Purpose
Mechanical chest compression has been shown to be equivalent to manual chest compression in providing survival benefits to patients experiencing cardiac arrest. There has been a growing need ...for a contemporary review of iatrogenic injuries caused by mechanical in comparison with manual chest compression. Our study aims to analyze the studies that document significant life-threatening iatrogenic injuries caused by mechanical and manual chest compression.
Methods
A systematic review of PubMed and Embase was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. All studies published after January 1st, 2000 were reviewed using inclusion/exclusion criteria and completed by May 2020. A total of 7202 patients enrolled in 15 studies were included in our meta-analysis.
Results
Significant life-threatening iatrogenic injuries had higher odds of occurring when mechanical chest compression was used compared to manual chest compression, especially for hemothorax and liver lacerations. Mechanical chest compression involves consistently deeper compression depths compared to manual chest compression, potentially resulting in more injuries. In the mechanical chest compression cohort, chest wall fractures had the highest incidence rate (55.7%), followed by sternal fracture (28.3%), lung injuries (3.7%), liver (1.0%), and diaphragm (.2%) lacerations.
Conclusions
Mechanical chest compression was associated with more iatrogenic injuries as compared to manual chest compression. Further research is needed to define the appropriate application of mechanical in comparison with manual chest compression in different scenarios. Levels of provider training, different mechanical chest compression device types, patient demographics, and compression duration/depth may all play roles in influencing outcomes.
Traumatic brain injury (TBI) is a significant source of morbidity and mortality in the United States. Recent shifts in state legislation have increased the use of recreational and medical marijuana. ...While cannabinoids and tetrahydrocannabinol (THC) have known anti-inflammatory effects, the impact of preinjury THC use on clinical outcomes in the setting of severe TBI is unknown. We hypothesized that preinjury THC use in trauma patients suffering TBI would be associated with decreased thromboembolic events and adverse outcomes.
The American College of Surgeons Trauma Quality Improvement Program was used to identify patients aged ≥18 y with TBI and severe injury (Injury Severity Score ≥ 16) in admit year 2017. Patients with smoking or tobacco history or missing or positive toxicology tests for drug and/or alcohol use other than THC were excluded. Propensity score matching was used to compare THC+ patients to similar THC− patients.
A total of 13,266 patients met inclusion criteria, of which 1669 were THC+. A total of 1377 THC+ patients were matched to 1377 THC− patients. No significant differences were found in in-hospital outcomes, including mortality, length of stay, cardiac arrest, pulmonary embolism, deep vein thrombosis, or acute respiratory distress syndrome. No patients had ischemic stroke, and THC+ patients had significantly decreased rates of hemorrhagic stroke (0.5% versus 1.5%, P = 0.02, odds ratio 0.41 95% confidence interval 0.18-0.86).
Preinjury THC use may be associated with decreased hemorrhagic stroke in severely injured patients with TBI, but there was no difference in thromboembolic outcomes. Further research into pathophysiological mechanisms related to THC are needed.
Penetrating trauma to the cardiac box is associated with high rates of cardiac injury, structural complications, morbidity, and mortality. Early identification and intervention of these injuries is ...paramount to obtaining good patient outcomes. In this paper, we report a 55-year-old male who sustained a single stab wound to left chest which perforated the right ventricle. The patient also sustained a muscular ventricular septal defect (VSD) which led to a prolonged intensive care unit (ICU) course complicated by late pericardial tamponade. We present successful management of this patient’s initial injury along with his ICU course culminating in successful endovascular occlusive patch VSD repair.
Trauma represents the leading cause of nonobstetrical maternal death. How in-hospital outcomes of acutely injured pregnant patients (PP) compares to that of similarly aged nonpregnant control groups ...(CGs) has not been described. We hypothesized that PPs suffering acute traumatic injuries would have worse outcomes compared to a matched CG.
The American College of Surgeons Trauma Quality Improvement Program (TQIP) was used to identify traumatically injured females between 2017 and 2019. Propensity score matching on age, race, injury severity score , and type of trauma (blunt, penetrating, or other) was used to compare PPs and the CG. Primary outcomes were mortality, disposition, length of stay (LOS), and complications.
A total of 1078 traumatically injured pregnant females were identified. Propensity score matching resulted in 990 patients in the PP and CG cohorts. After matching, PPs were more likely to be assault victims (11% versus 6%, P < 0.001), had longer length of stay (LOS) (5 versus 3 d, P < 0.001), and were more likely to require mechanical ventilation (26% versus 16%, P < 0.001) or intensive care unit (ICU) admission (44% versus 32%, P < 0.001). PPs were more likely to proceed directly to the operating room (OR)(34% versus 15%, P < 0.001) and less likely to be discharged home from the emergency department (ED) (1% versus 12%, P < 0.001). Complications and mortality rates were similar among PPs.
After acute trauma, PPs did not have increased mortality or complications when compared to matched controls, although they were more likely to be victims of assault, directly proceed to the OR, require mechanical ventilation or ICU admission, and have longer LOSs.
To address the issues of multidrug-resistance and newly emerging pathogens DeepDrug is developing computer aided drug design software utilizing Artificial Intelligence (AI)-based techniques that ...access very large datasets and, in turn, creates an improved method for identify new compounds rapidly thereby dramatically shortening the developmental time line and the cost to have a new drug accepted. The software the DeepDrug team has developed is collectively referred to as DeepDrug which is comprised of the lead program eSynth (creates new molecules for a researcher's use) together with eMolFrag (decomposes organic compounds into non-redundant fragments) and eToxPred (predicts the possible side effects.). eDrugRes, an AI based module allows the examination of the genomes of pathogens, etc. to aid in developing new compounds.
Introduction
Preventable deaths following trauma are high and unchanged over the last two decades. The objective of this study was to describe the location of death in patients with penetrating ...trauma, stratified by anatomic location of injury, in order to better tailor our approach to reducing preventable deaths from trauma.
Methods
This retrospective analysis of a prospectively maintained trauma registry included consecutive adult trauma activations with penetrating trauma at a level 1 trauma center between 07/2012 and 03/2018. Injuries were categorized as extremity, junctional, and torso. Head and neck injuries were excluded. Patients injured in >1 defined location were categorized as “multiple.” Location of death was defined as on-scene, emergency department (ED), or hospital. Two-sided χ2 tests were used to compare groups. Multivariate analysis was performed using logistic regression.
Results
A total of 1024 patients were included with an overall case fatality rate (CFR) of 7.8%. The CFR following extremity injury (3.0%) was significantly lower than all other injury sites (P = .02).There were no significant differences in CFR for junctional (10.4%), torso (8.3%), or multiple injuries (9.6%). Forty percent of fatalities following junctional injury occurred on-scene and an additional 20% occurred in the ED.
Discussion
To our knowledge, this is the first study to describe location of death stratified by anatomic location of injury. There was no difference in the CFRs of junctional and torso injuries, and a large proportion of deaths occurred prior to reaching the hospital or in the trauma bay. These findings support reevaluating the classical algorithms and care pathways for patients with proximal penetrating trauma.
The diagnosis and management of poisoning is essential in critical care medicine. Traditionally, these conditions fall under the category of toxidromes that are the signs and symptoms associated with ...a particular class of poisons. However, there has been a steady increase in designer drugs and contaminants of recreational drugs themselves. Examples of adulterants in cocaine include the local anesthetic benzocaine and the anti-parasitic levamisole. This paper presents the clinical signs, laboratory findings, and treatment of patients who have been exposed to these substances.
Acute hemorrhage commonly leads to coagulopathy and organ dysfunction or failure. Recent evidence suggests that damage to the endothelial glycocalyx contributes to these adverse outcomes. The ...physiological events mediating acute glycocalyx shedding are undefined, however. Here, we show that succinate accumulation within endothelial cells drives glycocalyx degradation through a membrane reorganization-mediated mechanism. We investigated this mechanism in a cultured endothelial cell hypoxia-reoxygenation model, in a rat model of hemorrhage, and in trauma patient plasma samples. We found that succinate metabolism by succinate dehydrogenase mediates glycocalyx damage through lipid oxidation and phospholipase A2-mediated membrane reorganization, promoting the interaction of matrix metalloproteinase 24 (MMP24) and MMP25 with glycocalyx constituents. In a rat hemorrhage model, inhibiting succinate metabolism or membrane reorganization prevented glycocalyx damage and coagulopathy. In patients with trauma, succinate levels were associated with glycocalyx damage and the development of coagulopathy, and the interaction of MMP24 and syndecan-1 was elevated compared to healthy controls.
Background: The effects of resuscitative endovascular balloon occlusion of the aorta (REBOA) on progression of traumatic brain injury (TBI) are unclear. Two hypotheses prevail: increased mean ...arterial pressure may improve cerebral perfusion, or cause cerebral edema due to elevated intracranial pressure. This study compares outcomes in hypotensive, blunt trauma patients with TBI treated with and without REBOA. Methods: A retrospective analysis compared hypotensive (systolic blood pressure SBP >90) blunt trauma patients with TBI treated with REBOA to those treated without. Patients with spontaneous circulation at admission and at initiation of aortic occlusion were included. Patients requiring cardiopulmonary resuscitation in the emergency department (ED) were excluded. Radius matching used age, injury severity score (ISS), abbreviated injury score (AIS)head, and Glasgow coma score (GCS) and SBP at ED arrival. Results: Of 232 patients, 135 were treated with REBOA and 97 without. REBOA patients were older and had higher ISS, AIS-head, AIS-chest and AIS- extremity. There was no difference in TBI severity, and mortality. In the matched analysis (n = 76 REBOA, n = 54 non-REBOA), there was no difference in ISS, AIS-head, pre-hospital, ED, or discharge GCS, ED SBP, or mortality. Despite longer hospital stays for REBOA patients, there was no difference in intensive care unit length of stay, rate of discharge home, or discharge GCS. Conclusions: REBOA was used in more severely injured patients, but was not associated with higher mortality rate. REBOA should be considered for use in patients with non-compressible torso hemorrhage and concomitant TBI, as it did not increase mortality, and outcomes were similar to non-REBOA patients.
