Hiroshi Toyoda

Outcomes from Prehospital Cardiac Arrest in Blunt Trauma Patients

BackgroundThere are few strategies for treating patients who have suffered cardiopulmonary arrest due to blunt trauma (BT-CPA). The aim of this population-based case series observational study was to clarify the outcome of BT-CPA patients treated with a standardized strategy that included an emergency department thoracotomy (EDT) under an emergency medical service (EMS) system with a rapid transportation system.MethodsThe 477 BT-CPA registry data were augmented by a review of the detailed medical records in our emergency department (ED) and action reports in the prehospital EMS records.ResultsOf those, 76% were witnessed and 20% were CPA after leaving the scene. In all, 18% of the patients went to the intensive care unit (ICU), the transcatheter arterial embolization (TAE) room, or the operating room (OR). Only 3% survived to be discharged. Among the 363 witnessed patients—11 of whom had ventricular fibrillation (VF) as the initial rhythm, 134 exhibiting pulseless electrical activity (PEA), and 221 with asystole—13, 1, and 3%, respectively, survived to discharge. The most common initial rhythm just after collapse was not VF but PEA, and asystole increased over the 7xa0min after collapse. There were no differences in the interval between arrival at the hospital and the return of spontaneous circulation between the patients that survived to discharge and deceased patients in the ED, OR, TAE room, or ICU. The longest interval was 17xa0min.ConclusionsIn BT-CPA patients, a 20-min resuscitation effort and termination of the effort are thought to be relevant. The initial rhythm is not a prognostic indicator. We believe that the decision on whether to undertake aggressive resuscitation efforts should be made on a case-by-case basis.

Lung adenosquamous carcinoma with lingual and cardiac metastases

Abstract Metastatic lingual tumors are very rare, and hematogenous myocardial metastasis is also relatively uncommon. We report a case of lung adenosquamous carcinoma with metastases to the tongue and the myocardium. A 65-year-old man underwent a partial upper lobectomy for a primary lung cancer in June 1997. He developed a local recurrence and received two courses of radiotherapy, in March and September 1998. A follow-up computed tomography (CT) scan showed a myocardial tumor, suggestive of cardiac metastasis. In October 1998, he began to complain of angina-like chest oppression and showed ischemic changes on electrocardiogram (ECG), and he also developed lingual, subcutaneous, and brain metastases. He died of respiratory failure in December 1998, 20 months after the initial diagnosis of primary lung cancer; metastases to the tongue and myocardium were confirmed by autopsy.