Pre-Hospital Delay in Patients With Acute Stroke During the Initial Phase of the Coronavirus Disease 2019 Outbreak.

BACKGROUND: When a sudden outbreak of an infectious disease occurs, emergency medical services (EMS) response could be negatively affected. The poor prognosis of acute stroke may be largely attributed to delays in treatment. This study aimed to identify the impact of the sudden outbreak of coronavirus disease 2019 (COVID-19) on EMS response for patients with acute stroke. METHODS: This comparative cross-sectional study was conducted in 25 safety centers in Seoul, Korea. We enrolled patients with acute stroke who were transferred to the emergency department by EMS. The study period was from February-April 2020 and the same period in 2019. Patients were divided into two groups, pre-COVID-19 period and early-COVID-19 period, and previously collected patient data were analyzed. We performed comparative analyses of EMS response and clinical outcomes between the groups. RESULTS: Of 465 patients, 231 (49.7%) had an acute stroke during the study period. There was no significant difference between clinical characteristics of patients with acute stroke before and after the COVID-19 outbreak. EMS response times increased significantly during the early COVID-19 outbreak. The intensive care unit admission rate and mortality rate increased during the early COVID-19 outbreak. CONCLUSION: In the initial phase after the sudden COVID-19 outbreak, EMS response times for acute stroke were delayed and the clinical outcomes of patients with acute stroke deteriorated.

Magnesium augments immunosuppressive effects of a corticosteroid in obese mice with airway inflammation.

BACKGROUND: Magnesium deficiency common in obesity is known to promote chronic low-grade inflammation and aggravate asthma symptoms; however, the effects of magnesium supplementation in obese asthmatic patients have not been investigated. OBJECTIVE: To examine the effects of magnesium co-administration with dexamethasone on airway inflammation in obese mice. METHODS: Female C57BL/6 mice were fed a high-fat diet, sensitized with ovalbumin (OVA) to induce allergic reactions, challenged with aerosolized OVA, and administered dexamethasone (3 mg/kg) with or without magnesium. Bronchial inflammation was analyzed based on the presence of inflammatory cells and cytokines in bronchoalveolar lavage fluid, total and OVA-specific IgE in serum, goblet cells ratios, bronchial wall thickness, and expression of α-smooth muscle actin. RESULTS: In obese mice, co-administration of magnesium and dexamethasone decreased IL-13 in bronchoalveolar lavage fluid and total and OVA-specific IgE in serum, and reduced α-smooth muscle actin-positive areas in the bronchi compared with mice treated with dexamethasone alone. However, no differences were observed in dexamethasone-treated normal-weight mice depending on magnesium supplementation. CONCLUSION: These results suggest that magnesium increases immunosuppressive effects of dexamethasone in airway inflammation aggravated by obesity, suggesting that magnesium supplementation may have a potential in alleviating asthma symptoms in obese patients with reduced responses to corticosteroids.

Factors Associated with Delay of Emergency Medical Services Activation in Patients with Acute Stroke.

BACKGROUND: The poor prognosis of acute stroke may be largely attributed to delays in treatment. Emergency medical services (EMS) usage is associated with a significant reduction in the delay in stroke treatment. The aims of this study were to identify factors associated with the delay in EMS activation for patients with acute stroke. METHODS: This study was conducted at 26 Fire Safety Centers in five districts of Seoul, Korea. Patients with acute stroke transferred by EMS and admitted to a tertiary referral hospital from January 2014 to December 2018 were enrolled. In this cross-sectional study, the dependent variable was the time from stroke onset to EMS activation time. Patients were divided into two groups, onset-to-alarm time ≤ 30 min and onset-to-alarm time > 30 min, and previously collected patient data were analyzed. We performed logistical regression analyses of characteristics differing significantly between groups. RESULTS: Out of 480 patients, 197 (41%) had onset-to-alarm times > 30 min. Significant variables in the logistical analysis were alert mental state (adjusted odds ratio [aOR]: 2.77; 95% confidence interval [CI]: 1.31-6.13), pre-stroke mRS ≥ 2 (aOR: 2.46; 95% CI: 1.26-4.95), onset occurrence at private space (aOR: 2.31; 95% CI: 1.23-4.41), recognizing symptoms between 0 and 8 am (aOR: 2.30; 95% CI: 1.25-4.31), ischemic stroke (aOR: 1.88; 95% CI: 1.04-3.43), and witnessed by others (aOR: 0.32; 95% CI: 0.18-0.55). CONCLUSIONS: Delay in EMS activation for acute stroke cases is possibly related to difficult situations to recognize stroke symptoms, such as alert mental state, pre-stroke mRS ≥ 2, onset occurrence at private space, recognizing symptoms between 0 and 8 am, and unwitnessed by others.

The Effect of a Mechanical Compression Device and Supraglottic Airway on Flow Time: A Simulation Study of Out-of-Hospital Cardiac Arrest in a High-Rise Building.

High-rise buildings present unique challenges to providing high-quality CPR. We investigated the effect of using a mechanical compressor and supraglottic airway on flow time and CPR quality in simulated cardiac arrests occurring within a high-rise building. Twelve teams of EMS providers performed CPR according to 4 scenarios: manual compression and ventilation through bag-valve-mask (MAB) or supraglottic airway (MAS); mechanical compression and ventilation through bag-valve-mask (MEB) or supraglottic airway (MES). Chest compression indices did not differ significantly among the groups. The mechanical compression groups had a higher flow time fraction from exiting the elevator until the manikin was loaded into the ambulance than the manual compression groups. The supraglottic airway groups had higher flow time fractions from entering the elevator until the end of the scenario than the bag-valve-mask groups. The total flow time fraction was lowest in the MAB group and was highest in the MEB group (P < 0.001). In simulated cardiac arrest in a high-rise building, the use of a supraglottic airway maintained flow time at a level similar to that observed with the use of a mechanical compressor. Moreover, the use of a mechanical compressor and a supraglottic airway increased the flow time most effectively.

Varying levels of difficulty index of skills-test items randomly selected by examinees on the Korean emergency medical technician licensing examination.

PURPOSE: The goal of this study was to characterize the difficulty index of the items in the skills test components of the class I and II Korean emergency medical technician licensing examination (KEMTLE), which requires examinees to select items randomly. METHODS: The results of 1,309 class I KEMTLE examinations and 1,801 class II KEMTLE examinations in 2013 were subjected to analysis. Items from the basic and advanced skills test sections of the KEMTLE were compared to determine whether some were significantly more difficult than others. RESULTS: In the class I KEMTLE, all 4 of the items on the basic skills test showed significant variation in difficulty index (P<0.01), as well as 4 of the 5 items on the advanced skills test (P<0.05). In the class II KEMTLE, 4 of the 5 items on the basic skills test showed significantly different difficulty index (P<0.01), as well as all 3 of the advanced skills test items (P<0.01). CONCLUSION: In the skills test components of the class I and II KEMTLE, the procedure in which examinees randomly select questions should be revised to require examinees to respond to a set of fixed items in order to improve the reliability of the national licensing examination.