Keiko Fujie

Do dispatcher instructions facilitate bystander-initiated cardiopulmonary resuscitation and improve outcomes in patients with out-of-hospital cardiac arrest? A comparison of family and non-family bystanders

OBJECTIVES Bystander-initiated cardiopulmonary resuscitation (CPR) has been reported to increase the possibility of survival in patients with out-of-hospital cardiopulmonary arrest (OHCA). We evaluated the effects of CPR instructions by emergency medical dispatchers on the frequency of bystander CPR and outcomes, and whether these effects differed between family and non-family bystanders. METHODS We conducted a retrospective cohort study, using Utstein-style records of OHCA taken in a rural area of Japan between January 2004 and December 2009. RESULTS Of the 559 patients with non-traumatic OHCA witnessed by laypeople, 231 (41.3%) were given bystander CPR. More OHCA patients received resuscitation when the OHCA was witnessed by non-family bystanders than when it was witnessed by family members (61.4% vs. 34.2%). The patients with non-family-witnessed OHCA were more likely to be given conventional CPR (chest compression plus rescue breathing) or defibrillation with an AED than were those with family-witnessed OHCA. Dispatcher instructions significantly increased the provision of bystander CPR regardless of who the witnesses were. Neurologically favorable survival was increased by CPR in non-family-witnessed, but not in family-witnessed, OHCA patients. No difference in survival rate was observed between the cases provided with dispatcher instructions and those not provided with the instructions. CONCLUSIONS Dispatcher instructions increased the frequency of bystander CPR, but did not improve the rate of neurologically favorable survival in patients with witnessed OHCA. Efforts to enhance the frequency and quality of resuscitation, especially by family members, are required for dispatcher-assisted CPR.

IV–4 Acceleration of Tibial Open and/or Comminuted Fracture Healing by Low-Intensity Pulsed Ultrasound (LIPUS); A Retrospective Cohort Study

Objective: To investigate the efficacy of LIPUS for fracture healing of tibial open and/or comminuted fracture. Study Design: Retrospective multicenter cohort study. Institute: Thirty-seven hospitals (University hospitals and community teaching hospitals) in Japan. Patients and Methods: A 1-year observational retrospective cohort study was conducted with a consecutive cohort of 343 open and/or comminuted tibial shaft fractures in adults (18 years or older). All patients were treated with an intramedullary nail, a plate and screws, or an external fixator and screws/wires between April 1, 2007 and September 30, 2010. Cases for which LIPUS was applied within 21 days after definitive fixation were defined as the LIPUS group (n = 103); all other patients were in the Non-LIPUS group (n = 240). Five orthopaedic surgeons who did not participate in the treatment of the cases determined the radiographic healing date for each case. Main Outcome: Kaplan-Meier curve between healing periods and cumulative healing rate was plotted. Log-rank examination was performed to evaluate the effectiveness of LIPUS on fracture healing. Results: There were no significant demographic differences between the LIPUS group and the Non-LIPUS group. Median healing time was 143 days for the LIPUS group and 150.5 days for the Non-LIPUS group (P = 0.067). LIPUS was applied as adjuvant therapy in 49 patients in the Non-LIPUS group, after a diagnosis of delayed union and/or nonunion. Eliminating these 49 cases from the Non-LIPUS group, there was no statistically significant difference in healing time between the LIPUS and Non-LIPUS groups (P = 0.855). Subgroup analysis revealed that LIPUS accelerated fracture healing significantly in cases treated by plate fixation (P < 0.001), but not in cases treated by intramedullary nail. Conclusion: LIPUS may have a positive effect on fracture healing for open and/or comminuted tibial shaft fracture, especially for the cases treated by plate fixation.

Comparison of Glucose Concentrations between Flash and Continuous Monitoring Systems in Patients with Diabetes Mellitus

Flash glucose (FGMS) and continuous glucose (CGMS) monitoring systems are becoming increasingly prevalent in clinical practice. We directly compared FGMS (FreeStyle Libre-Pro, FSL-Pro) and CGMS (iPro2) in a patient with diabetes mellitus (T1DM/T2DM = 3/10). Analysis of 7,365 paired values revealed a close correlation between FSL-Pro and iPro2 glucose values (r = 0.93, p 180 mg/dL) compared with normoglycemic values (70-180 mg/dL) (32.0 (19.0-47.0) vs. 23.0 (14.0-31.0) mg/dL, p Disclosure R. Kumagai: None. A. Muramatsu: None. M. Fujii: None. Y. Katakura: None. K. Fujie: None. Y. Nakata: None. K. Hashimoto: None. H. Yagyu: None.