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This study aimed to establish a deep learning-based predictive model for the prognosis of idiopathic sudden sensorineural hearing loss (SSNHL). Data from 1108 patients with SSNHL between January 2015 and May 2023 were retrospectively analyzed. Patients underwent standardized treatment protocols including high-dose steroid therapy and hearing outcomes were assessed after three months using Siegel's criteria and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification. For predicting patient recovery, a two-layered classification process was implemented. Initially, a set of 22 Multilayer Perceptrons (MLP) networks was employed to categorize the patients. The outcomes from this initial categorization were subsequently relayed to a second-layer meta-classifier for final prognosis determination. The validity of this methodology was ascertained through a K-fold cross-validation procedure executed with 10 distinct splits. The prediction model for complete recovery, based on Siegel's criteria, demonstrated an accuracy of 0.892 and area under the curve (AUC) of 0.922. For the class A prediction, according to AAO-HNS classification, the model showed an accuracy of 0.847 and AUC of 0.918. These results suggest that the model may have the potential to contribute to the establishment of tailored patient management strategies by predicting hearing recovery in patients with SSNHL.
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Aprendizado Profundo , Perda Auditiva Neurossensorial , Perda Auditiva Súbita , Humanos , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/tratamento farmacológico , Masculino , Feminino , Pessoa de Meia-Idade , Perda Auditiva Súbita/diagnóstico , Perda Auditiva Súbita/tratamento farmacológico , Perda Auditiva Súbita/terapia , Perda Auditiva Súbita/fisiopatologia , Estudos Retrospectivos , Adulto , Prognóstico , Idoso , Recuperação de Função Fisiológica , Algoritmos , Audição/fisiologiaRESUMO
This study was performed to segment the urinary system as the basis for diagnosing urinary system diseases on non-contrast computed tomography (CT). This study was conducted with images obtained between January 2016 and December 2020. During the study period, non-contrast abdominopelvic CT scans of patients and diagnosed and treated with urinary stones at the emergency departments of two institutions were collected. Region of interest extraction was first performed, and urinary system segmentation was performed using a modified U-Net. Thereafter, fivefold cross-validation was performed to evaluate the robustness of the model performance. In fivefold cross-validation results of the segmentation of the urinary system, the average dice coefficient was 0.8673, and the dice coefficients for each class (kidney, ureter, and urinary bladder) were 0.9651, 0.7172, and 0.9196, respectively. In the test dataset, the average dice coefficient of best performing model in fivefold cross validation for whole urinary system was 0.8623, and the dice coefficients for each class (kidney, ureter, and urinary bladder) were 0.9613, 0.7225, and 0.9032, respectively. The segmentation of the urinary system using the modified U-Net proposed in this study could be the basis for the detection of kidney, ureter, and urinary bladder lesions, such as stones and tumours, through machine learning.
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Rim , Tomografia Computadorizada por Raios X , Ureter , Bexiga Urinária , Humanos , Tomografia Computadorizada por Raios X/métodos , Bexiga Urinária/diagnóstico por imagem , Ureter/diagnóstico por imagem , Rim/diagnóstico por imagem , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Processamento de Imagem Assistida por Computador/métodos , Redes Neurais de ComputaçãoRESUMO
PURPOSE: Previous studies have suggested that serum phosphate concentration is a prognostic factor in critically ill patients. However, the association between changes in serum phosphate levels and prognosis of patients with trauma remains unclear. MATERIALS AND METHODS: This study included patients with severe trauma who were treated at the emergency department. Delta phosphate (Δ phosphate) was defined as the difference between serum phosphate concentrations measured at baseline and after 24 hours from the initial measurement. Patients were divided into five groups according to their Δ phosphate levels: group I (Δ phosphate <-2 mg/dL), group II (Δ phosphate -2 to -0.5 mg/dL), group III (Δ phosphate -0.5 to 0.5 mg/dL), group IV (Δ phosphate 0.5 to 2 mg/dL), and group V (Δ phosphate ≥2 mg/dL). RESULTS: Overall, 1905 patients with severe trauma were included in the analysis. The 30-day mortality was the lowest in group III and tended to increase in groups with a larger Δ phosphate in both the positive and negative directions (group I: 13.7%, group II: 6.8%, group III: 4.6%, group IV: 6.6%, and group V: 26.8%). In multivariable analysis with group III as the reference group, the odds ratios (ORs) of mortality were statistically significant in group IV [OR, 1.92; 95% confidence interval (CI), 1.05-3.56] and group V (OR, 5.28; 95% CI, 2.47-11.24). CONCLUSION: An increase in serum phosphate concentrations 24 hours after the initial measurement could be considered as an independent prognostic factor in patients with severe trauma.
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Serviço Hospitalar de Emergência , Fosfatos , Humanos , PrognósticoRESUMO
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a significant public health issue worldwide and is associated with low survival rates and poor neurological outcomes. The generation of optimal coronary perfusion pressure (CPP) via high-quality chest compressions is a key factor in enhancing survival rates. However, it is often challenging to provide adequate CPP in real-world cardiopulmonary resuscitation (CPR) scenarios. Based on animal studies and human trials on improving CPP in patients with nontraumatic OHCA, resuscitative endovascular balloon occlusion of the aorta (REBOA) is a promising technique in these cases. This study aims to investigate the benefits of REBOA adjunct to CPR compared with conventional CPR for the clinical management of nontraumatic OHCA. METHODS: This is a parallel-group, randomized, controlled, multinational trial that will be conducted at two urban academic tertiary hospitals in Korea and Taiwan. Patients aged 20-80 years presenting with witnessed OHCA will be enrolled in this study. Eligible participants must fulfill the inclusion criteria, and written informed consent should be collected from their legal representatives. Patients will be randomly assigned to the intervention (REBOA-CPR) or control (conventional CPR) group. The intervention group will receive REBOA and standard advanced cardiovascular life support (ACLS). Meanwhile, the control group will receive ACLS based on the 2020 American Heart Association guidelines. The primary outcome is the return of spontaneous circulation (ROSC). The secondary outcomes include sustained ROSC, survival to admission, survival to discharge, neurological outcome, and hemodynamic changes. DISCUSSION: Our upcoming trial can provide essential evidence regarding the efficacy of REBOA, a mechanical method for enhancing CPP, in OHCA resuscitation. Our study aims to determine whether REBOA can improve treatment strategies for patients with nontraumatic OHCA based on clinical outcomes, thereby potentially providing valuable insights and guiding further advancements in this critical public health area. TRIAL REGISTRATION: ClinicalTrials.gov NCT06031623. Registered on September 9, 2023.
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Oclusão com Balão , Reanimação Cardiopulmonar , Procedimentos Endovasculares , Parada Cardíaca Extra-Hospitalar , Animais , Humanos , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/terapia , Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/métodos , Ressuscitação/métodos , Aorta , Hemodinâmica , Oclusão com Balão/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodosRESUMO
BACKGRUOUND: Nonalcoholic steatohepatitis (NASH) is a liver disease caused by obesity that leads to hepatic lipoapoptosis, resulting in fibrosis and cirrhosis. However, the mechanism underlying NASH is largely unknown, and there is currently no effective therapeutic agent against it. DWN12088, an agent used for treating idiopathic pulmonary fibrosis, is a selective prolyl-tRNA synthetase (PRS) inhibitor that suppresses the synthesis of collagen. However, the mechanism underlying the hepatoprotective effect of DWN12088 is not clear. Therefore, we investigated the role of DWN12088 in NASH progression. METHODS: Mice were fed a chow diet or methionine-choline deficient (MCD)-diet, which was administered with DWN12088 or saline by oral gavage for 6 weeks. The effects of DWN12088 on NASH were evaluated by pathophysiological examinations, such as real-time quantitative reverse transcription polymerase chain reaction, immunoblotting, biochemical analysis, and immunohistochemistry. Molecular and cellular mechanisms of hepatic injury were assessed by in vitro cell culture. RESULTS: DWN12088 attenuated palmitic acid (PA)-induced lipid accumulation and lipoapoptosis by downregulating the Rho-kinase (ROCK)/AMP-activated protein kinase (AMPK)/sterol regulatory element-binding protein-1c (SREBP-1c) and protein kinase R-like endoplasmic reticulum kinase (PERK)/α subunit of eukaryotic initiation factor 2 (eIF2α)/activating transcription factor 4 (ATF4)/C/EBP-homologous protein (CHOP) signaling cascades. PA increased but DWN12088 inhibited the phosphorylation of nuclear factor-κB (NF-κB) p65 (Ser536, Ser276) and the expression of proinflammatory genes. Moreover, the DWN12088 inhibited transforming growth factor ß (TGFß)-induced pro-fibrotic gene expression by suppressing TGFß receptor 1 (TGFßR1)/Smad2/3 and TGFßR1/glutamyl-prolyl-tRNA synthetase (EPRS)/signal transducer and activator of transcription 6 (STAT6) axis signaling. In the case of MCD-diet-induced NASH, DWN12088 reduced hepatic steatosis, inflammation, and lipoapoptosis and prevented the progression of fibrosis. CONCLUSION: Our findings provide new insights about DWN12088, namely that it plays an important role in the overall improvement of NASH. Hence, DWN12088 shows great potential to be developed as a new integrated therapeutic agent for NASH.
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Aminoacil-tRNA Sintetases , Hepatopatia Gordurosa não Alcoólica , Camundongos , Animais , Hepatopatia Gordurosa não Alcoólica/complicações , Cirrose Hepática/metabolismo , Fibrose , Colina , Metionina , Fator de Crescimento Transformador betaRESUMO
Airway procedures in life-threatening situations are vital for saving lives. Video laryngoscopy (VL) is commonly performed during endotracheal intubation (ETI) in the emergency department. Artificial intelligence (AI) is widely used in the medical field, particularly to detect anatomical structures. This study aimed to develop an AI algorithm that detects vocal cords from VL images acquired during emergent situations. This retrospective study used VL images acquired in the emergency department to facilitate the ETI. The vocal cord image was labeled with a ground-truth bounding box. The dataset was divided into training and validation datasets. The algorithm was developed from a training dataset using the YOLOv4 model. The performance of the algorithm was evaluated using a test set. The test set was further divided into specific environments during the ETI for clinical subgroup analysis. In total, 20,161 images from 84 patients were used in this study. A total of 10,287, 5766, and 4108 images were used for the model training, validation, and test sets, respectively. The developed algorithm achieved F1 score 0.906, sensitivity 0.963, and specificity 0.842 in the validation set. The performance in the test set was F1 score 0.808, sensitivity 0.823, and specificity 0.804. We developed and validated an AI algorithm to detect vocal cords in VL. This algorithm demonstrated a high performance. The algorithm can be used to determine the vocal cord to ensure safe ETI.
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Inteligência Artificial , Prega Vocal , Humanos , Prega Vocal/diagnóstico por imagem , Laringoscopia/métodos , Estudos Retrospectivos , Algoritmos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodosRESUMO
BACKGROUND: In Korea, during the early phase of the coronavirus disease 2019 (COVID-19) pandemic, we responded to the uncertainty of treatments under various conditions, consistently playing catch up with the speed of evidence updates. Therefore, there was high demand for national-level evidence-based clinical practice guidelines for clinicians in a timely manner. We developed evidence-based and updated living recommendations for clinicians through a transparent development process and multidisciplinary expert collaboration. METHODS: The National Evidence-based Healthcare Collaborating Agency (NECA) and the Korean Academy of Medical Sciences (KAMS) collaborated to develop trustworthy Korean living guidelines. The NECA-supported methodological sections and 8 professional medical societies of the KAMS worked with clinical experts, and 31 clinicians were involved annually. We developed a total of 35 clinical questions, including medications, respiratory/critical care, pediatric care, emergency care, diagnostic tests, and radiological examinations. RESULTS: An evidence-based search for treatments began in March 2021 and monthly updates were performed. It was expanded to other areas, and the search interval was organized by a steering committee owing to priority changes. Evidence synthesis and recommendation review was performed by researchers, and living recommendations were updated within 3-4 months. CONCLUSION: We provided timely recommendations on living schemes and disseminated them to the public, policymakers and various stakeholders using webpages and social media. Although the output was successful, there were some limitations. The rigor of development issues, urgent timelines for public dissemination, education for new developers, and spread of several new COVID-19 variants have worked as barriers. Therefore, we must prepare systematic processes and funding for future pandemics.
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COVID-19 , Criança , Humanos , Adenosina-5'-(N-etilcarboxamida) , República da Coreia , SARS-CoV-2 , Guias de Prática Clínica como AssuntoRESUMO
AIM: Prehospital management of out-of-hospital cardiac arrest (OHCA) is based on basic life support, with the addition of advanced life support (ALS) if possible. This study aimed to investigate the effect of delayed arrival of ALS on neurological outcomes of patients with OHCA at hospital discharge. METHODS: This was a retrospective study of a registry of patients with OHCA. A multi-tier emergency response system was established in the study area. ALS was initiated when the second-arrival team arrived at the scene. A restricted cubic spline curve was used to investigate the relationship between the response time interval of the second-arrival team and neurological outcomes at hospital discharge. Multivariable logistic regression analysis was performed to assess the independent association between the response time interval of the second-arrival team and neurological outcomes of patients at hospital discharge. RESULTS: A total of 3186 adult OHCA patients who received ALS at the scene were included in the final analysis. A restricted cubic spline curve showed that a long response time interval of the second-arrival team was correlated with a high likelihood of poor neurological outcomes. Meanwhile, multivariable logistic regression analysis showed that a long response time interval of the second-arrival team was independently associated with poor neurological outcomes (odds ratio, 1.10; 95% confidence interval, 1.03-1.17). CONCLUSION: In a multi-tiered prehospital emergency response system, the delayed arrival of ALS was associated with poor neurological outcomes at hospital discharge.
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Esclerose Lateral Amiotrófica , Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Adulto , Humanos , Estudos Retrospectivos , Cardioversão Elétrica , Parada Cardíaca Extra-Hospitalar/terapiaRESUMO
BACKGROUND: There are conflicting results regarding the association between body mass index and the prognosis of cardiac arrest patients. We investigated the association of the composition and distribution of muscle and fat with neurologic outcomes at hospital discharge in successfully resuscitated out-of-hospital cardiac arrest (OHCA) patients. METHODS: This prospective, single-centre, observational study involved adult OHCA patients, conducted between April 2019 and June 2021. The ratio of total skeletal muscle, upper limb muscle, lower limb muscle, and total fat to body weight was measured using InBody S10, a bioimpedance analyser, after achieving the return of spontaneous circulation. Restricted cubic spline curves with four knots were used to examine the relationship between total skeletal muscle, upper limb muscle, and lower limb muscle relative to total body weight and neurologic outcome at discharge. Multivariable logistic regression analysis was performed to assess an independent association. RESULTS: A total of 66 patients were enrolled in the study. The proportion of total muscle and lower limb muscle positively correlated with the possibility of having a good neurologic outcome. The proportion of lower limb muscle showed an independent association in the multivariable analysis (adjusted odds ratio, 2.29; 95% confidence interval, 1.06-13.98), and its optimal cut-off value calculated through receiver operating characteristic curve analysis was 23.1%, which can predict a good neurological outcome. CONCLUSIONS: A higher proportion of lower limb muscle to body weight was independently associated with the probability of having a good neurologic outcome in OHCA patients.
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Background: A non-reactive pupil in standard pupillary light reflex (sPLR) is regarded as a factor predicting neurological sequelae at 1-month after carbon monoxide (CO) poisoning. An automated pupillometer is used in the intensive care unit to quantitatively assess PLR. Quantitative PLR (qPLR) was superior to sPLR using penlight for prognosis of various neurological diseases. Therefore, this study aimed to analyze whether quantitative pupillary variables (neurological Pupil index [NPi] and qPLR) are superior to sPLR in predicting 1-month neurocognitive sequelae after acute CO poisoning. Methods: We performed a prospective observational study of consecutive patients with acute CO poisoning admitted to an emergency department (ED) between August 2019 and December 2020 in a single academic medical center. sPLR and pupillometer examinations (qPLR and NPi) were performed by emergency physicians at the ED on hospital days 0-2. The lowest values among those recorded within 24 h and during the total measurement period were considered the 24-h and total lowest values, respectively. Global Deterioration Scale scores were measured at 1 month as an outcome and were dichotomized into favorable (1-4) or poor (5-7) outcomes. Results: We analyzed the data of 104 adult patients with acute CO poisoning. qPLR was significantly higher in the favorable outcome group than in the poor outcome group 24-h and total lowest values (21.2% vs. 15.0%, p = 0.006 and 21.0% vs. 14.8%, p = 0.006). qPLR <18% had fair predictive power for poor neurocognitive outcomes [area under the curve (AUC), 0.70; 95% confidence interval (0.60-0.78)]. Among the patients with decreased mental status (Glasgow Coma Scale ≤12), the power of NPi and qPLR increased [AUC, 0.72 and AUC, 0.80]. NPi < 1 and qPLR <18% showed sensitivity (9.5% vs. 76.2%) and specificity (98.8% vs. 67.5%) for the prediction of poor outcomes. qPLR was significantly superior to sPLR in predicting poor neurocognitive outcomes at 1 month after CO poisoning (p = 0.007). Conclusion: qPLR and NPi were superior to sPLR in terms of predicting poor neurocognitive outcomes. qPLR and NPi measured from hospital days 0-2 may be valuable in predicting neurocognitive outcome.
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Acute thoracic aortic dissection is a life-threatening disease, in which blood leaking from the damaged inner layer of the aorta causes dissection between the intimal and adventitial layers. The diagnosis of this disease is challenging. Chest x-rays are usually performed for initial screening or diagnosis, but the diagnostic accuracy of this method is not high. Recently, deep learning has been successfully applied in multiple medical image analysis tasks. In this paper, we attempt to increase the accuracy of diagnosis of acute thoracic aortic dissection based on chest x-rays by applying deep learning techniques. In aggregate, 3,331 images, comprising 716 positive images and 2615 negative images, were collected from 3,331 patients. Residual neural network 18 was used to detect acute thoracic aortic dissection. The diagnostic accuracy of the ResNet18 was observed to be 90.20% with a precision of 75.00%, recall of 94.44%, and F1-score of 83.61%. Further research is required to improve diagnostic accuracy based on aorta segmentation.
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Dissecção Aórtica , Dissecção da Aorta Torácica , Humanos , Redes Neurais de Computação , Aorta , Radiografia Torácica/métodosRESUMO
Regulated in development and DNA damage response 1 (REDD1) expression is upregulated in response to metabolic imbalance and obesity. However, its role in obesity-associated complications is unclear. Here, we demonstrate that the REDD1-NF-κB axis is crucial for metabolic inflammation and dysregulation. Mice lacking Redd1 in the whole body or adipocytes exhibited restrained diet-induced obesity, inflammation, insulin resistance, and hepatic steatosis. Myeloid Redd1-deficient mice showed similar results, without restrained obesity and hepatic steatosis. Redd1-deficient adipose-derived stem cells lost their potential to differentiate into adipocytes; however, REDD1 overexpression stimulated preadipocyte differentiation and proinflammatory cytokine expression through atypical IKK-independent NF-κB activation by sequestering IκBα from the NF-κB/IκBα complex. REDD1 with mutated Lys219/220Ala, key amino acid residues for IκBα binding, could not stimulate NF-κB activation, adipogenesis, and inflammation in vitro and prevented obesity-related phenotypes in knock-in mice. The REDD1-atypical NF-κB activation axis is a therapeutic target for obesity, meta-inflammation, and metabolic complications.
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Fígado Gorduroso , NF-kappa B , Camundongos , Animais , NF-kappa B/metabolismo , Inibidor de NF-kappaB alfa/genética , Obesidade/complicações , Obesidade/genética , Obesidade/metabolismo , Inflamação/metabolismo , Fígado Gorduroso/metabolismo , Citocinas , AminoácidosRESUMO
BACKGROUND: The purpose of this study is to compare and analyze the treatment outcomes between two groups which are both immediately placed implant cases, one is immediate loading, and the other is conventional loading group. METHODS: Medical records of the patients who underwent implant treatment which were immediately placed after tooth extraction were analyzed. Demographic data were collected and by using periapical or panoramic radiographic image, marginal bone level and distant crestal bone level were measured. Marginal bone change over time was analyzed and compared between immediate loading group and conventional loading group. RESULTS: A total of 71 patients, 112 immediately placed implants after tooth extraction were initially involved. Measuring was done with implants which had not failed (81). 10 implants were had failed and removed. The others were excluded because of follow-up loss, absence of radiographic image, etc. Demographic data were collected, and measured values were averaged at each follow-up and showed in linear graphs. CONCLUSIONS: In case of immediate implantation of dental implant after extraction, loading time could affect marginal bone level or biological width of the implant. Immediate loading group showed 0.92 mm (mean value) more bone loss compared to conventional loading group at bone-implant contact points 24 months after implantation. At distant crestal points, there was no noticeable difference in bone change pattern between two groups.
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Perda do Osso Alveolar , Implantes Dentários para Um Único Dente , Implantes Dentários , Carga Imediata em Implante Dentário , Perda do Osso Alveolar/diagnóstico por imagem , Implantação Dentária Endóssea/efeitos adversos , Implantes Dentários para Um Único Dente/efeitos adversos , Humanos , Carga Imediata em Implante Dentário/efeitos adversos , Estudos Retrospectivos , Alvéolo Dental/cirurgiaRESUMO
Background: This study aimed to develop an algorithm for multilabel classification according to the distance from carina to endotracheal tube (ETT) tip (absence, shallow > 70 mm, 30 mm ≤ proper ≤ 70 mm, and deep position < 30 mm) with the application of automatic segmentation of the trachea and the ETT on chest radiographs using deep convolutional neural network (CNN). Methods: This study was a retrospective study using plain chest radiographs. We segmented the trachea and the ETT on images and labeled the classification of the ETT position. We proposed models for the classification of the ETT position using EfficientNet B0 with the application of automatic segmentation using Mask R-CNN and ResNet50. Primary outcomes were favorable performance for automatic segmentation and four-label classification through five-fold validation with segmented images and a test with non-segmented images. Results: Of 1985 images, 596 images were manually segmented and consisted of 298 absence, 97 shallow, 100 proper, and 101 deep images according to the ETT position. In five-fold validations with segmented images, Dice coefficients [mean (SD)] between segmented and predicted masks were 0.841 (0.063) for the trachea and 0.893 (0.078) for the ETT, and the accuracy for four-label classification was 0.945 (0.017). In the test for classification with 1389 non-segmented images, overall values were 0.922 for accuracy, 0.843 for precision, 0.843 for sensitivity, 0.922 for specificity, and 0.843 for F1-score. Conclusions: Automatic segmentation of the ETT and trachea images and classification of the ETT position using deep CNN with plain chest radiographs could achieve good performance and improve the physician's performance in deciding the appropriateness of ETT depth.
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OBJECTIVE: Extended Reality (XR) is a simultaneous combination of the virtual and real world. This paper presents the details of the framework and development methods for an XR basic life support (XR-BLS) simulator, as well as the results of an expert usability survey. METHODS: The XR-BLS simulator was created by employing a half-torso manikin in a virtual reality environment and using BLS education data that is in line with the 2020 American Heart Association guidelines. A head-mounted display (HMD) and hand-tracking device were used to perform chest compressions and ventilation and to enable the use of an automated external defibrillator in a virtual environment. A usability study of the XR-BLS simulator through an expert survey was also conducted. The survey consisted of a total of 8 items: 3, 2, and 2 questions about the ease of use of XR-BLS, delivery of training, and artificial intelligence (AI) instructor in the simulator, respectively. RESULTS: The XR simulator was developed, and the expert survey showed that it was easy to use, the BLS training was well delivered, and the interaction with the AI instructor was clear and understandable. DISCUSSION/CONCLUSION: The XR-BLS simulator is useful as it can conduct BLS education without requiring instructors and trainees to gather.
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Reanimação Cardiopulmonar , Inteligência Artificial , Reanimação Cardiopulmonar/educação , Desfibriladores , Avaliação Educacional , Manequins , Estados UnidosRESUMO
AIM OF THE STUDY: Resuscitative endovascular balloon occlusion of the aorta (REBOA), originally designed to block blood flow to the distal part of the aorta by placing a balloon in trauma patients, has recently been shown to increase coronary perfusion in cardiac arrest patients. This study evaluated the effect of REBOA on aortic pressure and coronary perfusion pressure (CPP) in non-traumatic out of-hospital cardiac arrest (OHCA) patients. METHODS: Adult OHCA patients with cerebral performance category 1 or 2 prior to cardiac arrest, and without evidence of aortic disease, were enrolled from January to December 2021. Aortic pressure and right atrial pressure were measured before and after balloon occlusion. The CPP was calculated using the measured aortic and right atrial pressures, and the values before and after the balloon occlusion were compared. RESULTS: Fifteen non-traumatic OHCA patients were enrolled in the study. The median call to balloon time was 46.0 (IQR, 38.0-54.5) min. The median CPP before and after balloon occlusion was 13.5 (IQR, 5.8-25.0) and 25.2 (IQR, 12.0-44.6) mmHg, respectively (P = 0.001). The median increase in the estimated CPP after balloon occlusion was 86.7%. CONCLUSIONS: The results of this study suggest that REBOA may increase the CPP during cardiopulmonary resuscitation in patients with non-traumatic OHCA. Additional studies are needed to investigate the effect on clinical outcomes.
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Oclusão com Balão , Reanimação Cardiopulmonar , Procedimentos Endovasculares , Parada Cardíaca Extra-Hospitalar , Choque Hemorrágico , Adulto , Aorta , Oclusão com Balão/métodos , Reanimação Cardiopulmonar/métodos , Procedimentos Endovasculares/métodos , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Perfusão , Ressuscitação/métodosRESUMO
AIM OF THE STUDY: This study aimed to investigate the effect of the head-up position implemented during cardiopulmonary resuscitation (CPR) on cerebral blood flow (CBF) using near-infrared spectroscopy in out-of-hospital cardiac arrest patients. METHODS: Baseline characteristics (age, sex, cerebral performance category before cardiac arrest, witnessed cardiac arrest, bystander CPR, first monitored rhythm, no-flow time, prehospital low-flow time, CPR duration in the emergency department (ED), and reason for stopping CPR in the ED) were recorded. The changes of CBF were derived from the optical oscillation waveform measured by near-infrared spectroscopy in adult patients with out-of-hospital cardiac arrest by alternating head-up and supine positions at 4-minute intervals while performing CPR. The CBF velocity according to the head position was also evaluated using the time derivative of the oscillation waveform. RESULTS: During the study period, 28 patients were enrolled. The median increase in CBF in the prefrontal area in the head-up position was 14.6% (Interquartile range, 8.8-65.0), more than that in the supine position. An increase in CBF was observed in the head-up position compared with the supine position in 83.3% of the patients included in the analysis. CONCLUSION: CBF increased when the head-up position was used during CPR in non-traumatic out-of-hospital cardiac arrest patients.
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Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Adulto , Reanimação Cardiopulmonar/métodos , Circulação Cerebrovascular , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Projetos Piloto , Estudos Prospectivos , Espectroscopia de Luz Próxima ao InfravermelhoRESUMO
PURPOSE: The study aimed to develop an objectified Korean Triage and Acuity Scale (OTAS) that can objectively and quickly classify severity, as well as a simple age-adjusted OTAS (S-OTAS) that reflects age and evaluate its usefulness. MATERIALS AND METHODS: A retrospective analysis was performed of all adult patients who had visited the emergency department at three teaching hospitals. Sex, systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, body temperature, O2 saturation, and consciousness level were collected from medical records. The OTAS was developed with objective criterion and minimal OTAS level, and S-OTAS was developed by adding the age variable. For usefulness evaluation, the 30-day mortality, the rates of computed tomography scan and emergency procedures were compared between Korean Triage and Acuity Scale (KTAS) and OTAS. RESULTS: A total of 44402 patients were analyzed. For 30-day mortality, S-OTAS showed a higher area under the curve (AUC) compared to KTAS (0.751 vs. 0.812 for KTAS and S-OTAS, respectively, p<0.001). Regarding the rates of emergency procedures, AUC was significantly higher in S-OTAS, compared to KTAS (0.807 vs. 0.830, for KTAS and S-OTAS, respectively, p=0.013). CONCLUSION: S-OTAS showed comparative usefulness for adult patients visiting the emergency department as a triage tool compared to KTAS.