Kyota Nakamura

Airway scope versus macintosh laryngoscope in patients with simulated limitation of neck movements.

BACKGROUND Tracheal intubation in patients with suspected neck injuries should achieve two contradicting goals-sufficient laryngeal exposure and the least cervical spine movement. Because the former involves displacements of the cervical vertebrae, intubation under immobilization is widely performed today to prevent exacerbation of spinal code injuries. The unique curving blade of the Airway Scope (AWS) is designed to fit the oropharyngeal anatomy. A camera at the tip of the blade displays the view of the larynx, but unlike the direct laryngoscope, it needs no line-of-sight of the oral, pharyngeal, and tracheal axis. Our purpose is to determine whether AWS could be a suitable airway device for the intubation of patients with potential neck injury. METHODS Thirty-six patients scheduled for surgery were randomly assigned to undergo intubation using either AWS or Macintosh laryngoscope (MLS). After general anesthetic induction, the patients head was set in a neutral position, and an appropriately sized semi-rigid neck collar was placed. Measurements include intubation time, number of attempts, success rate, Cormack-Lehane classification, airway optimization maneuver, Intubation Difficulty Scale scores, and complications. RESULTS Intubation time proved no statistical significance (mean ± SD, AWS, 62.9 seconds ± 26.0 seconds, MLS, 55.6 seconds ± 26.0 seconds; p = 0.42). AWS scored less in Cormack-Lehane classification (median [range], AWS I [I-I], MLS IIIa [I-IIIb]; p < 0.0001), required fewer additional airway optimization maneuvers (p = 0.0003), and scored less in Intubation Difficulty Scale scores (AWS 0 [0-1], MLS 2 [0-5]; p < 0.0001). CONCLUSIONS In neck-immobilized patients using semi-rigid cervical collars, AWS improves laryngeal exposure and facilitates tracheal intubation. AWS may be a suitable intubation device for trauma patients.

Airway Scope Laryngoscopy Under Manual Inline Stabilization and Cervical Collar Immobilization: A Crossover In Vivo Cinefluoroscopic Study

BACKGROUND Direct laryngoscopy along with manual inline stabilization (MIS) is currently the standard care for patients with suspected neck injuries. However, cervical collar immobilization is more commonly performed in the prehospital environment, and its early removal is necessary before intubation. We hypothesized that if usability of Airway Scope (AWS) in a difficult airway could also bring merits to intubation under cervical collar immobilization, unnecessary risk caused by the removal of a neck collar may be prevented. METHODS In this crossover study, 30 consenting patients presenting for surgery were assigned to undergo intubation using AWS. Neck was stabilized manually and by a neck collar in a random order before laryngoscopy was performed by the same anesthesiologist. Measurements include interincisor distance (IID), success rate, intubation time, and fluoroscopic examination of the upper and middle cervical spine. RESULTS IID was notably narrower after application of a neck collar (mean ± SE: MIS, 19 mm ± 1 mm; collar, 10 mm ± 1 mm; p < 0.01). One and 9 failures were encountered in MIS and collar groups, respectively (p = 0.012). Intubation time proved no statistical significance. Extension of craniocervical junction was observed in both groups, but occipitoatlantal joint was significantly more extended in collar group (median [range]: AWS, 10-degree angle [-1 to 20-degree angle]; collar, 14-degree angle [5 to 26-degree angle]; p < 0.01). DISCUSSION AWS laryngoscopy under cervical collar immobilization fails to meet our expectation. Intubation failed in 30% of the cases in collar group whereas only 3.3% of the cases in MIS group. Significant difference of mouth opening limitation is probably the major reason, as 7 of 9 failed cases in collar group had IID <10 mm. This was insufficient to insert the 18-mm blade of AWS. In addition, occipitoatlantal joint suffered a greater extension when wearing a neck collar. Differences in the method to stabilize the neck may be the reason. CONCLUSION When compared with cervical collar immobilization, AWS laryngoscopy along with MIS seems to be a safer and more definite method to secure airway of neck-injured trauma patients because it limits less mouth opening and upper cervical spine movement.

Evaluation of the Pentax-AWS® and the Macintosh laryngoscope in difficult intubation: a manikin study

Background: The Pentax‐AWS (AWS®), a new video laryngoscope, has been shown to be useful in cases of difficult intubation. We hypothesized that the AWS® would be more useful in the settings of a narrow upper airway than the Macintosh laryngoscope. We compared each device in simulated scenarios of representative difficulty of tracheal intubation using a manikin. The primary endpoint was the rate of successful intubation.

Usability and performance of a wearable tele-echography robot for focused assessment of trauma using sonography.

Focused Assessment with Sonography for Trauma (FAST) is widely used as a first lifesaving step for patients suffering from internal bleeding. Because it may take a long time to transport such patients to a hospital, a wearable and portable tele-echography robot that a paramedic can attach to the patient has been developed. In the current study, experiments were conducted to evaluate the usability and performance of attached FAST. The proposed robot must be attached to 4 areas to perform FAST. The time required for attachment and the positions of attachment completed by 9 non-medical staff members, as well as the time it took for the FAST to reach a medical doctor, were measured. The echo images obtained when the patients body was in motion were evaluated by a medical doctor. The robot could be attached to all 4 areas within approximately 5min, and the maximum gap was 4.8cm. This indicates that a paramedic who has received training in emergency medical care should be able to attach the robot to a patient quickly and accurately. Additionally, it was confirmed that the robot could be used to complete FAST under a doctors control within 9min and that the extracted echo images were suitable for FAST. A comparison of the results with current ambulance transportation time confirmed that FAST could be completed approximately 14min before the patient reached the hospital. The results of the current study indicate that the robot is worth using, is suitable for FAST, and will be effective in emergency medical care.

An analysis of spoken language expression during simulated emergency call triage.

Objectives: Volunteer citizens were recruited to perform simulated emergency calls, and the expressions and content of these telephone calls were analysed to examine risk factors associated with the success or failure of communication. Subjects and methods: Six physicians played the role of patients who had various symptoms, such as cerebral stroke and ischaemic heart disease. Eighty-four volunteer citizens made simulated emergency calls. Physicians at a simulated call centre communicated with each caller regarding the patients body position, respiratory condition, and cardiovascular status. Details of the telephone communications were analysed to determine if communication was successful. Results: Telephone communications that resulted in the correct understanding of a simulated patients condition were as follows: 60.2% of sessions (32/50) on whether or not a patient was breathing; 47.8% of sessions (22/46) on whether or not a patient had a pulse (carotid or radial artery); and 86.2% of sessions (56/65) on patient body position. How a simulated dispatcher verbally expressed questions was the most influential factor in the success of communication regarding respiratory condition and body position. Avoiding vague language, giving specific instructions for checking a patient, and finally reminding the caller to perform the explained procedures led to a high rate of successful communications. Various spoken expressions by simulated dispatchers in confirming patient pulse did not have any impact on the success or failure of communications. Conclusion: In developing a ‘protocol for emergency call triage’ to achieve a high rate of successful emergency communications, an analysis of expressions using simulated patients is useful.

Tracheal intubation using Airway Scope in two patients with difficult airway during cardiopulmonary resuscitation.

The Airway Scope AWS-S100® (AWS, Pentax, Tokyo), a rigid video laryngoscope with integrated tube guidance that has recently become commercially available, helped the authors to establish airways in two patients with in-hospital cardiopulmonary arrest, after failed attempts to intubate the patients using the Macintosh laryngoscope (that only commanded the Cormack–Lehane grade 4 glottic views), the laryngeal mask airway, and even surgical cricothyroidotomy for the second case. This showed the utility of the AWS in the management of difficult airway cases even in emergency settings.

Two cases with intra-aortic balloon pumping use for severe septic cardiomyopathy

Septic cardiomyopathy is defined as a reversible left ventricular systolic dysfunction. Patients with severe septic cardiomyopathy have a high mortality rate, even if they receive conventional therapy. For those patients, previous reports showed intra‐aortic balloon pump (IABP) efficacy. We report two rare cases with IABP introduction leading them to drastic improvement, and survival from severe septic cardiomyopathy. Case 1 is a 78‐year‐old woman diagnosed with renal calculus pyelonephritis, septic shock, and septic cardiomyopathy. Case 2 is a 62‐year‐old man diagnosed with pneumonia, septic shock, and septic cardiomyopathy.

Non-inflammatory or non-ischemic vascular gas on emergent multi-detector computed tomography: Eight years' experience

the study aimed to characterize the etiology and clinical significance of non-inflammatory or non-ischemic vascular gas on multi-detector computed tomography (MDct). We reviewed MDct images and clinical charts of patients with vascular gas excluding inflammatory or ischemic entities in our hospital between 2008 and 2015. the local cases and the case report papers, which were extracted from English literature in PubMed were summarized according to iatrogenic or non-iatrogenic causes to analyze etiology for the entry of air into the circulation. Our local series demonstrated single or multiple collection of vascular gas in 15 patients including one with systemic arterial gas; the most frequent was cerebral vascular gas (cVG, n = 11, 0.8– 12 mL) followed by hepatic vascular gas (n = 10, 0.4–256 mL). the accumulative 144 cases including the 15 local cases included 62 (43.1%) with iatrogenic vascular gas; the most frequent was central venous catheter-related cVG (48 cases) with 39.5% mortality followed by hepatic portal venous gas (20 cases) with 15% mortality. A careful search for clues on MDct images was Kazuya Sugimori1, Izumi Torimoto1, Kyota Nakamura1, Masaaki Kondo1, Kazushi Numata1, Shigeo Takebayashi1 Affiliations: 1From the Gastroenterology Center (KS, MK, KN), the Department of Diagnostic Radiology (IT, ST) and, the Critical Care and Emergency Center (KN), Yokohama City University Medical Center. Corresponding Author: Izumi Torimoto, Department of Diagnostic Radiology, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 2320024, Japan; E-mail: izumi_t@yokohama-cu.ac.jp Received: 13 July 2016 Accepted: 01 August 2016 Published: 26 August 2016 useful in discussing the etiology of vascular gas entry points and increased awareness of the emergent clinical settings where the vascular gas occurred.

Systemic air-angiogram appearance caused by aortobronchial fistula in a cardiac arrest patient with ruptured aortic arch aneurysm

Introduction: We report a very rare finding of air replacement of systemic arteries appeared as air-angiogram on radiographs and multidetector computed tomography (MDCT). Case Report: A 70-year-old male suffered cardiac arrest after a massive hemoptysis and received endotracheal intubation and positive pressure ventilation. Chest and abdominal radiographs showed massive air in the heart, the aorta and the systemic arteries appeared as “air-angiogram”. Postmortem multi-detector computed tomography images obtained shortly after death confirmed a ruptured aortic arch aneurysm and air replacement of the left heart chambers, the aorta and systematic arteries. Conclusion: Positive pressure ventilation causes massive air embolism in the patient with aortobronchial fistula secondary to the aneurysmal rupture.

Usefulness of N-butyl cyanoacrylate embolization versus coil embolization for control of massive hemorrhage in patients with pelvic fracture

Aims: to evaluate the usefulness of N-butyl cyanoacrylate (NbcA) in transarterial embolization (tAE) in patients with pelvic fracture and massive hemorrhage. Methods: We retrospectively reviewed 91 patients with pelvic fracture and massive hemorrhage requiring a >2 L of blood transfusion and tAE at a single institution from July 2008 to september 2015. the backgrounds and outcomes were compared between the NbcA group, which consisted of 46 patients treated by tEA including NbcALipiodol embolization beginning in 2012, and the remaining 46 patients (non-NbcA group). statistical analyses were performed to compare various factors among the two groups and to determine factors associated with mortality. results: between the NbcA group and the non-NbcA group, there were no significant differences in the backgrounds, the mean number of embolized arteries (4.22 ± 2.26 versus 4.24 ± 1.75), the mean time required for tAE (73.4 minutes ± 31.0 versus 74.3 minutes ± 29.2),