Osborn Wave Is Related to Ventricular Fibrillation and Tachycardia in Hypothermic Patients.

BACKGROUND: The Osborn wave (OW) is often observed in hypothermic patients; however, whether OW in hypothermic patients is related to the development of fatal ventricular arrhythmia, including ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT), remains undetermined. This study aimed to estimate the association between OW and the incidence of fatal ventricular arrhythmias.Methods and Results: This retrospective study used the Japanese Accidental Hypothermia Network registry database and included 572 hypothermic patients. Patients were divided into the OW group (those with OW) and non-OW group (those without OW). The relationship between the development of fatal arrhythmias and presence of OW was assessed using the chi-squared test. All patients who developed VF/VT (n=10) had OW on electrocardiogram upon hospital arrival. The presence of OW had a sensitivity of 100%, specificity of 47.8%, positive predictive value of 4.0%, and negative predictive value of 100% for VF/VT development. The in-hospital mortality rate was 22.3% in the OW group and 21.2% in the non-OW group (P=0.781). CONCLUSIONS: OW was observed in all hypothermic patients with VF/VT. The occurrence of ventricular arrhythmias is highly unlikely in the absence of OW on the electrocardiogram. Although the presence of OW might be used to predict these fatal arrhythmias in hypothermic patients, there was no association between the presence of OW and in-hospital mortality.

Aging is only significant factor causing CPR-induced injuries and serious injuries.

BACKGROUND: Cardiopulmonary resuscitation (CPR) sometime cause severe injuries and can affect quality of life, lead to long-term disabilities or death of the patient. The aim of this study is to identify the risk factors causing CPR-induced injuries and those of serious injuries. METHODS: This was a retrospective forensic autopsy study in a single institution. Among 885 forensic autopsies undertaken between 2011 and 2018, those in which the victim had undergone CPR immediately after cardiac arrest were recorded. 'Serious injuries' were defined as an Abbreviated Injury Scale (AIS) score ≥ 3. CPR-induced injuries were evaluated by three experienced forensic pathologists. With the background and history of the patient, the circumstances of cardiac arrest and risks of causing CPR-induced injuries were determined by multivariate analyses. RESULTS: Seventy-five victims comprised the study cohort. CPR-induced injuries were found in 52 victims (69.3%). Rib fracture was the most common (60.0%), followed by sternal fracture (37.3%), heart injury (21.3%) and liver injury (8.0%). Multivariate analysis revealed higher age to be an independent factor causing CPR-induced injuries (odds ratio [OR], 1.07, P < 0.001). Thirty-six victims had 39 serious injuries in the chest or abdomen: fracture of ≥ 3 ribs (35 cases), aortic dissection (two), lung contusion (one) and rupture of the heart (one). Multivariate analysis revealed higher age to be an independent factor causing CPR-induced serious injuries (OR, 1.09; P < 0.001). CONCLUSION: Aging was the significant factor causing CPR-induced injuries and serious injuries.

Both Autopsy and Computed Tomography Are Necessary for Accurately Detecting Rib Fractures Due to Cardiopulmonary Resuscitation.

Few studies have compared the sensitivities of autopsy and post mortem computed tomography (PMCT) in detecting rib fractures caused by cardiopulmonary resuscitation (CPR). We aimed to compare the characteristics between both modalities for accurately detecting CPR-related rib fractures. This single-centre observational study included adult patients with autopsy records and PMCT scans at our institution from January 2013 to March 2019. CPR-related rib fractures were evaluated using autopsy and PMCT findings. In 62 patients enrolled, 339 rib fractures were detected on autopsy and/or PMCT (222 fractures on both PMCT and autopsy, 69 on PMCT alone, and 50 on autopsy alone). The agreement of detection for both modalities was substantial (kappa coefficient, 0.78). In the logistic regression model, incomplete fractures detected by PMCT and age <75 years were significantly associated with findings that were negative on autopsy but positive on PMCT, while rib number (ribs 1-3 and 7-12) and fracture location (posterolateral and paravertebral) were significantly associated with negative PMCT findings but positive autopsy findings. Autopsy and PMCT showed complementary roles, and are thus necessary in accurately detecting CPR-related rib fractures. Combining both modalities may contribute to improved CPR quality and better understanding of discrepancy in characteristics between the two modalities.

Cerebral oxygenation monitoring during resuscitation by emergency medical technicians: a prospective multicenter observational study.

AIM: To assess the feasibility and predictive ability of regional cerebral oxygen saturation monitoring during cardiopulmonary resuscitation by emergency medical technicians. METHODS: This prospective observational study included 33 cardiac arrest patients who received cardiopulmonary resuscitation in a prehospital setting. Patients were connected to a near-infrared spectrometer through two disposable probes immediately after entering the ambulance. The monitor, which showed regional cerebral oxygen saturation readings, was obscured by covering it with a sheet of paper. Regional cerebral oxygen saturation was measured continuously until hospital arrival. Outcome variables included the prehospital return of spontaneous circulation, survival to hospital admission, and survival at 90 days. RESULTS: For patients who survived >90 days after hospital admission (n = 2), the mean regional cerebral oxygen saturation values upon ambulance and hospital arrival were 24% and 60%, respectively; for patients who did not survive (n = 31), the mean regional cerebral oxygen saturation values were 15% and 17%, respectively. Regional cerebral oxygen saturation values increased to a greater extent between ambulance arrival and hospital arrival in patients who survived >90 days (median, 36%; interquartile range, 32-40%) than in those who did not survive (0; 0-6%; P = 0.07). Additionally, regional cerebral oxygen saturation values were not related to the prehospital return of spontaneous circulation or survival to hospital admission. CONCLUSION: Regional cerebral oxygen saturation could be monitored during resuscitation by emergency medical technicians, and it can be used during physiological monitor-guided cardiopulmonary resuscitation.

Successful Balloon-Assisted Hepatic Tract Embolization Using the Pull-Through Technique to Remove a Malpositioned Chest Tube Penetrating the Liver and into the Right Ventricle.

Intra-abdominal injury is an uncommon complication of chest tube insertion. A 66-year-old man had empyema and underwent chest tube insertion for drainage. Massive hemorrhage occurred; the postprocedural radiograph showed the malpositioned chest tube in the mediastinum. Computed tomography scan showed that the tube's tip penetrated through the liver capsule and passed through the hepatic vein to the right ventricle. Hepatic tract embolization with coiling was performed during chest tube removal under a controlled condition with the hepatic tract occluded by a balloon catheter. The balloon catheter was placed from the right jugular vein using the pull-through technique, establishing a through-and-through guidewire. This is the first report of successful removal of a chest tube malpositioned in the hepatic vein by balloon-assisted hepatic tract embolization without complication.

Successful non-operative management of traumatic extrahepatic portal venous injury without intraperitoneal hemorrhage: a case report.

Case: A 52-year-old woman was admitted to our hospital with hypotension after falling from the fifth floor of an apartment building. Contrast-enhanced computed tomography showed liver injury with extravasation of contrast material from the hepatic artery, and extrahepatic portal venous injury with extravasation and pseudoaneurysm. Intra-abdominal hemorrhage was not observed, and bleeding was confined to the retroperitoneal space. Hepatic arteriography showed extravasation, while portal venography showed pseudoaneurysm but no extravasation. After transarterial embolization, the patient's vital signs improved. Non-operative management was selected for the portal venous injury. Outcome: Computed tomography on the 58th hospital day revealed disappearance of the portal venous pseudoaneurysm. The patient was discharged on the 90th hospital day without any complications. Conclusion: This case shows that non-operative management can be selected for portal venous injury when there is no retroperitoneal injury and bleeding is confined to the retroperitoneal space.

Infected iliac artery aneurysm with aortocaval fistula.

Case: We report a case of an infected iliac artery aneurysm complicated by an aortocaval fistula. Outcome: A 74-year-old-man was admitted with fever, chills, general fatigue, and appetite loss. The patient was diagnosed with an infected iliac artery aneurysm, which was controlled with antibiotics preoperatively. During hospitalization, deep vein thrombosis developed with a pulmonary embolism resulting from an aortocaval fistula. The patient was successfully operated on with in situ autologous vein graft reconstruction. Conclusion: An infected iliac artery aneurysm with aortocaval shunt has rarely been reported. We successfully treated the patient with a combination of appropriate i.v. antibiotics and surgical resection.