The Association Between the Duration of Chest Compression and Thoracic Injuries in Patients With Non-Traumatic Out-of-Hospital Cardiac Arrest.

BACKGROUND: Current guidelines emphasize the indispensability of high-quality chest compression for improving survival in patients who experience out-of-hospital cardiac arrest (OHCA). However, chest compression can cause thoracic injuries that may contribute to poor prognosis; therefore, the purpose of this study is to identify the predictors of thoracic injuries and evaluate the association between thoracic injuries and prognosis.Methods and Results: Between June 2017 to July 2019, Utstein-style data on 384 consecutive adult patients who experienced non-traumatic OHCA and who were transferred to our hospital (Aso Iizuka Hospital) were collected. Each patient underwent a full-body computed tomography scan. Two-hundred and thirty-four patients (76%) had thoracic injuries (Group-T). The duration of chest compression was significantly longer in Group-T than in patients without thoracic injuries (Group-N; 43 vs. 32 min, respectively, P<0.001). Multivariate analysis revealed that older age and longer chest compression duration were predictors of thoracic injuries (odds ratios 1.03 and 1.07, respectively, P≤0.005). Among patients who achieved return of spontaneous circulation, Kaplan-Meier curves showed a significantly higher cumulative survival rate in Group-N than in Group-T at the 30-day follow up (log-rank test P=0.009). CONCLUSIONS: Older age and longer chest compression duration were independent predictors of thoracic injuries due to chest compression in patients who experienced non-traumatic OHCA. Moreover, the presence of thoracic injuries was associated with worse short-term prognosis.

Plastic additives as tracers of microplastic sources in Japanese road dusts.

Plastic waste and microplastic pollution has been reported around the world. Up to 80% of marine plastic debris is derived from land, thus it is important to identify the terrestrial sources of microplastics to reduce their environmental impact. In this study, the abundance and polymer type of microplastics were characterized for road dusts collected from Kumamoto, Okinawa, and Tokyo, Japan. In addition, the profiles of additives in plastic products on the road and in road dust microplastics were determined to evaluate the potential use of additives as chemical tracers of microplastic sources. The abundance of microplastics in road dusts was 96 ± 85 pieces/kg (dry wt.) (n = 16), 68 ± 77 pieces/kg (n = 12), and 230 ± 50 pieces/kg (n = 8) in Kumamoto, Okinawa and Tokyo, respectively. In Kumamoto and Okinawa, significant correlations were observed between total microplastic abundance in road dusts and daily vehicle traffic. In Tokyo, high population and traffic density may account for the greater abundance of microplastics in road dusts than in the other cities. Polymer analysis shows that poly (diallyl phthalate), polyvinyl chloride, polymethyl methacrylate and polyester accounted for 60% to 70% of the total microplastics analyzed. To determine the potential sources of microplastics, plastic additives were analyzed in road dusts and fragments of road marking from the study area. Five common additives including plasticizers and flame retardants were identified in both road dusts and road markings. This suggests that road markings are a significant source of microplastics in Japanese road dust, and that additive profiles in plastic samples may be suitable tracers for determining the sources of microplastics in road dust.