Shunji Kasaoka

Effect of admission glasgow coma scale motor score on neurological outcome in out-of-hospital cardiac arrest patients receiving therapeutic hypothermia

BACKGROUND Because the initial (on admission) Glasgow Coma Scale (GCS) examination has not been fully evaluated in comatose survivors of cardiac arrest (CA) who receive therapeutic hypothermia (TH), the aim of the present study was to determine any association between the admission GCS motor score and neurologic outcomes in patients with out-of-hospital CA who receive TH. METHODSANDRESULTS In the J-PULSE-HYPO study registry, patients with bystander-witnessed CA were eligible for inclusion. Patients were divided into 3 groups based on GCS motor score (1, 2-3, and 4-5) to assess various effects on neurologic outcome. Univariate and multivariate analyses were performed to identify independent predictors of good neurologic outcome at 90 days. Of 452 patients, 302 were enrolled. There was a significant difference among the 3 patient groups with regard to neurologic outcome at 90 days in the univariate analysis. Multiple logistic regression analyses showed that the GCS motor score on admission, age >65 years, bystander cardiopulmonary resuscitation, the time from collapse to return of spontaneous circulation, and pupil size <4 mm were independent predictors of a good neurologic outcome at 90 days in cases of CA (GCS motor score, 4-5: odds ratio, 8.18; 95% confidence interval: 1.90-60.28; P<0.01). CONCLUSIONS GCS motor score is an independent predictor of good neurologic outcome at 90 days in patients sustaining out-of-hospital CA who receive TH.

Comparison of the McGrath MAC video laryngoscope and the Pentax Airwayscope during chest compression: a manikin study

We tested the utility of the McGrath MAC® (McG) video laryngoscope during chest compression compared with the Pentax Airwayscope® (AWS). We recruited 59 participants into the simulation study. The difference in the time to intubation (TTI [sec]) between without and with chest compression was significant for the AWS attempts (median 13, range 6–28 vs. median 15, range 6–72, p = 0.0247) but not significant for the McG attempts (median 16, range 6–75 vs. median 16, range 6–71); however, the difference of the TTIs is not serious clinically. The utility of the two devices during chest compressions is almost similar although their characteristics are different.

Evolved role of the cardiovascular intensive care unit (CICU)

Cardiovascular intensive care refers to special systemic management for the patients with severe cardiovascular disease (CVD), which consists of heart disease and vascular disease. CVD is one of the leading causes of death in the world. In order to prevent death due to CVDs, an intensive care unit for severe CVD patients, so-called cardiovascular intensive care unit (CICU), has been developed in many general hospitals. The technological developments of clinical cardiology, such as invasive hemodynamic monitoring and intracoronary interventional procedures and devices, have resulted in evolution of intensive care for CVDs. Subsequently, severe CVD patients admitted to CICU are increasing year by year. Dedicated medical staff is required for CICU in order to perform best patient management. It is necessary for optimal patient care to select effective means from various hemodynamic tools and to adjust the usage according to the clinical situation such as cardiogenic shock and acute heart failure. Furthermore, the patients in the CICU often have various complications such as respiratory failure and renal failure. Therefore, medical staffs who work at CICU are required to have the ability to practice systemic intensive care.

A resuscitated case of cardiopulmonary arrest due to massive hemoptysis caused by a ruptured thoracic aortic aneurysm

Dear Editor, We report a resuscitated case of cardiopulmonary arrest (CPA) following massive hemoptysis due to a ruptured thoracic aortic aneurysm (TAA). A 73-year-old man was admitted with a sudden onset of hemoptysis. He presented with atrial fibrillation, and he had been taking warfarin (1 mg/day). He had not been previously diagnosed as having a TAA and had had no episode of hemoptysis. On admission, he was lucid with the following vital data: blood pressure, 143/107 mmHg; pulse rate, 90–110 b.p.m.; respiratory rate, 20/min. His breathing sound was reduced in his left lung field. Laboratory tests showed: hemoglobin, 14.7 g/dL; total leukocyte count, 10,800/mm; platelet count, 135,000/mm; PT (INR), 1.17; d-dimer, 29.4 μg/mL. A chest X-ray revealed a hazy shadow in the patient’s left lung field (Fig. 1A). A contrast-enhanced chest computed tomography scan showed a leakage of the contrast material from the TAA and consolidated lung tissue adjacent to the TAA (Fig. 1B). He was diagnosed as having a ruptured TAA into the tracheobronchial trees or the lung, and an emergent endovascular stent-grafting was scheduled. Just before the induction of general anesthesia, CPA following sudden massive hemoptysis occurred. He was intubated immediately, and we started cardiopulmonary resuscitation (CPR). An endovascular intervention was also started under the CPR. We inserted the stent-graft through the femoral artery with fluoroscopy guidance. After the dilation of the stent-graft with an endovascular balloon, the patient was resuscitated. The duration of the CPR was 67 min; however, we had to interrupt the chest compression several times during the fluoroscopy guidance. During the CPR, his electrocardiogram revealed pulseless electrical activity and mechanical ventilation was continued with 100% oxygen; however, the lowest PaO2 was 52 mmHg and the highest PaCO2 was 98 mmHg. The lowest value of

Slow rewarming improved the neurological outcomes of prolonged mild therapeutic hypothermia in patients with severe traumatic brain injury and an evacuated hematoma

Mild therapeutic hypothermia (MTH) is expected to improve the neurological outcomes of patients with severe traumatic brain injury (TBI). However, there are no standard protocols for managing the temperature of patients with severe TBI in order to improve their neurological outcomes. We conducted a post hoc analysis of the B-HYPO study, a randomized controlled trial of MTH in patients with TBI in Japan. We evaluated the impact of MTH methods on neurological outcomes. Ninety-seven patients who received MTH were included in the present analyses. The neurological outcomes were compared among subgroups of patients divided by cutoff values for the induction, maintenance, and rewarming times of MTH in all patients, in patients with diffuse injury, and in patients with an evacuated hematoma. The proportion of patients with a good neurological outcome was significantly different between patients with an evacuated hematoma divided into subgroups by the cutoff value of rewarming time of 48 h (>48 h vs. ≤ 48 h: 65% vs. 22%; odds ratio: 6.61; 95% confidence interval: 1.13–38.7, P = 0.0498). Slow rewarming for >48 h might improve the neurological outcomes of prolonged MTH in patients with TBI and an evacuated hematoma. Further studies are needed to investigate the optimal rewarming protocol in patients with TBI.

Comparison of the conventional Macintosh laryngoscope, the Pentax Airwayscope, and the McGrath MAC video laryngoscope under restricted cervical motion: a manikin study

We compared the utility of the conventional Macintosh laryngoscope, the Pentax Airway Scope, and the McGrath MAC video laryngoscope under restricted cervical motion using a manikin.

Comparison of the utility of the Pentax Airway Scope (AWS) with that of the conventional Macintosh laryngoscope during chest compression: is the AWS an easy‐to‐use device for a novice?

The Pentax Airway Scope occasionally contacts the arm of the chest compressor at insertion because of its large body. Here, we test the Airway Scopes ease of use compared to that of the conventional Macintosh laryngoscope during chest compression, when operated by a novice.

Electrocardiogram findings of patients with serum potassium levels of nearly 10.0 mmol/L: a report of two cases

In Case 1, a 63‐year‐old woman was admitted with muscular weakness. She had hypertension, diabetes mellitus, and chronic renal failure on hemodialysis. She was taking a beta‐blocker. Her pulse rate was 42 b.p.m. (irregular rhythm); serum potassium level was 9.8 mmol/L; electrocardiogram revealed widening of the QRS complex (0.256 s). In Case 2, a 59‐year‐old man was admitted with muscular weakness. He had hypertension and chronic renal failure, and was taking a renin–angiotensin–aldosterone system inhibitor. His pulse rate was 42 b.p.m. (irregular rhythm); serum potassium level was 10.1 mmol/L; electrocardiogram revealed widening of the QRS complex (0.180 s).