Tatsuya Norii

Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with propensity score-adjusted untreated patients.

BACKGROUND Despite a growing call for use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for critically uncontrolled hemorrhagic shock, there is limited evidence of treatment efficacy. We compared the mortality between patients who received a REBOA with those who did not, adjusting for the likelihood of treatment and injury severity, to measure efficacy. METHODS We analyzed observational prospective data from the Japan Trauma Data Bank (2004–2011) to compare the mortality between adult patients who received a REBOA with those who did not. To adjust for potential treatment bias, we calculated the likelihood of REBOA treatment via a propensity score (PS) using available pretreatment variables (vital signs, age, sex, as well as anatomic and physiologic injury severity) and matched treated patients to up to five similar PS untreated patients. We compared survival to discharge between treated and untreated groups using conditional logistic regression and Cox proportional hazards regression. RESULTS Of 45,153 patients who met inclusion, 452 patients (1.0%) received REBOA placement. These patients were seriously injured (median Injury Severity Score [ISS], 35) and had high mortality (76%). Patients who did not receive a REBOA had significantly lower injury severity (median ISS, 13; p < 0.0001) and lower mortality (16%). After matching REBOA patients with controls with similar PSs for treatment, the crude conditional odds ratio of survival by REBOA treatment was 0.30 (95% confidence interval, 0.23–0.40). CONCLUSION REBOA treatment is associated with higher mortality compared with similarly ill trauma patients who did not receive a REBOA. The higher observed mortality among REBOA-treated patients may signal “last ditch” efforts for severity not otherwise identified in the trauma registry. LEVEL OF EVIDENCE Epidemiologic study, level III; therapeutic study, level IV.

Electronic cigarette explosion resulting in a C1 and C2 fracture: a case report

BACKGROUND Electronic cigarettes have seen a drastic increase in use. A lithium-ion battery is often used as the rechargeable battery of the electronic cigarette device and has recently received much attention in terms of safety. There are several recent case reports in the scientific literature of injuries due to electronic cigarette explosions that involved soft-tissue injuries. CASE REPORT We report a significant spinal fracture from an electronic-cigarette explosion in a 27-year-old male. The electronic cigarette exploded during use, sending the mouthpiece through the pharynx and into the first cervical vertebra and resulting in fractures of the first and second vertebrae. An x-ray study of the neck showed a foreign body in the neck at the level of C1. A computed tomography scan of the neck showed fractures of C1. The foreign body was removed in the operating room. The patient was discharged home without neurologic sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Our case report is the first case of a cervical spine injury due to the explosion of an electronic cigarette. This case demonstrates that an electronic cigarette explosion can cause potentially serious penetrating neck injury. Emergency physicians should be aware of the potential danger of electronic cigarettes and have a low threshold to obtain radiographic tests and surgical consultation in the case of electronic cigarette explosion in the oral cavity. As the use of electronic cigarettes continue to increase, it is likely that injuries associated with them will also increase.

Resuscitative endovascular balloon occlusion of the aorta in trauma patients in youth

BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) has received increasing attention for critically uncontrolled hemorrhagic shock. However, the efficacy of REBOA in patients in youth is unknown. OBJECTIVES The aim of this study was to evaluate the mortality and characteristics of patients of age ⩽18 years with severe traumatic injury who received REBOA. METHODS We retrospectively analyzed observational cohort data from the Japan Trauma Data Bank (JTDB) from 2004 to 2015. All patients ⩽18 years old who underwent REBOA were included. Clinical characteristics and mortalities were analyzed and compared among patients ⩽15 years old (young children) and 16–18 years old (adolescents). RESULTS Of the 236,698 patients in the JTDB (2004–2015), 22,907 patients were 18 years old or younger. A total of 3,440 patients without survival data were excluded. Of the remaining 19,467, 54 (0.3%) patients underwent REBOA, among which 15 (27.8%) were young children. Both young children and adolescents who underwent REBOA were seriously injured (median Injury Severity Score [ISS], 41 and 38, respectively). Also, 53.3% of young children and 38.5% of adolescents survived to discharge after undergoing REBOA. CONCLUSION In a cohort of young trauma patients from the JTDB who underwent REBOA to control hemorrhage, we found that both young children and adolescents who underwent REBOA were seriously injured and had an equivalent survival rate compared to the reported survival rate from studies in adults. REBOA treatment may be a reasonable option in severely injured young patients in the appropriate clinical settings. Further prospective studies are needed to confirm our findings. LEVEL OF EVIDENCE Epidemiologic study, level III; therapeutic study, level IV.

Airway obstruction due to sticky rice cake (mochi): a case series and review of the literature

BackgroundForeign body airway obstruction is a significant public health issue around the world. Mochi, a traditional sticky rice cake in Japan, has gained popularity in many countries including the USA. However, the associated aspiration danger has not yet been well recognized.Case presentationWe describe three cases of foreign body airway obstruction due to mochi. Case 1 was an elderly man who was brought to the emergency department by an ambulance after he choked on mochi. Despite extensive efforts to remove pieces of mochi including use of Magill forceps, bronchoscopy, and endotracheal intubation, he suffered severe hypoxia and died. Case 2 was a middle-aged man who was found unconscious in a park. The rhythm upon arrival was pulseless electrical activity. During intubation, large pieces of mochi were found in the oropharynx and removed with Magill forceps. He developed aspiration pneumonitis and hypoxic brain injury. The patient was discharged to a skilled nursing facility with severe neurological disability. Case 3 was an elderly man who choked while eating soup with mochi at home. His initial cardiac rhythm was asystole. During intubation, obvious foreign body was found in the oropharynx. Several pieces of mochi were removed by suctioning through the endotracheal tube. He suffered severe hypoxic injury and died.ConclusionsAll of our cases resulted in death or poor neurological outcome. As the popularity of mochi continues to increase, it is likely that cases of aspiration from mochi will also increase. Emergency physician should be aware of the potential danger of mochi and be familiar with the techniques to remove mochi from the airway.

Effect of Time to Vascular Access in Out-of-Hospital Cardiac Arrest

The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Need for Randomized Controlled Trial

The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

TEMPORARY REMOVAL: Need for Randomized Controlled Trial

The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

The D-BLADE™ in the C-MAC® System Should Not Be Used as a Direct Laryngoscope

We would like to thank Dr. Sakles et al. for their interesting paper about the use of C-MAC (Karl Storz, Tuttlingen, Germany) as a direct laryngoscope at their institution (1). It is our understanding from personal communication that the study was performed using only the Macintosh blade C-MAC (sizes 3 and 4), but we are concerned that this was not explicitly stated, which might lead to confusion and unintended consequences. A variety of laryngoscope blades are currently available for the C-MAC system, including those resembling common Macintoshand Miller-type blades. The C-MAC system also offers its unique, hyperangulated D-BLADE . Although C-MAC’s curved and straight blades can be used for both direct and video laryngoscopy, the D-BLADE should not be used as a direct laryngoscope. The C-MAC D-BLADE is designed for difficult airways and has a highly angulated shape that gives the blade an almost half-moon shape (Figure 1). The angulation of the D-blade is 40 degrees compared to 18 degrees in the conventional C-MAC Macintosh blade. Due to the