Use of Slack for COVID-19 disaster response in Hyogo Prefecture.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has caused great disruptions in education and healthcare systems. However, before the COVID-19 pandemic, Hyogo Prefecture did not have a centralized system for sharing information among hospitals, public healthcare centers, the government, fire departments, and medical associations. In March 2021, we used Slack,® an enterprise social network, to invite people from hospitals, healthcare centers, the government, fire departments, and medical associations to join our workspace. This study was undertaken to verify whether the use of Slack can improve information sharing during a disaster. METHODS: A questionnaire on whether information-sharing tools such as Slack are useful for disaster response in Hyogo Prefecture, including for COVID-19, was administered using a Google Form. RESULTS: Of the 19 people who responded to the questionnaire, 15 (78.9 percent) were first-time users of Slack and 18 (94.7 percent) found it easy to use. All 19 participants stated that Slack proved useful in providing pertinent information regarding preventive measures for the control of COVID-19, and they believed that it would be a helpful tool if such disasters were to occur in the future. Regarding the launch time of Slack, 11 respondents (57.9 percent) answered that it was launched at the appropriate time, while five respondents (26.3 percent) answered that it was launched too late. CONCLUSIONS: The participants thought that Slack was effective for accelerating their communication. The use of Slack could also improve future disaster response communications.

Improving residential care amid COVID-19: The link between risk factors and hospitalization.

AIM: This study was conducted to investigate the relationship between the hospitalizations and backgrounds of patients with coronavirus disease 2019 to identify specific risk factors. METHODS: This retrospective study used health observation records to analyze the relationship between certain risk factors and the subsequent hospitalization of 321 patients who were discharged from a residential care facility between January 16 and February 8, 2021. The usefulness of a hospitalization prediction score, created based on the presence of comorbidities and sex, was examined. RESULTS: Being older, male, and having a history of high blood pressure or vascular disease were all risk factors. A multivariate analysis with age and hospitalization predictive score as independent variables and hospitalization as the dependent variable showed that age (odds ratio: 1.07, 95 percent confidence interval: 1.03-1.11, p < 0.01) significantly increased hospitalization risk by 7 percent for every 1-year age increase. The median time from illness onset to hospitalization for all patients was 9 days (interquartile range: 8-10). Hypoxia was the most common cause of hospitalization. However, hypoxia and other symptoms, such as cough and dyspnea, were not correlated. CONCLUSION: Given the pandemic, there may come another time when hospitals are not able to accommodate all patients who require care. In such instances, age, sex, the presence of comorbidities, and checking oxygen saturation regularly using a pulse oximeter around 9 days after the onset of the disease should all be considered important, as it may lead to improved and safer operation of overnight care facilities.

Pitfall of left sided triple-lumen catheter for continuous renal replacement therapy: A case report.

We report a case of vascular injury caused by a multi-lumen catheter for CRRT inserted through left jugular vein. Diagnosis was delayed because CRRT could be continued. Clinicians should be aware of potential vascular complications associated with the wrong placement of multi-lumen catheters even if blood flow continues without difficulty.

Association Between Converting Asystole From Initial Shockable ECG Rhythm Before Extracorporeal Cardiopulmonary Resuscitation and Outcome.

BACKGROUND: Initial electrocardiogram (ECG) rhythm is a predictor of outcomes in out-of-hospital cardiac arrest (OHCA) in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). However, ECG rhythm often changes before ECPR, and the consequence of this change remains unclear. This study aimed to assess the relationship between the conversion of ECG rhythm from initial shockable rhythm before ECPR and mortality. PATIENTS AND METHODS: This was a retrospective cohort study of OHCA patients with initial shockable rhythm who underwent ECPR between January 2010 and September 2020. Patients were classified into two groups: asystole (patients whose ECG rhythm converted to asystole at any time before initiating ECPR) and non-asystole (patients whose ECG rhythm did not convert to asystole at any time before initiating ECPR) groups. The primary outcome was in-hospital mortality. RESULTS: A total of 102 patients were included in the study; in-hospital mortality rate was 46.1% (n = 47) and 76 (74.5%) patients had unfavorable neurological outcomes (Cerebral Performance Category: 3-5). There were 33 and 69 patients in the asystole and non-asystole groups, respectively. The mortality rates in the asystole and non-asystole groups were 69.7% and 34.8%, respectively (P = 0.001). On multivariable analysis, the asystole group showed a significant association with mortality (odds ratio, 5.42; 95% confidence interval, 2.11-15.36; P < 0.001). CONCLUSION: Conversion to asystole before ECPR at any time in patients with OHCA is associated with mortality in patients with an initial shockable ECG rhythm.

Successful interhospital transfer for extracorporeal cardiopulmonary resuscitation of a patient who had a cardiac arrest after cesarean section.

BACKGROUND: Studies describing the effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for peripartum cardiopulmonary arrest are lacking. CASE PRESENTATION: A 39-year-old woman underwent elective cesarean section. Right after surgery, she fell into a cardiac arrest and was promptly transferred to our institute by ambulance. On arrival, we immediately initiated ECPR, within 63 min of the cardiac arrest. Return of spontaneous circulation was achieved 80 min after induction of extracorporeal membrane oxygenation. As the hemodynamics of the patient stabilized, extracorporeal membrane oxygenation was discontinued on day 3 of hospitalization. The patient's cerebral performance category score was 3 at discharge, which improved to 2 after 3 months. CONCLUSION: This case suggests that prompt interhospital transfer and ECPR might be effective for peripartum cardiac arrest due to nonhemorrhagic events.

Therapeutic efficacy for traumatic asphyxia with a focus on cardiac arrest.

AIM: To investigate the clinical features of traumatic asphyxia, specifically the presence of cardiac arrest and therapeutic efficacy. This review will be useful for future emergencies. METHODS: Sixteen traumatic asphyxia cases from our hospital between April 2007 and March 2019 were reviewed and divided into three groups: those experiencing cardiac arrest at the time of rescue (group A, six cases), those experiencing cardiac arrest after rescue (group B, five cases), and those who did not experience cardiac arrest (group C, five cases). RESULTS: All cases had abnormal findings in the skin or conjunctiva. The total mortality rate reached 56%. Among the 11 cases in groups A and B that resulted in cardiac arrest, 10 had an Injury Severity Score of 16 or higher and an Abbreviated Injury Scale score in the chest of 3 or higher. The patients' injuries included pneumothorax, flail chest, and pericardial hematoma. The heartbeat was restarted in seven cases, and two cases completely recovered. CONCLUSION: In some traumatic asphyxia cases, the treatment course was relatively effective even with cardiac arrest; thus, life support efforts should not be spared in such cases.

False negative of pericardial effusion using focused assessment with sonography for trauma and enhanced CT following traumatic cardiac rupture; A case report.

BACKGROUND: The focused assessment with sonography for trauma (FAST) examination is helpful for the identification of pericardial effusion in trauma. However, in a cardiac rupture with a pericardial perforation, pericardial effusion is not always detected by FAST. We experienced the case that FAST and enhanced CT failed to detect pericardial effusion. CASE PRESENTATION: A 51-year old woman injured after falling from a height of 3 m was brought to our institute. Focused assessment with sonography for trauma and enhanced computed tomography did not reveal any pericardial effusion; however, a massive hemothorax was revealed. Because the patient's hemodynamic state had become unstable, we performed an urgent left anterolateral thoracotomy. A left pericardial perforation was detected. By performing a clamshell thoracotomy, we found a rupture of 1 cm in diameter at the left atrial appendage. The hemodynamic state was stabilized by suturing the injury site. The postoperative course was uneventful, and the patient was transferred to another hospital after 31 days of admission. CONCLUSIONS: Cardiac injury in the left atrial appendage is rare and sometimes difficult to diagnose and to repair. In the case of a blunt chest trauma with a massive hemothorax, although focused assessment with sonography for trauma gives negative results for pericardial effusion, a cardiac rupture with pericardial perforation should be considered.

Aortic valve repair for aortic regurgitation: intermediate-term results in patients with tricuspid morphology.

BACKGROUND AND AIM OF THE STUDY: Surgical results after aortic valve repair in patients with aortic regurgitation (AR) of tricuspid valve morphology and with no evidence of aortic root disease have not yet been clarified. METHODS: Between January 1994 and June 2001, aortic valve repair was performed in 40 patients (eight females, 32 males; mean age 61.0 +/- 10.5 years) of this type. Surgical results and follow up data were summarized after aortic valve repair (for AR) in these patients. RESULTS: One patient died in hospital (mortality 2.5%). The mean cardiopulmonary bypass time was 143.5 +/- 47.4 min, and mean aortic cross-clamp time 99.8 +/- 34.3 min. At follow up, the mean AR grade was 1.5 +/- 0.8 and mean NYHA class 1.0 +/- 0; both parameters showed significant improvement compared to preoperative status (p < 0.0001). Survival was 94.9% at one year and 82.6% at five years. The five-year reoperation-free rate was 87%. CONCLUSION: Aortic valve repair for AR in patients with tricuspid valve morphology is a safe procedure that provides good intermediate-term results.

All internal thoracic artery composite graft revascularization.

The aim of this study was to determine the most efficient design of composite grafts and clarify the technical feasibility rate of composite grafting using internal thoracic artery exclusively in patients undergoing triple-vessel revascularization. Retrospective analysis of 104 consecutive patients was carried out. An in situ left internal thoracic artery graft for the left anterior descending artery area, with attachment of the right internal thoracic artery to the side of the left internal thoracic artery to revascularize the circumflex and right coronary vessels, was the most efficient graft design. The technical feasibility rate was 80% (83/104 patients). The mean number of distal anastomoses for the entire group was 3.8+/-0.8 per patient. Intraoperative left internal thoracic artery flow rate was 91.6+/-37.8 mL.min-1. With more experience, it is thought that the technical feasibility rate could be increased.

Subvalvular circular annuloplasty as a component of aortic valve repair.

BACKGROUND AND AIM OF THE STUDY: A recently developed technique of aortic annuloplasty, together with immediate postoperative results, are described. METHODS: Between June 1998 and October 2000, 26 patients (22 men, four women; mean age 59 years) with chronic dominant aortic regurgitation (AR) underwent aortic valve repair in which subvalvular circular annuloplasty was used. A concomitant repair technique was performed in all patients. Operative results are summarized, along with perioperative changes in NYHA status and echocardiographic findings. RESULTS: There were no hospital deaths. Mean cardiopulmonary bypass time was 139.0+/-32.8 min, and mean aortic cross-clamp time 106.0+/-33.2 min. Mean postoperative NYHA class at one month postoperatively was 1.0. Mean postoperative AR grade at hospital discharge was 0.9+/-0.7, which represented an improvement over preoperative grade (p <0.0001). LVEDD was reduced from 6.3+/-0.9 cm to 5.1+/-1.1 cm (n = 25; p <0.001), and LVEF from 64.3+/-9.2% to 51.9+/-11.0% (n = 26; p <0.0001). Annulus size was reduced from 2.6+/-0.3 cm to 2.2+/-0.2 cm (n = 18; p <0.0001). CONCLUSION: A new technique of aortic annuloplasty as a component of aortic valve repair was developed and used successfully in 26 consecutive patients. The short-term postoperative outcome was satisfactory.

Right atrial obstruction due to cardiac extension of hepatocellular carcinoma.

Hepatocellular carcinoma is fatal and has a marked propensity for vascular invasion. However, tumor thrombi rarely occur in the right atrium. A 72-year-old man was admitted with dyspnea and disturbed consciousness. Abdominal computed tomography and echocardiography showed a huge tumor thrombus in the inferior vena cava and the right atrium. The tumor thrombus was surgically removed to treat the hemodynamic compromise. The patient underwent transcatheter arterial chemoembolization postoperatively and survived for 6 months.

Occlusion of left coronary ostium with a rudimentary aortic cusp.

A 74-year-old woman with exertional angina was diagnosed with occlusion of the left coronary ostium associated with a rudimentary aortic valve cusp. A transesophageal echocardiogram, a multi-detector computed tomographic scan, and a coronary angiographic scan revealed the rudimentary aortic cusp covering the small left coronary aortic sinus leading to occlusion of the ostium of the left coronary artery, despite the intact coronary arteries. After excision of the rudimentary left coronary cusp, the left coronary ostium appeared intact. An aortic valve replacement with annular enlargement using a bioprosthetic valve was performed. The patient uneventfully recovered without angina.

Apicoaortic conduit for the dilated phase of hypertrophic obstructive cardiomyopathy as an alternative to heart transplantation.

We describe a 16-year-old suffering from the dilated phase of mid-ventricular obstructive hypertrophic cardiomyopathy with end-stage heart failure. Her plasma type-B natriuretic peptide level exceeded 8000 pg/ml, and she refused heart transplantation. She underwent an apicoaortic valved conduit as an alternative to the heart transplant procedure. This traditional procedure is still an ideal operation for very sick cardiomyopathy patients to avoid or delay heart transplantation.