Association between disseminated intravascular coagulation scores and mortality in patients with traumatic brain injury

Objective@#Disseminated intravascular coagulation (DIC) is common in patients with traumatic brain injury (TBI) and is associated with the prognosis of TBI. We aimed to analyze and compare the performances of the International Society on Thrombosis and Hemostasis (ISTH), the Korean Society on Thrombosis and Hemostasis (KSTH) and the Japanese Association for Acute Medicine (JAAM) scoring systems in predicting in-hospital mortality. @*Methods@#In this retrospective observational study, severe trauma patients with TBI who visited our emergency department between January 2018 and December 2020 were included. Receiver operating characteristic analysis was performed to examine the prognostic performance of the three different DIC scoring systems. The primary outcome was inhospital mortality. @*Results@#A total of 851 patients were included, and the in-hospital mortality rate was 17.7% (n=151). According to the multivariate analysis results, the ISTH (odds ratio [OR], 1.784; 95% confidence interval [CI], 1.320-2.412), KSTH (OR, 2.735; 95% CI, 2.022-3.698) and JAAM (OR, 1.751; 95% CI, 1.473-2.083) scores were associated with in-hospital mortality. The areas under the curves (AUCs) of ISTH, KSTH and JAAM scores for predicting in-hospital mortality were 0.686 (95% CI, 0.654-0.717), 0.708 (95% CI, 0.676-0.738) and 0.762 (95% CI, 0.731-0.790), respectively. The AUC of the JAAM score was significantly different from that of the ISTH and KSTH scores. @*Conclusion@#Three different DIC scores were associated with in-hospital mortality in TBI patients. Among the DIC scores, the JAAM score can be a useful tool for predicting in-hospital mortality in TBI patients.

Analysis of Factors Affecting Emergency Physicians’ Attitudes toward Deceased Organ & Tissue Donation

Background@#This study aimed to investigate differences in knowledge, and attitudes toward deceased organ and tissue donation of emergency physicians. Additionally, we analyzed factors affecting the attitudes toward deceased organ and tissue donation. @*Methods@#We conducted a survey of specialists and residents registered with the Korean Society of Emergency Medicine in December 2020. The respondents’ sex, age, position, personal registration for organ donation, experience of soliciting organ donation, participation in related education, knowledge, and attitude about brain death organ donation, and attitude toward stopping life-sustaining treatments were investigated.According to the characteristics of the respondents (specialists or residents, experience and education on organ and tissue donation), their knowledge and attitude toward deceased organ donation were compared. Stepwise hierarchical multiple regression analysis was used to investigate the factors affecting the attitudes toward deceased organ and tissue donation. @*Results@#Of the total 428 respondents, there were 292 emergency medicine specialists and 136 medical residents. Specialists and those who registered or wished to donate organs had higher knowledge and attitude scores regarding deceased organ and tissue donation.Those who had experience recommending organ and tissue donation more than 6 times had higher knowledge scores on deceased organ and tissue donation and higher overall scores in attitude. Those who received education from the Korean Organ Donation Agency had higher knowledge scores. Specialists, and those who wished to donate or had registered as organ donors and had a higher life-sustaining treatment attitude score and knowledge about deceased organ and tissue donation, had more positive attitudes toward deceased organ and tissue donation. @*Conclusion@#For more potential deceased organ and tissue donors to be referred for donation, there should be continuous education for emergency physicians on brain-dead organ and tissue donation-related knowledge and procedures. In addition, institutional or systematic improvements that can lead to organ donation when deciding on the withdrawal of life-sustaining treatment should be considered.

Emergency Physicians’ Experience of Communication About Brain-Death Organ and Tissue Donation / 의료커뮤니케이션

Background@#: Emergency physicians are increasingly participating in brain-death organ tissue donation (OTD).It is difficult communication to inform family members about suspected brain-death and potential donor.This study sought to explore the experiences and communication of emergency physicians in brain-death OTD. @*Methods@#: This is a qualitative study that interviewed 10 experienced emergency physicians with brain-death OTD and analyzed the data by thematic analysis method. @*Results@#: The study revealed 20 subthemes and 5 themes; 1) Families who are invited to donate organs make decisions after long periods of consideration by the entire family, 2) It is uncomfortable to recommend organ donation, 3) Explaining and obtaining consent is ‘the hardest job’ for the attending physician, 4) The way the attending physician does ‘the hardest job’ is by explaining, 5) Passively solicit donation. @*Conclusion@#: The experienced emergency physicians with brain-death OTD were using methods of communication to understand and sympathized with the family members and had abundant experiences. The findings of this study will help inexperienced emergency physicians with brain-death OTD.

Benefit of Extracorporeal Membrane Oxygenation before Revascularization in Patients with Acute Myocardial Infarction Complicated by Profound Cardiogenic Shock after Resuscitated Cardiac Arrest

Background and Objectives@#The study sought to investigate the impact of early extracorporeal membrane oxygenation (ECMO) support before revascularization in patients with acute myocardial infarction (AMI) complicated by profound cardiogenic shock after resuscitated cardiac arrest. It is difficult to determine optimal timing of ECMO in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest. @*Methods@#Among 116,374 patients experiencing out-of-hospital cardiac arrest in South Korea, a total of 184 resuscitated patients with AMI complicated by profound cardiogenic shock, and who were treated successfully with percutaneous coronary intervention (PCI) and ECMO, were enrolled. Patients were divided into 2 groups according to the timing of ECMO: pre-PCI ECMO (n=117) and post-PCI ECMO (n=67). We compared 30-day mortality between the 2 groups. @*Results@#In-hospital mortality was 78.8% in the entire study population and significantly lower in the pre-PCI ECMO group (73.5% vs. 88.1%, p=0.020). Thirty-day mortality was also lower in the pre-PCI ECMO group compared to the post-PCI ECMO group (74.4% vs.91.0%; adjusted hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.47–0.93; p=0.017). Shockable rhythm at the emergency room (HR, 0.57; 95% CI, 0.36–0.91; p=0.019) and successful therapeutic hypothermia (HR, 0.40; 95% CI, 0.23–0.69; p=0.001) were also associated with improved 30-day survival. @*Conclusions@#ECMO support before revascularization was associated with an improved short-term survival rate compared to ECMO after revascularization in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest.

Benefit of Extracorporeal Membrane Oxygenation before Revascularization in Patients with Acute Myocardial Infarction Complicated by Profound Cardiogenic Shock after Resuscitated Cardiac Arrest

Background and Objectives@#The study sought to investigate the impact of early extracorporeal membrane oxygenation (ECMO) support before revascularization in patients with acute myocardial infarction (AMI) complicated by profound cardiogenic shock after resuscitated cardiac arrest. It is difficult to determine optimal timing of ECMO in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest. @*Methods@#Among 116,374 patients experiencing out-of-hospital cardiac arrest in South Korea, a total of 184 resuscitated patients with AMI complicated by profound cardiogenic shock, and who were treated successfully with percutaneous coronary intervention (PCI) and ECMO, were enrolled. Patients were divided into 2 groups according to the timing of ECMO: pre-PCI ECMO (n=117) and post-PCI ECMO (n=67). We compared 30-day mortality between the 2 groups. @*Results@#In-hospital mortality was 78.8% in the entire study population and significantly lower in the pre-PCI ECMO group (73.5% vs. 88.1%, p=0.020). Thirty-day mortality was also lower in the pre-PCI ECMO group compared to the post-PCI ECMO group (74.4% vs.91.0%; adjusted hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.47–0.93; p=0.017). Shockable rhythm at the emergency room (HR, 0.57; 95% CI, 0.36–0.91; p=0.019) and successful therapeutic hypothermia (HR, 0.40; 95% CI, 0.23–0.69; p=0.001) were also associated with improved 30-day survival. @*Conclusions@#ECMO support before revascularization was associated with an improved short-term survival rate compared to ECMO after revascularization in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest.

Effect of intraperitoneally administered propentofylline in a rat model of postoperative pain

Background@#In this study, we sought to evaluate whether systemic propentofylline (PPF) has antiallodynic effects in a rat model of postoperative pain, and to assess the mechanism involved. @*Methods@#After plantar incision, rats were intraperitoneally injected with various doses of PPF to evaluate its antiallodynic effect. To investigate the involved mechanism, rats were intraperitoneally injected with yohimbine, dexmedetomidine, prazosin, naloxone, atropine or mecamylamine, following the incision of the rat hind paws, and then PPF was administered intraperitoneally. The mechanical withdrawal threshold (MWT) was evaluated using von Frey filaments at various time points and serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6 were measured to determine the inflammatory response level. @*Results@#MWT was significantly increased after intraperitoneal injection of 30 mg/ kg of PPF when compared with the control group. Injection of PPF and yohimbine, atropine or mecamylamine showed significant decreases in the MWT, while injection of PPF and dexmedetomidine showed a significant increase. Systemic administration of PPF inhibited the post-incisional increase in serum level of TNF-α and IL-1β. @*Conclusions@#Systemic administration of PPF following surgery presented antiallodynic effects in a rat model of postoperative pain. The antiallodynic effects against mechanical allodynia could be mediated by α-adrenergic and cholinergic receptors.

Performance of four different tools for predicting mortality in elderly patients with severe trauma

Objective@#The present study aimed to analyze and compare the prognostic performances of Revised Trauma Score (RTS), Injury Severity Score (ISS), shock index (SI), and modified Early Warning Score (MEWS) for in-hospital mortality in severe trauma. @*Methods@#This retrospective observational study included elderly (≥65 years) patients admitted for severe trauma between January 2018 and December 2018. Receiver operating characteristics analysis was performed to examine the prognostic performance of the four different tools. The primary outcome was in-hospital mortality following an injury. @*Results@#Of the 279 patients included in the study, in-hospital mortality was 20.1% (n=56). In multivariate analysis, age (odds ratio [OR], 1.055; 95% confidence interval [CI], 1.004-1.109), ISS (OR, 1.080; 95% CI, 1.008-1.157), Glasgow Coma Scale (OR, 0.842; 95% CI, 0.785-0.904), and respiratory rate (OR, 1.261; 95% CI, 1.071-1.486) were independently associated with in-hospital mortality. The area under the curves (AUCs) of MEWS, RTS, ISS, and SI were 0.851 (95% CI, 0.763-0.857), 0.733 (0.677-0.784), 0.664 (0.606-0.720), and 0.567 (0.506-0.626), respectively. The AUC of MEWS was significantly different from those of RTS (P=0.034), ISS (P=0.001), and SI (P<0.001). @*Conclusion@#MEWS has the highest prognostic performance for in-hospital mortality among four different tools in elderly patients with severe trauma.

Use of amplitude-integrated electroencephalography in decision-making for extracorporeal membrane oxygenation in comatose cardiac arrest patients whose eventual neurologic recovery is uncertain

Comatose cardiac arrest patients frequently experience cardiogenic shock or recurrent arrest. Extracorporeal membrane oxygenation (ECMO) can be used to salvage patients with cardiogenic shock or cardiac arrest refractory to conventional therapies. However, in comatose cardiac arrest patients whose neurologic recovery is uncertain, the use of ECMO is restricted because it requires considerable financial and human resources. Amplitude-integrated electroencephalography is an easily applicable, real-time electroencephalography monitoring tool that has been increasingly used to monitor brain activity in comatose cardiac arrest patients. We describe our experience of using amplitude-integrated electroencephalography in decision-making to place ECMO for comatose cardiac arrest patients whose eventual neurologic recovery appeared uncertain at the time of ECMO placement.

Effect of pralidoxime on coronary perfusion pressure during cardiopulmonary resuscitation in a pig model

OBJECTIVE: Pralidoxime is widely used for the treatment of organophosphate poisoning. Multiple studies have reported its vasoconstrictive property, which may facilitate the restoration of spontaneous circulation (ROSC) after cardiac arrest by increasing the coronary perfusion pressure (CPP). 2,3-Butanedione monoxime, which belongs to the same oxime family, has been shown to facilitate ROSC by reducing left ventricular ischemic contracture. Because pralidoxime and 2,3-butanedione monoxime have several common mechanisms of action, both drugs may have similar effects on ischemic contracture. Thus, we investigated the effects of pralidoxime administration during cardiopulmonary resuscitation in a pig model with a focus on ischemic contracture and CPP.METHODS: After 14 minutes of untreated ventricular fibrillation, followed by 8 minutes of basic life support, 16 pigs randomly received either 80 mg/kg of pralidoxime (pralidoxime group) or an equivalent volume of saline (control group) during advanced cardiovascular life support (ACLS).RESULTS: Mixed-model analyses of left ventricular wall thickness and chamber area during ACLS revealed no significant group effects or group-time interactions, whereas a mixed-model analysis of the CPP during ACLS revealed a significant group effect (P=0.038) and group-time interaction (P<0.001). Post-hoc analyses revealed significant increases in CPP in the pralidoxime group, starting at 5 minutes after pralidoxime administration. No animal, except one in the pralidoxime group, achieved ROSC; thus, the rate of ROSC did not differ between the two groups.CONCLUSION: In a pig model of cardiac arrest, pralidoxime administered during cardiopulmonary resuscitation did not reduce ischemic contracture; however, it significantly improved CPP.

Five-year Experience of Extracorporeal Life Support in Emergency Physicians / 대한구급학회지

BACKGROUND: This study aimed to present our 5-year experience of extracorporeal cardiopulmonary resuscitation (ECPR) performed by emergency physicians. METHODS: We retrospectively analyzed 58 patients who underwent ECPR between January 2010 and December 2014. The primary parameter analyzed was survival to hospital discharge. The secondary parameters analyzed were neurologic outcome at hospital discharge, cannulation time, and ECPR-related complications. RESULTS: Thirty-one patients (53.4%) were successfully weaned from extracorporeal membrane oxygenation, and 18 (31.0%) survived to hospital discharge. Twelve patients (20.7%) were discharged with good neurologic outcomes. The median cannulation time was 25.0 min (interquartile range 20.0-31.0 min). Nineteen patients (32.8%) had ECPR-related complications, the most frequent being distal limb ischemia. Regarding the initial presentation, 52 patients (83.9%) collapsed due to a cardiac etiology, and acute myocardial infarction (33/62, 53.2%) was the most common cause of cardiac arrest. CONCLUSIONS: The survival to hospital discharge rate for cardiac arrest patients who underwent ECPR conducted by an emergency physician was within the acceptable limits. The cannulation time and complications following ECPR were comparable to those found in previous studies.

Association between lactate clearance during post-resuscitation care and neurologic outcome in cardiac arrest survivors treated with targeted temperature management

OBJECTIVE: We investigated the association between lactate clearance or serum lactate levels and neurologic outcomes or in-hospital mortality in cardiac arrest survivors who were treated with targeted temperature management (TTM). METHODS: A retrospective analysis of data from cardiac arrest survivors treated with TTM between 2012 and 2015 was conducted. Serum lactate levels were measured on admission and at 12, 24, and 48 hours following admission. Lactate clearance at 12, 24, and 48 hours was also calculated. The primary outcome was neurologic outcome at discharge. The secondary outcome was in-hospital mortality. RESULTS: The study included 282 patients; 184 (65.2%) were discharged with a poor neurologic outcome, and 62 (22.0%) died. Higher serum lactate levels at 12 hours (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.006 to 1.331), 24 hours (OR, 1.320; 95% CI, 1.084 to 1.607), and 48 hours (OR, 2.474; 95% CI, 1.459 to 4.195) after admission were associated with a poor neurologic outcome. Furthermore, a higher serum lactate level at 48 hours (OR, 1.459; 95% CI, 1.181 to 1.803) following admission was associated with in-hospital mortality. Lactate clearance was not associated with neurologic outcome or in-hospital mortality at any time point after adjusting for confounders. CONCLUSION: Increased serum lactate levels after admission are associated with a poor neurologic outcome at discharge and in-hospital mortality in cardiac arrest survivors treated with TTM. Conversely, lactate clearance is not a robust surrogate marker of neurologic outcome or in-hospital mortality.

Five-year Experience of Extracorporeal Life Support in Emergency Physicians / 대한중환자의학회지

BACKGROUND: This study aimed to present our 5-year experience of extracorporeal cardiopulmonary resuscitation (ECPR) performed by emergency physicians. METHODS: We retrospectively analyzed 58 patients who underwent ECPR between January 2010 and December 2014. The primary parameter analyzed was survival to hospital discharge. The secondary parameters analyzed were neurologic outcome at hospital discharge, cannulation time, and ECPR-related complications. RESULTS: Thirty-one patients (53.4%) were successfully weaned from extracorporeal membrane oxygenation, and 18 (31.0%) survived to hospital discharge. Twelve patients (20.7%) were discharged with good neurologic outcomes. The median cannulation time was 25.0 min (interquartile range 20.0-31.0 min). Nineteen patients (32.8%) had ECPR-related complications, the most frequent being distal limb ischemia. Regarding the initial presentation, 52 patients (83.9%) collapsed due to a cardiac etiology, and acute myocardial infarction (33/62, 53.2%) was the most common cause of cardiac arrest. CONCLUSIONS: The survival to hospital discharge rate for cardiac arrest patients who underwent ECPR conducted by an emergency physician was within the acceptable limits. The cannulation time and complications following ECPR were comparable to those found in previous studies.

Comparison of the streamlined liner of the pharynx airway (SLIPA™) with the I-gel™ in paralyzed, anesthetized patients

BACKGROUND: I-gel™ and Streamlined Liner of the Pharynx Airway (SLIPA™) are the second generation supraglottic airway devices characterized by disposability and non-inflatable cuff that provide adequate sealing pressure and easy use. This study was designed to compare oro-pharyngeal leakage pressure of the I-gel™ with the SLIPA™. METHODS: Seventy-eight adult patients were randomly assigned to undergo general anesthesia with either I-gel™ or SLIPA™. Hemodynamic changes and Oro-pharyngeal leakage pressure were assessed at one minute after the insertion. The total insertion time, number of attempts, ease of insertion, and presence of blood staining and regurgitation were recorded. After surgery, postoperative sore throat and other complications (dysphonia, dysphagia or paresthesia of tongue) were evaluated. RESULTS: Oro-pharyngeal leakage pressure after device insertion was higher in the SLIPA™ group than the I-gel™ group. Insertion time was significantly shorter in the I-gel™ group than the SLIPA™ group. Blood staining was presented in 21.1% of the SLIPA™ group vs. 2.6% of the I-gel™ group. In the recovery room, postoperative sore throat measured in visual rating scale (VAS) was significantly higher in the SLIPA™ group than in the I-gel™ group. Ease of insertion, regurgitation, respiratory index and hemodynamic change after insertion showed no significant differences. CONCLUSIONS: In this study, the SLIPA™ devices provided higher oro-pharyngeal leakage pressure than I-gel™. However, the results verified ease of insertion, and safety of ventilation and hemodynamic changes, without any severe complications in both I-gel™ and SLIPA™.

Accidental middle turbinectomy by nasotracheal intubation: A case report

Nasotracheal intubation is an anesthetic technique widely used for maxillofacial surgery. It has the advantage of easier access to the surgical site to surgeon. However, when the nasothracheal intubation is performed a few complications may occur, such as nasal mucosa damage, epistaxis, sinusitis by sinus drainage occlusion and transient bacteremia. In addition, concha bullosa is a common anatomic variant of the middle turbinate, which is pneumatized, and very susceptible to trauma. We report a case of accidental middle turbinectomy by nasotracheal intubation, in the patient who had bilateral concha bullosa.

The changes of non-invasive hemoglobin and perfusion index of Pulse CO-Oximetry during induction of general anesthesia / 대한마취과학회지

BACKGROUND: We hypothesized that induction of general anesthesia using sevoflurane improves the accuracy of non-invasive hemoglobin (SpHb) measurement of Masimo Radical-7(R) Pulse CO-Oximetry by inducing peripheral vasodilation and increasing the perfusion index (PI). The aim of this study is to investigate the change in the SpHb and the PI measured by Rad7 during induction of general anesthesia using sevoflurane. METHODS: The laboratory hemoglobin (Hb(lab)) was measured before surgery by venous blood sampling. The SpHb and the PI was measured twice; before and after the induction of general anesthesia using sevoflurane. The changes of SpHb, Hb(bias) (Hb(bias) = SpHb - Hb(lab)), and PI before and after the induction of general anesthesia were analyzed using a paired t-test. Also, a Pearson correlation coefficient analysis was used to analyze the correlation between the Hb(bias) and the PI. RESULTS: The SpHb and the PI were increased after the induction of general anesthesia using sevoflurane. There was a statistically significant change in the Hb(bias) from -2.8 to -0.7 after the induction of general anesthesia. However, the limit of agreement (2 SD) of the Hb(bias) did not change after the induction of general anesthesia. The Pearson correlation coefficient between the Hb(bias) and the PI was not statistically significant. CONCLUSIONS: During induction of general anesthesia using sevoflurane, the accuracy of SpHb measurement was improved and precision was not changed. The correlation between Hb(bias) and PI was not significant.

The Association between Dyscarbia and Outcome in Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia

PURPOSE: There is a lack of clinical evidence in terms of the association between carbon dioxide tension and outcomes in cardiac arrest survivors treated with therapeutic hypothermia (TH). We investigated the association of time-weighted mean carbon dioxide tension (TWMCO2) and outcomes in out-of-hospital cardiac arrest (OHCA) survivors treated with TH. METHODS: This was a retrospective cohort study including 177 OHCA survivors. The patients were divided into three groups according to the values of TWMCO2 (normocarbia, 35~45 mmHg; hypocarbia, 45 mmHg). The primary outcome was in-hospital mortality and the secondary outcome was neurologic outcome at discharge. We assessed neurologic outcome at hospital discharge using the Cerebral Performance Categories (CPC). Neurologic outcome was dichotomized as either good neurologic outcome (CPC1 and CPC2) or poor neurologic outcome (CPC 3 to 5). The odds ratio with 95% confidence interval (CI) was estimated. RESULTS: The median value of PaCO2 was 38.2 (33.9-43.3) mmHg. Among a total of 1,239 PaCO2 values, normocarbia, hypocarbia, and hypercarbia were 618 (49.8%), 380 (30.7%), and 241 (19.5%), respectively. Results of univariate logistic regression analysis showed that hypocarbia had a significantly high odds ratio for in-hospital mortality (2.474 (95% CI, 1.129-5.424), p=0.024) compared with normocarbia. Results of multivariate logistic regression analysis showed that hypocarbia (2.926; 95% CI, 1.212-7.066; p=0.017) and hypercarbia (4.673; 95% CI, 1.348-16.205; p=0.015) had a significantly high odds ratio for in-hospital mortality compared with normocarbia. CONCLUSION: In OHCA survivors treated with TH, dyscarbia (hypocarbia and hypercarbia) was frequent and dyscarbia showed an association with in-hospital mortality.

The Relation between Time-weighted Mean Oxygen Tension and Outcome in Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia

PURPOSE: Studies to determine the relation between oxygen tension and outcome in cardiac arrest survivors treated with therapeutic hypothermia (TH) are lacking. We investigated the relation of time-weighted mean oxygen tension (TWMO2) and outcome in cardiac arrest survivors treated with TH. METHODS: This was a retrospective observational study including 177 out-of-hospital cardiac arrest (OHCA) survivors. The patients were divided into four categories according to quartile values of TWMO2. The primary outcome was neurologic outcome at discharge and the secondary outcome was all cause in-hospital mortality. We assessed neurologic outcome using the Cerebral Performance Categories (CPC) at hospital discharge. Neurologic outcome was dichotomised as either good neurologic outcome (CPC1 and CPC2) or poor neurologic outcome (CPC 3 to 5). The odds ratio with 95% confidence interval (CI) was estimated. RESULTS: The median value of PaO2 was 139(104.5-170.0) mmHg. Among a total of 1,239 PaO2 values, 22(1.8%) values were hypoxia (300 mmHg). Results of univariate logistic regression analysis showed a significantly low odds ratio for poor neurologic outcome [0.353(95% CI, 0.133-0.938) and 0.321(95% CI, 0.121-0.850), respectively] and for in-hospital mortality [0.338(95% CI, 0.132-0.870) and 0.387(95% CI, 0.154-0.975), respectively] for the third quartile and the fourth quartile. However, results of multivariate logistic regression analysis showed no significant relation between TWMO2 and outcomes. CONCLUSION: In OHCA survivors treated with TH, time-weighted oxygen tension did not show an association with neurologic outcome and in-hospital mortality.

The Clinical Features and Prognostic Factors in Adults with Acute Etrodotoxin Poisoning Caused by Ingesting Puffer Fish

PURPOSE: We conducted this study in order to determine clinical features and prognostic factors in adults with acute tetrodotoxin (TTX) poisoning caused by ingestion of puffer fish. METHODS: In this retrospective study, 107 patients were diagnosed with TTX poisoning. The subjects were divided into two groups according to duration of treatment; Group I, patients were discharged within 48 hours (n=76, 71.0%), Group II patients were discharged after more than 48 hours (n=31, 29.0%). Group II was subsequently divided into two subgroups [IIa (n=12, 11.2%), IIb (n=19, 17.8%)] according to the need for mechanical ventilation support. RESULTS: In multivariable logistic regression analysis, the predictors of the need for treatment over 48 hours were dizziness (odds ratio [OR], 4.72; 95% confidence intervals [CI], 1.59-12.83), time interval between onset of symptom and ingestion (OR, 0.56; 95% CI, 0.16-0.97), PaCO2<35 mmHg (OR, 8.37; 95% CI, 2.37-23.59). In addition, predictors of the need for mechanical ventilation were a time interval between onset of symptoms and ingestion (OR, 0.54; 95% CI, 0.11-0.96) and PaCO2<35 mmHg (OR, 5.65; 95% CI, 1.96-18.66). CONCLUSION: Overall, dizziness, time interval between onset of symptoms and ingestion, DeltaDBP and PaCO2<35 mmHg predict the need for treatment over 48 hours, time interval between onset of symptoms and ingestion and PaCO2<35 mmHg predict the need for mechanical ventilation support after acute TTX poisoning.

Capnothorax during urologic laparoscopic surgery: A case report

As the use of laparoscopy in urologic surgery gradually increase, the possibility of complication is also increasing. Pneumothorax from many complications is more likely to occur in the urologic surgery than other surgery. A 64-year-old male patient was admitted for laparoscopic multiple renal cysts marsupialization under general anesthesia. About 80 minutes after beginning the operation, the peak airway pressure was suddenly increased and the oxygen saturation was decreased. We suspected the pneumothorax based on decreasing breath sounds in the right chest area and checked for the diaphragmatic injury through communicating with surgeon. Positive end expiratory pressure and hyperventilation was applied to the patient. Surgeon sutured the diaphragmatic injure site, and the chest tube was placed. In conclusion, iatrogenic pneumothorax occurrence during the laparoscopic surgery can be early detected and treated through appropriate monitoring, risk awareness, and close communication with surgeon.

Ultrasound-Assisted Mental Nerve Block and Pulsed Radiofrequency Treatment for Intractable Postherpetic Neuralgia: Three Case Studies

Postherpetic neuralgia (PHN) is one of the most difficult pain syndromes to treat. Invasive treatments may be considered when patients fail to obtain adequate pain relief from noninvasive treatment approaches. Here, we present three cases of PHN in the mandibular branch treated with ultrasound-assisted mental nerve block and pulsed radiofrequency treatment. None of the patients had adequate pain relief from the medical therapy, so we performed the mental nerve block on the affected side under ultrasound assistance. Two patients showed satisfactory pain relief continuously over 12 months without any further interventions, whereas one patient only had short-term pain relief. For the patient had short-term pain relief we performed pulsed radiofrequency treatment (PRFT) on the left mental nerve under ultrasound assistance. After PRFT, the patient had adequate pain relief for 6 months and there was no need for further management.