Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest

10.1186/cc10483Critical Care155R23

Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest

Introduction: Both supraglottic airway devices (SGA) and endotracheal intubation (ETI) have been used by emergency life-saving technicians (ELST) in Japan to treat out-of-hospital cardiac arrests (OHCAs). Despite traditional emphasis on airway management during cardiac arrest, its impact on survival from OHCA and time dependent effectiveness remains unclear.Methods: All adults with witnessed, non-traumatic OHCA, from 1 January 2005 to 31 December 2008, treated by the emergency medical services (EMS) with an advanced airway in Osaka, Japan were studied in a prospective Utstein-style population cohort database. The primary outcome measure was one-month survival with neurologically favorable outcome. The association between type of advanced airway (ETI/SGA), timing of device placement and neurological outcome was assessed by multiple logistic regression.Results: Of 7,517 witnessed non-traumatic OHCAs, 5,377 cases were treated with advanced airways. Of these, 1,679 were ETI while 3,698 were SGA. Favorable neurological outcome was similar between ETI and SGA (3.6% versus 3.6%, P = 0.95). The time interval from collapse to ETI placement was significantly longer than for SGA (17.2 minutes versus 15.8 minutes, P < 0.001). From multivariate analysis, early placement of an advanced airway was significantly associated with better neurological outcome (Adjusted Odds Ratio (AOR) for one minute delay, 0.91, 95% confidence interval (CI) 0.88 to 0.95). ETI was not a significant predictor (AOR 0.71, 95% CI 0.39 to 1.30) but the presence of an ETI certified ELST (AOR, 1.86, 95% CI 1.04 to 3.34) was a significant predictor for favorable neurological outcome.Conclusions: There was no difference in neurologically favorable outcome from witnessed OHCA for ETI versus SGA. Early airway management with advanced airway regardless of type and rhythm was associated with improved outcomes.Kajino, K., Iwami, T., Kitamura, T. et al. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care 15, R236 (2011). https://doi.org/10.1186/cc1048

Lyman Break Galaxies at z~5: Rest-Frame UV Spectra. III

We present results of optical spectroscopic observations of candidates of Lyman Break Galaxies (LBGs) at $z \sim 5$ in the region including the GOODS-N and the J0053+1234 region by using GMOS-N and GMOS-S, respectively. Among 25 candidates, five objects are identified to be at $z \sim 5$ (two of them were already identified by an earlier study) and one object very close to the color-selection window turned out to be a foreground galaxy. With this spectroscopically identified sample and those from previous studies, we derived the lower limits on the number density of bright ($M_{UV}<-22.0$ mag) LBGs at $z \sim 5$. These lower limits are comparable to or slightly smaller than the number densities of UV luminosity functions (UVLFs) that show the smaller number density among $z \sim 5$ UVLFs in literature. However, by considering that there remain many LBG candidates without spectroscopic observations, the number density of bright LBGs is expected to increase by a factor of two or more. The evidence for the deficiency of UV luminous LBGs with large Ly$\alpha$ equivalent widths was reinforced. We discuss possible causes for the deficiency and prefer the interpretation of dust absorption.Comment: 28 pages, 5 figures, accepted for publication in Ap

Comparison of trauma systems in Asian countries: a cross-sectional study.

OBJECTIVE: This study aimed to compare the demographic characteristics and trauma service structures and processes of hospitals in 15 countries across the Asia Pacific, and to provide baseline data for the integrated trauma database: the Pan-Asian Trauma Outcomes Study (PATOS). METHODS: Medical directors and emergency physicians at PATOS-participating hospitals in countries across the Asia Pacific were surveyed through a standardized questionnaire. General information, trauma care system data, and trauma emergency department (ED) outcomes at each hospital were collected by email and analyzed using descriptive statistics. RESULTS: Survey data from 35 hospitals across 15 countries were collected from archived data between June 2014 and July 2015. Designated trauma centers were identified as the highest hospital level for trauma patients in 70% of surveyed countries. Half of the hospitals surveyed had special teams for trauma care, and almost all prepared activation protocol documents for these teams. Most hospitals offered specialized trauma education programs, and 72.7% of hospitals had a hospital-based trauma registry. The total number of trauma patients visiting the ED across 25 of the hospitals was 300,376. The overall survival-to-discharge rate was 97.2%; however, it varied greatly between 85.1% and 99.7%. The difference between survival-to-discharge rates of moderate and severe injury groups was highest in Taiwan (41.8%) and lowest in Thailand (18.6%). CONCLUSION: Trauma care systems and ED outcomes vary widely among surveyed hospitals and countries. This information is useful to build further detailed, systematic platforms for trauma surveillance and evidence-based trauma care policies

Effectiveness of prehospital Magill forceps use for out-of-hospital cardiac arrest due to foreign body airway obstruction in Osaka City

Background: Although foreign body airway obstruction (FBAO) accounts for many preventable unintentional accidents, little is known about the epidemiology of FBAO patients and the effect of forceps use on those patients. This study aimed to assess characteristics of FBAO patients transported to hospitals by emergency medical service (EMS) personnel, and to verify the relationship between prehospital Magill forceps use and outcomes among out-of-hospital cardiac arrests (OHCA) patients with FBAO. Methods: We retrospectively reviewed ambulance records of all patients who suffered FBAO, and were treated by EMS in Osaka City from 2000 through 2007, and assessed the characteristics of those patients. We also performed a multivariate logistic-regression analysis to assess factors associated with neurologically favorable survival among bystander-witnessed OHCA patients with FBAO in larynx or pharynx. Results: A total of 2,354 patients suffered from FBAO during the study period. There was a bimodal distribution by age among infants and old adults. Among them, 466 (19.8%) had an OHCA when EMS arrived at the scene, and 344 were witnessed by bystanders. In the multivariate analysis, Magill forceps use for OHCA with FBAO in larynx or pharynx was an independent predictor of neurologically favorable survival (16.4% [24/146] in the Magill forceps use group versus 4.3% [4/94] in the non-use group; adjusted odds ratio, 3.96 [95% confidence interval, 1.21-13.00], p = 0.023).Conclusions: From this large registry in Osaka, we revealed that prehospital Magill forceps use was associated with the improved outcome of bystander-witnessed OHCA patients with FBAO

Comparison of trauma systems in Asian countries: a cross-sectional study

Objective This study aimed to compare the demographic characteristics and trauma service structures and processes of hospitals in 15 countries across the Asia Pacific, and to provide baseline data for the integrated trauma database: the Pan-Asian Trauma Outcomes Study (PATOS). Methods Medical directors and emergency physicians at PATOS-participating hospitals in countries across the Asia Pacific were surveyed through a standardized questionnaire. General information, trauma care system data, and trauma emergency department (ED) outcomes at each hospital were collected by email and analyzed using descriptive statistics. Results Survey data from 35 hospitals across 15 countries were collected from archived data between June 2014 and July 2015. Designated trauma centers were identified as the highest hospital level for trauma patients in 70% of surveyed countries. Half of the hospitals surveyed had special teams for trauma care, and almost all prepared activation protocol documents for these teams. Most hospitals offered specialized trauma education programs, and 72.7% of hospitals had a hospital-based trauma registry. The total number of trauma patients visiting the ED across 25 of the hospitals was 300,376. The overall survival-to-discharge rate was 97.2%; however, it varied greatly between 85.1% and 99.7%. The difference between survival-to-discharge rates of moderate and severe injury groups was highest in Taiwan (41.8%) and lowest in Thailand (18.6%). Conclusion Trauma care systems and ED outcomes vary widely among surveyed hospitals and countries. This information is useful to build further detailed, systematic platforms for trauma surveillance and evidence-based trauma care policies

Effects of aerosol dynamics and gas-particle conversion on dry deposition of inorganic reactive nitrogen in a temperate forest

Dry deposition has an impact on nitrogen status in forest environments. However, the mechanism for the high dry-deposition rates of fine nitrate particles (NO3-) observed in forests remains unknown and is thus a potential source of error in chemical transport models (CTMs). Here, we modified and applied a multilayer land surface model coupled with dry-deposition and aerosol dynamic processes for a temperate mixed forest in Japan. This represents the first application of such a model to ammonium nitrate (NH4NO3) gas-particle conversion (gpc) and the aerosol water uptake of reactive nitrogen compounds. Thermodynamics, kinetics, and dry deposition for mixed inorganic particles are modeled by a triple-moment modal method. Data for inorganic mass and size-resolved total number concentrations measured by a filter pack and electrical low-pressure impactor in autumn were used for model inputs and subsequent numerical analysis. The model successfully reproduces turbulent fluxes observed above the canopy and vertical micrometeorological profiles noted in our previous studies. The sensitivity tests with and without gpc demonstrated clear changes in the inorganic mass and size-resolved total number concentrations within the canopy. The results also revealed that within-canopy evaporation of NH4NO3 under dry conditions significantly enhances the deposition flux of fine-NO3- and fine-NH4+ particles, while reducing the deposition flux of nitric acid gas (HNO3). As a result of the evaporation of particulate NH4NO3, the calculated daytime mass flux of fine NO over the canopy was 15 times higher in the scenario of "gpc" than in the scenario of "no gpc". This increase caused high contributions from particle deposition flux (NO3 and NH4+) to total nitrogen flux over the forest ecosystem (similar to 39 %), although the contribution of NH3 was still considerable. A dry-deposition scheme coupled with aerosol dynamics may be required to improve the predictive accuracy of chemical transport models for the surface concentration of inorganic reactive nitrogen

Impact of early intravenous epinephrine administration on outcomes following out-of-hospital cardiac arrest

Yasuyuki Hayashi, Taku Iwami, Tetsuhisa Kitamura, Tatsuya Nishiuchi, Kentaro Kajino, Tomohiko Sakai, Chika Nishiyama, Masahiko Nitta, Atsushi Hiraide, Tatsuro Kai, Impact of Early Intravenous Epinephrine Administration on Outcomes Following Out-of-Hospital Cardiac Arrest, Circulation Journal, 2012, Volume 76, Issue 7, Pages 1639-1645, Released June 25, 2012, [Advance publication] Released April 05, 2012, Online ISSN 1347-4820, Print ISSN 1346-9843, https://doi.org/10.1253/circj.CJ-11-1433, https://www.jstage.jst.go.jp/article/circj/76/7/76_CJ-11-1433/_article/-char/e