Ikuo Yamanaka

Utility of colorimetric end-tidal carbon dioxide detector for monitoring during prehospital cardiopulmonary resuscitation

The purpose of this study was to evaluate a colorimetric end-tidal CO2 (ETCO2) detector (EASY CAP) as a monitor during prehospital cardiopulmonary resuscitation (CPR) without tracheal intubation. This detector was used for 121 patients during CPR with a laryngeal mask airway or face mask by authorized emergency lifesaving technicians. At 7 to 15 minutes after the initiation of CPR, ETCO was <0.5% in 30 cases (group A), 0.5% to 2.0% in 46 cases (group B) and >2.0% in 45 cases (group C). The rate of return of spontaneous circulation was 17% in group A, 24% in group B, and 48% in group C (groups A v C, P < .01). There was a significant difference in the rate of hospital admission between groups A and C. The ETCO2 value may be useful for monitoring during prehospital CPR with a laryngeal mask airway or face mask.

Clinical trial of argatroban, a direct thrombin inhibitor, as an anticoagulant in cardiopulmonary support and apheresis in emergency patients: a preliminary report

Abstract To evaluate the safe and effective use of argatroban, a competitive direct thrombin inhibitor, as an alternative anticoagulant for percutaneous cardiopulmonary support (PCPS) and continuous hemofiltration or hemodiafiltration (CHF/CHDF), a preliminary multicenter clinical trial was conducted between October 1999 and September 2000. Nine patients who underwent PCPS and/or CHF/CHDF were enrolled in the study during this period. The dosage of argatroban was controlled so that the activated clotting time (ACT) was maintained at around 180 to 200 s. The mean duration of argatroban administration was 82 ± 92 h, and the mean dose was 0.67 ± 0.40 μg kg+1 min−1. Severe hemorrhagic complications requiring the discontinuation of argatroban administration were not observed in any of the patients. Platelet loss was prevented to some degree, and plasma levels of fibrinogen were well preserved during PCPS/CHDF. Except for two patients undergoing CHDF, clot formation within the extracorporeal circulation circuit was not identified macroscopically after the discontinuation of the procedures. We conclude that argatroban might be useful as an alternative anticoagulant in cases where heparin cannot be safely used because of the increased risk of bleeding complications, thrombocytopenia, and/or hypofibrinogenemia. Although the optimal dose of argatroban has not been established, we propose an initial starting dose of 0.7 to 1.0 μg kg−1 min−1, followed by adjustments to maintain an ACT of between 180 and 250 s.

Continuous Monitoring of Jugular Bulb Oxygen Saturation in the Management of Patients with Severe Closed Head Injury

Continuous monitoring of intracranial pressure (ICP) is essential in the management of the patients with severe head injury, and various methods to decrease ICP have been utilized [1]. Hyperventilation, however, may occasionally cause inadequate cerebral perfusion, resulting in secondary brain damage in patients with increased ICP [2]. We have performed experimental and clinical studies using simultaneous monitoring of ICP and jugular bulb oxygen saturation (SjO2) with a fiberoptic catheter to evaluate dynamic changes in cerebral perfusion and cerebral metabolic rate, with the aim of finding an appropriate treatment strategy for patients with severe head injury [3]. On the basis of our previous data [3] and a review of the literature [4, 5], it was considered that a value for SjO2 less than 50% indicated hypoperfusion and a value more than 80% suggested hyperemia. We present herein our early experience of the management of severely head-injured patients by using simultaneous monitoring of ICP and SjO2 and discuss the treatment protocol we have developed.