A retrospective, multi-agency 'target trial emulation' for the comparison of post-resuscitation epinephrine to norepinephrine.

INTRODUCTION: Epinephrine and norepinephrine are the two most commonly used prehospital vasopressors in the United States. Prior studies have suggested that use of a post-ROSC epinephrine infusion may be associated with increased rearrest and mortality in comparison to use of norepinephrine. We used target trial emulation methodology to compare the rates of rearrest and mortality between the groups of OHCA patients receiving these vasopressors in the prehospital setting. METHODS: Adult (18-80 years of age) non-traumatic OHCA patients in the 2018-2022 ESO Data Collaborative datasets with a documented post-ROSC norepinephrine or epinephrine infusion were included in this study. Logistic regression modeling was used to evaluate the association between vasopressor agent and outcome using two sets of covariables. The first set of covariables included standard Utstein factors, the dispatch to ROSC interval, the ROSC to vasopressor interval, and the follow-up interval. The second set added prehospital systolic blood pressure and SpO2 values. Kaplan-Meier time-to-event analysis was also conducted and the vasopressor groups were compared using a multivariable Cox regression model. RESULTS: Overall, 1,893 patients treated by 309 EMS agencies were eligible for analysis. 1,010 (53.4%) received an epinephrine infusion and 883 (46.7%) received a norepinephrine infusion as their initial vasopressor. Adjusted analyses did not discover an association between vasopressor agent and rearrest (aOR: 0.93 [0.72, 1.21]) or mortality (aOR: 1.00 [0.59, 1.69]). CONCLUSIONS: In this multi-agency target trial emulation, the use of a post-resuscitation epinephrine infusion was not associated with increased odds of rearrest in comparison to the use of a norepinephrine infusion.

Regresión logística / Logistic regression

La regresión logística es un grupo de técnicas estadísticas que tienen como objetivo comprobar hipótesis o relaciones causales entre una variable dependiente categórica y otras variables independientes que pueden ser categóricas y cuantitativas. Mediante este modelo pretendemos estudiar la probabilidad de que ocurra el evento estudiado en función de unas variables que suponemos que son relevantes o influyentes. En este método es necesario detectar las variables modificadoras de efecto y las de confusión. Sus parámetros se estiman con el método de la máxima verosimilitud a través de un proceso con sucesivas iteraciones (AU)

Logistic regression is a group of statistical techniques that aim to test hypotheses or causal relationships between a categorical dependent variable and other independent variables that can be categorical and quantitative. Through this model we intend to study the probability that the event studied will occur based on some variables that we assume are relevant or influential. In this method it is necessary to detect effect modifier and confounding variables. Its parameters are estimated with the maximum likelihood method through a process with successive iterations (AU)

The association of clinical, treatment, and demographic characteristics with rearrest in a national dataset.

INTRODUCTION: Following initial resuscitation from out-of-hospital cardiac arrest, rearrest frequently occurs and has been associated with adverse outcomes. We aimed to identify clinical, treatment, and demographic characteristics associated with prehospital rearrest at the encounter and agency levels. METHODS: Adult non-traumatic cardiac arrest patients who achieved ROSC following EMS resuscitation in the 2018-2021 ESO annual datasets were included in this study. Patients were excluded if they had a documented DNR/POLST or achieved ROSC after bystander CPR only. Rearrest was defined as post-ROSC CPR initiation, administration of ≥ 1 milligram of adrenaline, defibrillation, or a documented non-perfusing rhythm on arrival at the receiving hospital. Multivariable logistic regression modeling was used to evaluate the association between rearrest and case characteristics. Linear regression modeling was used to evaluate the association between agency-level factors (ROSC rate, scene time, and scene termination rate), and rearrest rate. RESULTS: Among the 53,027 cases included, 16,116 (30.4%) experienced rearrest. Factors including longer response intervals, longer 'low-flow' intervals, unwitnessed OHCA, and a lack of bystander CPR were associated with rearrest. Among agencies that treated ≥ 30 patients with outcome data, the agency-level rate of rearrest was inversely associated with agency-level rate of survival to discharge to home (R2 = -0.393, p < 0.001). CONCLUSIONS: This multiagency retrospective study found that factors associated with increased ischaemic burden following OHCA were associated with rearrest. Agency-level rearrest frequency was inversely associated with agency-level survival to home. Interventions that decrease the burden of ischemia sustained by OHCA patients may decrease the rate of rearrest and increase survival.

The Association of Combined Prehospital Hypotension and Hypoxia with Outcomes following Out-of-Hospital Cardiac Arrest Resuscitation.

BACKGROUND: Prehospital post-resuscitation hypotension and hypoxia have been associated with adverse outcomes in the context of out-of-hospital cardiac arrest (OHCA). We aimed to investigate the association between clinical outcomes and post-resuscitation hypoxia alone, hypotension alone, and combined hypoxia and hypotension. METHODS: We used the 2018-2021 ESO annual datasets to conduct this study. All EMS-treated non-traumatic OHCA patients who had a documented prehospital return of spontaneous circulation (ROSC) and two or more SpO2 readings and systolic blood pressures recorded were evaluated for inclusion. Patients who were less than 18 years of age, pregnant, had a do-not-resuscitate order or similar, achieved ROSC after bystander CPR only, or had an EMS-witnessed cardiac arrest were excluded. Multivariable logistic regression adjusted for standard Utstein factors and highest prehospital Glasgow Coma Scale (GCS) score was used to investigate the association between hypoxia, hypotension, and outcomes. RESULTS: We analyzed data for 17,943 patients, of whom 3,979 had hospital disposition data. Hypotension and hypoxia were not documented in 1,343 (33.8%) patients, 1,144 (28.8%) had only hypoxia documented, 507 (12.7%) had only hypotension documented, and 985 (24.8%) had both hypoxia and hypotension documented. In comparison to patients who did not have documented hypotension or hypoxia, patients who had documented hypoxia (aOR: 1.76 [1.38, 2.24]), documented hypotension (aOR: 3.00 [2.15, 4.18]), and documented hypoxia and hypotension combined (aOR: 4.87 [3.63, 6.53]) had significantly increased mortality. The relationship between mortality and vital sign abnormalities (hypoxia and hypotension > hypotension > hypoxia) was observed in every evaluated subgroup. CONCLUSIONS: In this large dataset, hypotension and hypoxia were independently associated with mortality both alone and in combination. Compared to patients without documented hypotension and hypoxia, patients with documented hypotension and hypoxia had nearly five-fold greater odds of mortality.

[Logistic regression]. / Regresión logística.

Logistic regression is a group of statistical techniques that aim to test hypotheses or causal relationships between a categorical dependent variable and other independent variables that can be categorical and quantitative. Through this model we intend to study the probability that the event studied will occur based on some variables that we assume are relevant or influential. In this method it is necessary to detect effect modifier and confounding variables. Its parameters are estimated with the maximum likelihood method through a process with successive iterations.

A retrospective comparison of the King Laryngeal Tube and iGel supraglottic airway devices: A study for the CARES surveillance group.

OBJECTIVE: Supraglottic airway devices are increasingly used during the resuscitation of out-of-hospital cardiac arrest (OHCA) patients in the United States and worldwide. In this study, we aimed to compare the neurologic outcomes of OHCA patients managed with the King Laryngeal Tube (King LT) to the neurologic outcomes of patients managed with the iGel. METHODS: We used the Cardiac Arrest Registry to Enhance Survival (CARES) public use research dataset for our analysis. Non-traumatic OHCA cases with attempted EMS resuscitation enrolled from 2013-2021 were included. We used two-level mixed effects multivariable logistic regression analyses with treating EMS agency as the random effect to determine the association between supraglottic airway device and outcome. The primary outcome was survival with a Cerebral Performance Category (CPC) score of 1 or 2 at discharge. Secondary outcomes included survival to hospital admission and survival to hospital discharge. Age, sex, calendar year of OHCA, initial ECG rhythm, witnessed status (unwitnessed, bystander witnessed, 9-1-1 responder witnessed), bystander CPR, response interval, and OHCA location (private/home, public, institutional) were used as covariables. RESULTS: In comparison to use of the King LT, use of the iGel was associated with greater neurologically favorable survival (aOR: 1.45 [1.33, 1.58]). In addition, use of the iGel was associated with greater survival to hospital admission (1.07 [1.02, 1.12]) and survival to hospital discharge (1.35 [1.26, 1.46]). CONCLUSIONS: This study adds to the body of literature suggesting that use of the iGel during OHCA resuscitation is associated with better outcomes than use of the King LT.

La curva ROC / ROC curve

La curva ROC es una herramienta estadística que se utiliza para evaluar la capacidad discriminativa de una prueba diagnóstica dicotómica. Se trata de curvas en las que se presenta la sensibilidad en función de los falsos positivos (complementario de la especificidad) para distintos puntos de corte. Son útiles para elegir el punto de corte más adecuado de una prueba, conocer el rendimiento global de esta y comparar la capacidad discriminativa de 2 o más pruebas diagnósticas. (AU)

The ROC curve is a statistical tool used to evaluate the discriminative capacity of a dichotomous diagnostic test. These are curves in which sensitivity is presented as a function of false positives (complementary to specificity) for different cut-off points. They are useful for choosing the most appropriate cut-off point for a test, knowing its overall performance and comparing the discriminative capacity of 2 or more diagnostic tests. (AU)

[Intraclass correlation coefficient]. / Coeficiente de correlación intraclase.

The intraclass correlation coefficient makes it possible to measure the general concordance between two or more measurements that involve variables of a quantitative nature, obtained with different measuring instruments or evaluators. It is based on an analysis of variance model with repeated measures. Its use is only possible if there is normality of the distributions of the variables, equality of variances and independence between the errors produced by the observers.

[ROC curve]. / La curva ROC.

The ROC curve is a statistical tool used to evaluate the discriminative capacity of a dichotomous diagnostic test. These are curves in which sensitivity is presented as a function of false positives (complementary to specificity) for different cut-off points. They are useful for choosing the most appropriate cut-off point for a test, knowing its overall performance and comparing the discriminative capacity of 2 or more diagnostic tests.

Staffing in a Level 1 Trauma Center: Quantifying Capacity for Preparedness.

OBJECTIVE: We sought to determine who is involved in the care of a trauma patient. METHODS: We recorded hospital personnel involved in 24 adult Priority 1 trauma patient admissions for 12 h or until patient demise. Hospital personnel were delineated by professional background and role. RESULTS: We cataloged 19 males and 5 females with a median age of 50-y-old (interquartile range [IQR], 35.5-67.5). The average number of hospital personnel involved was 79.71 (standard deviation, 17.62; standard error 3.6). A median of 51.2% (IQR, 43.4%-59.8%) of personnel were first involved within hour 1. More personnel were involved in direct versus indirect care (median 54.5 [IQR, 47.5-67.0] vs 25.0 [IQR, 22.0-30.5]; P < 0.0001). Median number of health-care professionals and auxiliary staff were 74.5 (IQR, 63.5-90.5) and 6.0 (IQR, 5.0-7.0), respectively. More personnel were first involved in hospital locations external to the emergency department (median, 53.0 [IQR, 41.5-63.0] vs 27.5 [IQR, 24.0-30.0]; P < 0.0001). No differences existed in total personnel by Injury Severity Score (P = 0.1266), day (P = 0.7270), or time of admission (P = 0.2098). CONCLUSIONS: A large number of hospital personnel with varying job responsibilities respond to severe trauma. These data may guide hospital staffing and disaster preparedness policies.

[Early detection and prevalence of risk of eating disorders in Primary Care in Guadalajara city]. / Detección precoz y prevalencia de riesgo de trastorno de la conducta alimentaria en Atención Primaria en Guadalajara capital.

OBJECTIVES: To know the percentage of adolescent patients at risk of developing an eating disorder (ED); to identify the prevalence of risk for Anorexia Nervosa, Bulimia Nervosa and Unspecified Eating Disorders (NERD) according to age, sex, health centers, nationality and family data; determine the percentage of young people with subclinical forms and study the feasibility of using tools for the early detection of this pathology in Primary Care. MATERIAL AND METHODS: Observational, cross-sectional and multicentre study developed in the five health centers of the city of Guadalajara. Sample of 291 adolescents (124 males and 167 females) obtained through stratified, multi-stage and proportional random sampling according to age, sex and health centers. Sociodemographic, anthropometric and family variables were studied and the EAT-26, SCOFF and EDE-Q6.0 tests were applied in the first round and the EDE-12 interview in the second round. RESULTS: The global prevalence of risk of eating disorders was 17.5% (95% CI: 13.7%-19.4%). The variables, having siblings, being single-parent and having obesity were statistically significant. Among the various types of EDs, the NERD were statistically significant with respect to Anorexia and Bulimia. The subscale concern for the silhouette was statistically significant with respect to the others. The SCOFF questionnaire showed a sensitivity of 91.6% and a specificity of 91.0% and the EDE-Q, 99.3% and 91.7% respectively. CONCLUSIONS: High percentage of adolescents at risk of developing an eating disorder. The unspecified type of eating disorders and the concern for the silhouette subscale predominate. The SCOFF test proves to be a good screening instrument in Primary Care.

Measurement of muon neutrino quasielastic scattering on carbon.

The observation of neutrino oscillations is clear evidence for physics beyond the standard model. To make precise measurements of this phenomenon, neutrino oscillation experiments, including MiniBooNE, require an accurate description of neutrino charged current quasielastic (CCQE) cross sections to predict signal samples. Using a high-statistics sample of nu_(mu) CCQE events, MiniBooNE finds that a simple Fermi gas model, with appropriate adjustments, accurately characterizes the CCQE events observed in a carbon-based detector. The extracted parameters include an effective axial mass, M_(A)(eff)=1.23+/-0.20 GeV, that describes the four-momentum dependence of the axial-vector form factor of the nucleon, and a Pauli-suppression parameter, kappa=1.019+/-0.011. Such a modified Fermi gas model may also be used by future accelerator-based experiments measuring neutrino oscillations on nuclear targets.

Search for electron neutrino appearance at the Delta m2 approximately 1 eV2 scale.

The MiniBooNE Collaboration reports first results of a search for nu e appearance in a nu mu beam. With two largely independent analyses, we observe no significant excess of events above the background for reconstructed neutrino energies above 475 MeV. The data are consistent with no oscillations within a two-neutrino appearance-only oscillation model.

Dealing with coagulopathies of pregnancy-induced hypertension.

A woman with pregnancy-induced hypertension may experience a potentially fatal bleeding disorder. This article describes how to recognize trouble and intervene appropriately.

A molecular analysis of ground sloth diet through the last glaciation.

DNA was extracted from five coprolites, excavated in Gypsum Cave, Nevada and radiocarbon dated to approximately 11 000, 20 000 and 28 500 years BP. All coprolites contained mitochondrial DNA sequences identical to a DNA sequence determined from a bone of the extinct ground sloth Nothrotheriops shastensis. A 157-bp fragment of the chloroplast gene for the large subunit of the ribulosebisphosphate carboxylase (rbcL) was amplified from the boluses and several hundred clones were sequenced. In addition, the same DNA fragment was sequenced from 99 plant species that occur in the vicinity of Gypsum Cave today. When these were compared to the DNA sequences in GenBank, 69 were correctly (two incorrectly) assigned to taxonomic orders. The plant sequences from the five coprolites as well as from one previously studied coprolite were compared to rbcL sequences in GenBank and the contemporary plant species. Thirteen families or orders of plants that formed part of the diet of the Shasta ground sloth could be identified, showing that the ground sloth was feeding on trees as well as herbs and grasses. The plants in the boluses further indicate that the climate 11 000 years BP was dryer than 20 000 and 28 500 years BP. However, the sloths seem to have visited water sources more frequently at 11 000 BP than at earlier times.

Molecular coproscopy: dung and diet of the extinct ground sloth Nothrotheriops shastensis.

DNA from excrements can be amplified by means of the polymerase chain reaction. However, this has not been possible with ancient feces. Cross-links between reducing sugars and amino groups were shown to exist in a Pleistocene coprolite from Gypsum Cave, Nevada. A chemical agent, N-phenacylthiazolium bromide, that cleaves such cross-links made it possible to amplify DNA sequences. Analyses of these DNA sequences showed that the coprolite is derived from an extinct sloth, presumably the Shasta ground sloth Nothrotheriops shastensis. Plant DNA sequences from seven groups of plants were identified in the coprolite. The plant assemblage that formed part of the sloth's diet exists today at elevations about 800 meters higher than the cave.

Radiocarbon dates on bones of extinct birds from Hawaii.

Bones from a stratified sedimentary deposit in the Puu Naio Cave site on Maui, Hawaiian Islands, reveal the late Holocene extinction of 19 species of birds. The age of the sediment and associated fauna was determined by direct radiocarbon dating (tandem particle accelerator-mass spectrometer; TAMS) of amino acids extracted from bones weighing as little as 450 mg. The 14C dates indicate that sediment has been accumulating in the lava tube for at least the last 7750 years, a suitable time frame for testing the hypothesis that Holocene extinction on islands began after human colonization. Despite growing evidence that a worldwide wave of extinctions coincided with human colonization of oceanic islands, little radiometric data have been available to date the extinction of most small fossil vertebrates on islands. The TAMS technique of dating purified collagen from the bones of small vertebrates could lead to vastly improved chronologies of extinction for oceanic islands where catastrophic mid- to late-Holocene extinction is expected or known to have occurred. Chronologies derived from nonarcheological sites that show continuous sedimentation, such as the Puu Naio Cave deposit, may also yield key evidence on the timing of earliest human settlement of Oceania.