Role of resuscitative emergency field thoracotomy in the Japanese helicopter emergency medical service system.

OBJECTIVE: We investigated whether emergency thoracotomy (ET) performed in pre-hospital settings contributed to saving the lives of blunt trauma patients with impending or recent cardiac arrest. METHODS: Eighty-one consecutive cardiac arrest patients with blunt trauma were performed ET before or after arrival at the emergency department (ED). These were reviewed retrospectively and were classified into the following three groups: (1) an emergency field thoracotomy was performed (EFT group, n=34); (2) a doctor dispatched to the scene, but the thoracotomy was performed in the ED (EDT-a group, n=10); and (3) no doctor dispatched to the scene, and the thoracotomy was performed in the ED (EDT-b group, n=37). The patients in the EFT and EDT-a groups were managed within the Japanese helicopter emergency medical service system with a doctor dispatched to the scene. RESULT: The time between the arrival of the EMT at the scene and the start of the thoracotomy was significantly shorter in the EFT group than in the EDT-b group (19.2+/-7.9 min vs. 30.7+/-6.8 min, p<0.001). In the EFT group, the "ICU admission" rate was significantly higher among the patients who experienced cardiac arrest after the EMT arrival than among the patients who experienced cardiac arrest before the EMT arrival (70% vs. 8%, p=0.001). Unfortunately, however, there were no survivors in this series. CONCLUSION: These findings indicate that "early access" to a doctor's expertise and the performance of an "emergency field thoracotomy" might be two important factors for improving the possibility of saving the lives of blunt trauma patients with impending or recent cardiac arrest.

A case of abdominal aortic injury caused by a traffic accident.

A 30-year-old man was injured when the large motorcycle he was riding crashed into a power pole. Upon arrival at our institution, the patient complained of abdominal pain; blood pressure at admission was 160/70 mmHg, and the heart rate was 112 bpm. Abdominal ultrasonography showed a small collection of fluid in Morrison's pouch. A chest X-ray film showed a right rib fracture. Multidetector computed tomography (MD-CT) revealed pleural effusion, a hepatic lesion, and a dissection of the abdominal aorta distal to the renal artery. Because of the complicated intraluminal injuries, the insertion of a stent graft was difficult. On the 34th day after injury, elective surgery was performed. Because dissection of the lumen was observed, the vessel was replaced with an artificial graft. Medial degeneration of the aorta wall was not observed upon pathological examination, and no degenerative disorders have occurred. The postoperative progress was favorable, and the patient was discharged from hospital.

Effect of direct hemoperfusion with a polymyxin B immobilized fiber column on high mobility group box-1 (HMGB-1) in severe septic shock: report of a case.

Because of the many difficult aspects in the treatment of septic shock and poor outcome of this condition, establishing the most appropriate therapeutic strategy is problematic. Recently, high mobility group box-1 (HMGB-1) has been shown to activate inflammatory responses and to be a late mediator in endotoxemia and sepsis. Therefore, we considered that it might be worthwhile to investigate the therapeutic potential of HMGB-1 blockade in cases of septic shock.Herein, we describe the case of a patient with septic shock with hepatic portal venous gas caused by intestinal obstruction. Hepatic portal venous gas is a rare condition associated with significant radiographic findings and a fatal outcome. Our patient, however, recovered from severe septic shock and was saved by the use of direct hemoperfusion with a polymyxin B immobilized fiber column (DHP-PMX). This treatment resulted in a decrease in the serum levels of endotoxin, interleukin-6 (IL-6), and HMGB-1.

Effectiveness of a "doctor-helicopter" system in Japan.

BACKGROUND: In Japan, helicopters have rarely been used for emergency medical services. The use of helicopters not only ensures rapid evacuation but may also serve to provide emergency management to patients with life-threatening injuries in the prehospital setting. OBJECTIVES: To evaluate a Japanese helicopter-based emergency medical system including an onboard physician, particularly in terms of probability of survival. METHODS: We conducted a retrospective review of trauma victims, and calculated two estimates of PS--at the scene and on arrival at the emergency department--based on patient age, Injury Severity Score, and Revised Trauma Score. RESULTS: We identified trauma victims who had an ISS above 15 and were transported from the scene by helicopter. Excluding cardiopulmonary arrest at the scene, 151 cases were studied. Thirty-two patients had hemodynamic instability with systolic blood pressures below 90 mmHg, caused by hemorrhagic shock (29 cases) or obstructive shock (3 cases). Their PS values were 0.56 +/- 0.38 in the prehospital setting and 0.65 +/- 0.38 on arrival at the ED, representing a significant difference (P = 0.0003). Twenty-four of these patients survived, reflecting successful resuscitation during prehospital and ED management. CONCLUSIONS: A doctor-helicopter system was shown to improve probability of survival for life-threatening trauma in the Japanese emergency medical system.