arthroplasty using motor-evoked potential analysis and to identify risk factors influencing the nerve status.
From June 2019 to September 2020, 32 hips in 31 patients underwent primary total hip arthroplasty via the anterolateral approach. The integrity of the femoral nerve was tested by the motor-evoked potential at three time points: preoperatively as a control (first period), immediately after retractor placement on the anterior wall of the acetabulum (second period), and after the procedure (third period). In the second period, the hips were divided into the following two groups: a <50% femoral nerve amplitude group and a ≥50% group. The iliopsoas muscle volume was evaluated by measuring the muscle cross-sectional area on preoperative computed tomography images, and compared between the two groups.
The mean amplitude of the femoral nerve was significantly reduced from 100% in the first period to 35% in the second period (p < 0.01), but then significantly recovered to 54% in the third period (p < 0.01). In 26 (81%) hips, the femoral nerve amplitude was <50% in the second period. The muscle cross-sectional area of the iliopsoas muscle in the <50% group was significantly smaller than that in the ≥50% group (p < 0.05).
The mean amplitude of the femoral nerve was significantly reduced to 35% in the second period, and the iliopsoas muscle volume was considered to influence this femoral nerve status.
Background: We investigated whether patients with out-of-hospital cardiac arrest (OHCA) and sustained ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) or conversion to pulseless ...electrical activity/asystole (PEA/asystole) benefit more from extracorporeal cardiopulmonary resuscitation (ECPR). Methods and Results: We analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan, which was a prospective, multicenter, observational study with 22 institutions in the ECPR group and 17 institutions in the conventional CPR (CCPR) group. Patients were divided into 4 groups by cardiac rhythm and CPR group. The primary endpoint was favorable neurological outcome, defined as Cerebral Performance Category 1 or 2 at 6 months. A total of 407 patients had refractory OHCA with VF/pVT on initial electrocardiogram. The proportion of ECPR patients with favorable neurological outcome was significantly higher in the sustained VF/pVT group than in the conversion to PEA/asystole group (20%, 25/126 vs. 3%, 4/122, P<0.001). Stratifying by cardiac rhythm, on multivariable mixed logistic regression analysis an ECPR strategy significantly increased the proportion of patients with favorable neurological outcome at 6 months in the patients with sustained VF/pVT (OR, 7.35; 95% CI: 1.58–34.09), but these associations were not observed in patients with conversion to PEA/asystole. Conclusions: OHCA patients with sustained VF/pVT may be the most promising ECPR candidates (UMIN000001403).
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