Effects of rewarming therapies on outcomes in accidental hypothermia: A secondary analysis of a multicenter prospective study.

BACKGROUND: Rewarming therapies for accidental hypothermia (AH) include extracorporeal membrane oxygenation (ECMO) and non-ECMO related (conventional) therapies. However, there are limited data available to inform the selection of conventional rewarming therapy. The aim of the present study was to explore what patients' factors and which rewarming therapy predicted favorable prognosis. METHODS: This study is a secondary analysis of the Intensive Care with Extra Corporeal membrane oxygenation Rewarming in Accidentally Severe Hypothermia (ICE-CRASH) study, a multicenter prospective, observational study conducted in Japan. Enrolled in the ICE-CRASH study were patients aged ≥18 years with a core temperature of ≤32 °C who were transported to the emergency departments of 36 tertiary care hospitals in Japan between 1 December 2019 and 31 March 2022, among whom those who were rewarmed with conventional rewarming therapy were included in the present study. Logistic regression analysis was performed with 28-day survival as the objective variable; and seven factors including age, activities of daily living (ADL) independence, sequential organ failure assessment (SOFA) score, and each rewarming technique as explanatory variables. We performed linear regression analysis to identify whether each rewarming technique was associated with rewarming rate. RESULTS: Of the 499 patients enrolled in the ICE-CRASH study, 371 were eligible for this secondary analysis. The median age was 81 years, 50.9% were male, and the median initial body temperature was 28.8 °C. Age (odds ratio [OR]: 0.97, 95% confidence interval [CI]: 0.94-1.00) and SOFA score (OR: 0.73, 95% CI: 0.67-0.81) were associated with lower survival, whereas ADL independence (OR: 2.31, 95% CI: 1.15-4.63) was associated with higher survival. No conventional rewarming therapy was associated with 28-day survival. Hot bath was associated with a high rewarming rate (regression coefficient: 1.14, 95% CI: 0.75-1.53). CONCLUSION: No conventional rewarming therapy was associated with improved 28-day survival, which suggests that background factors such as age, ADL, and severity of condition contribute more to prognosis than does the selection of rewarming technique.

Outcome of extracorporeal membrane oxygenation use in severe accidental hypothermia with cardiac arrest and circulatory instability: A multicentre, prospective, observational study in Japan (ICE-CRASH study).

AIM: To elucidate the effectiveness of extracorporeal membrane oxygenation (ECMO) in accidental hypothermia (AH) patients with and without cardiac arrest (CA), including details of complications. METHODS: This study was a multicentre, prospective, observational study of AH in Japan. All adult (aged ≥18 years) AH patients with body temperature ≤32 °C who presented to the emergency department between December 2019 and March 2022 were included. Among the patients, those with CA or circulatory instability, defined as severe AH, were selected and divided into the ECMO and non-ECMO groups. We compared 28-day survival and favourable neurological outcomes at discharge between the ECMO and non-ECMO groups by adjusting for the patients' background characteristics using multivariable logistic regression analysis. RESULTS: Among the 499 patients in this study, 242 patients with severe AH were included in the analysis: 41 in the ECMO group and 201 in the non-ECMO group. Multivariable analysis showed that the ECMO group was significantly associated with better 28-day survival and favourable neurological outcomes at discharge in patients with CA compared to the non-ECMO group (odds ratio [OR] 0.17, 95% confidence interval [CI]: 0.05-0.58, and OR 0.22, 95%CI: 0.06-0.81). However, in patients without CA, ECMO not only did not improve 28-day survival and neurological outcomes, but also decreased the number of event-free days (ICU-, ventilator-, and catecholamine administration-free days) and increased the frequency of bleeding complications. CONCLUSIONS: ECMO improved survival and neurological outcomes in AH patients with CA, but not in AH patients without CA.

Early Initiation of Venovenous Extracorporeal Membrane Oxygenation for Critically Ill COVID-19 Patients.

The optimal timing for initiating extracorporeal membrane oxygenation (ECMO) after starting mechanical ventilation has yet to be clarified. We report herein the cases of two patients with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) who were successfully managed with an early ECMO induction strategy. Case 1 involved a 64-year-old man admitted in respiratory distress with polymerase chain reaction-confirmed COVID-19. On day 5 at hospital, he was intubated, but oxygenation remained unimproved despite mechanical ventilation treatment with high positive end-expiratory pressure (PEEP) (PaO2/FiO2 [P/F] ratio, 127; Respiratory ECMO Survival Prediction [RESP] score, 4). ECMO was initiated 4 hours after intubation, and stopped on day 16 at hospital. The patient was discharged from hospital on day 36. Case 2 involved a 49-year-old man who had been admitted 8 days prior. He was intubated on hospital on day 2. High PEEP mechanical ventilation did not improve oxygenation (P/F ratio, 93; RESP score, 7). ECMO was stopped on hospital on day 7 and he was discharged from hospital on day 21. The strategy of early initiation of ECMO in these two cases may have minimized the risk of ventilation-related lung injury and contributed to the achievement of favorable outcomes.

Japanese medical students' awareness of cardiopulmonary resuscitation in the context of the COVID-19 pandemic.

Aim: To evaluate Japanese medical students' awareness of newly recommended cardiopulmonary resuscitation (CPR) and airway management procedures in the context of the coronavirus disease (COVID-19) pandemic. Methods: An online survey was sent in December 2020 to all medical students at Hirosaki University in Japan. The survey included 15 questions and quizzes regarding prior experience of learning the new CPR guidelines in response to COVID-19, knowledge of conventional CPR, and COVID-19 context CPR and airway management procedures. Results: Of all medical students at the university, 457 (57.1%) responded to the survey. Among these, 22% reported that they were knowledgeable about CPR procedure in the COVID-19 pandemic setting. Prior knowledge of CPR in the context of COVID-19 was a significant positive predictor of quiz score regarding the CPR procedure (ß = 0.60, P < 0.01) and the airway management procedure (ß = 0.34, P = 0.02) in the context of the COVID-19 pandemic. Conclusions: Medical students with experience learning the new COVID-19 context CPR guidelines had sufficient knowledge of CPR and advanced airway management procedures in the setting of the COVID-19 pandemic. Implementation of a formal medical education curriculum based on the newly recommended CPR and advanced life support guidelines is needed to improve medical students' awareness and skills of CPR and airway management in the context of the COVID-19 pandemic.

Impact of air temperature on occurrence of bath-related cardiac arrest.

ABSTRACT: The mortality of the bath-related cardiac arrest (BRCA) is extremely high. While air temperature is reported to be associated with the BRCA occurrence, it is unclear whether daily minimum temperatures or the difference between maximum and minimum air temperatures influences BRCA occurrence the most.A retrospective cohort study of adult patients was conducted between January 2015 and February 2020 at Hirosaki University Hospital Emergency Department. The following data were collected: age, sex, day of cardiac arrest event, location of the event, initial cardiac rhythm, presence of return of spontaneous circulation, and overall mortality (status at 1 month after cardiac arrest event). Based on the day of the event and the location in which the event occurred, daily minimum and maximum temperatures were obtained from the Japan Meteorological Agency database.A total of 215 eligible cardiac arrest cases were identified, including 25 cases of BRCA. Comparing BRCA and non-BRCA, initial shockable cardiac rhythm (4.0% vs 44.7%), presence of return of spontaneous circulation (8.0% vs 34.7%), and overall mortality (96.0% vs 71.6%) differed significantly (P < .05 each). Daily minimum and maximum temperatures showed no significant relationships with BRCA or non-BRCA. Daily minimum temperature was a risk factor of BRCA occurrence after adjusting for age and temperature difference (risk ratio, 0.937; 95% confidence interval, 0.882-0.995).Daily minimum temperature represents a potential risk factor for BRCA occurrence.

Evaluating Effectiveness of YouTube Videos for Teaching Medical Students CPR: Solution to Optimizing Clinician Educator Workload during the COVID-19 Pandemic.

(1) Background: This study aimed to evaluate the effectiveness of using a pre-existing video on CPR to support preclinical resuscitation education for medical students; (2) Methods: In total, 129 students selected to learn CPR using a pre-existing YouTube video or the conventional screencast video by their university faculties. All students responded to the pre- and post-training multiple-choice questionnaire on the basic knowledge of CPR, and, based on their responses, an analysis of covariance (ANCOVA) was conducted to assess the comparability of effectiveness across learning modalities. (3) Results: Among the students, 49 (38.0%) students selected the YouTube video to learn about CPR and were treated as the intervention group. The mean pre-test scores and post-test scores of the YouTube and the instructor's video groups were 6.43 and 6.64, and 9.06 and 9.09, respectively. After controlling for the pre-test score effects, the results of ANCOVA did not show statistically significant differences between groups (p = 0.927), indicating comparable performance between groups that used YouTube and the instructor's videos. (4) Conclusion: Utilizing YouTube videos is a useful teaching strategy for teaching CPR knowledge, which would reduce the burden on faculty of creating screencast lecture videos for online learning on resuscitation.

Methodical history taking may help in timely diagnosis of spontaneous intracranial hypotension.

Orthostatic headache (OH) is a key symptom of spontaneous intracranial hypotension (SIH). However, there is no optimal history taking for OH. A 35-year-old man complained of headache that prevented him from performing routine physical activities, which was relieved on lying down. We initially considered migraine as the most likely diagnosis. However, detailed history taking revealed that his headache worsened on standing, and he was finally diagnosed with SIH. Headache relief on lying down is not a specific indicator of OH associated with SIH. Thus, with regard to headache history taking, we suggest it important to confirm headache aggravation on standing.