記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction Work-life balance (WLB) is a critical concern for emergency medical technicians (EMTs) because it significantly affects the provision of comprehensive emergency medical services (EMS). This study investigated personal and work-related factors influencing work-to-family negative spillover (WFNS), a key element of WLB, among EMTs. Methods A web-based survey was conducted from July 26 to September 13, 2021, among EMTs in Hokkaido, Japan. The study included 21 facilities that were randomly selected from 42 fire stations. The Japanese version of the Survey Work-Home Interaction-NijmeGen (SWING-J) was used to measure WFNS. Personal background factors, such as age, sex, years of work experience, and education, were surveyed. We also evaluated work environment factors, such as weekly working hours, monthly night shifts, monthly overtime hours, and yearly paid vacation days. Unpaired Student's t-tests, one-way analysis of variance (ANOVA), and multilevel generalized linear model (MGLM) analyses were used to explore the relationships between WFNS and personal and work-related factors. Results A total of 912 respondents were included in our analysis. They were predominantly male (98.2%), with an average EMT work experience of 12.7 years and a mean WFNS score of 1.16 (standard deviation (SD) = 1.67). MGLM analysis, adjusting for covariates, identified years of work experience (β = -0.129, p = 0.001), monthly overtime hours (β = 0.184, p < 0.001), and yearly paid vacation days (β = -0.170, p < 0.001) as independent factors associated with WFNS. Conclusion This study suggested that adjusting WFNS among EMTs could be achieved by reducing overtime hours and fostering an organized approach to paid leave within the work environment.

DOI： 10.7759/cureus.55447

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Because of a scant report, it is little known that thyroid storms can occur after trauma, even in adolescence. Significantly, this increases the risk of delaying diagnosis resulting in life-threatening. CASE PRESENTATION: A 13-year-old girl was admitted to the emergency department after a traffic accident. Despite receiving comprehensive trauma care, the patient developed hyperthermia and tachycardia that did not respond to temperature management therapy. On the 10th day of her admission, she was diagnosed with a thyroid storm. Treatment for thyroid storm was initiated; thereby, her condition was totally improved. CONCLUSION: We experienced a case of an adolescent girl, who developed a thyroid storm during the treatment of trauma and could save her life. Clinicians should consider thyroid storm in post-traumatic hyperthermia and tachycardia patients, even in children.

DOI： 10.1002/ams2.70004

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Gasping during resuscitation has been reported as a favorable factor for out-of-hospital cardiac arrest. We examined whether gasping during resuscitation is independently associated with favorable neurological outcomes in patients with refractory ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) undergoing extracorporeal cardiopulmonary resuscitation ECPR. METHODS: Data from a 2014 study on advanced cardiac life support for ventricular fibrillation with extracorporeal circulation in Japan (SAVE-J), which examined the efficacy of ECPR for refractory VF/pVT, were analyzed. The primary endpoint was survival with a 6-month favorable neurological outcome in patients who underwent ECPR with or without gasping during resuscitation. Multivariate logistic regression analysis was performed to evaluate the association between gasping and outcomes. RESULTS: Of the 454 patients included in the SAVE-J study, data from 212 patients were analyzed in this study after excluding those with missing information and those who did not undergo ECPR. Gasping has been observed in 47 patients during resuscitation; 11 (23.4%) had a favorable neurological outcome at 6 months. Multivariate logistic regression analysis showed that gasping during resuscitation was independently associated with a favorable neurological outcome (odds ratio [OR], 10.58 [95% confidence interval (CI) 3.22-34.74]). The adjusted OR for gasping during emergency medical service transport and on arrival at the hospital was 27.44 (95% CI 5.65-133.41). CONCLUSIONS: Gasping during resuscitation is a favorable factor in patients with refractory VF/pVT. Patients with refractory VF/pVT with continuously preserved gasping during EMS transportation to the hospital are expected to have more favorable outcomes.

DOI： 10.1186/s40560-023-00692-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BackgroundThe relationship among advanced airway management (AAM), ventilation, and oxygenation in patients with out-of-hospital cardiac arrest (OHCA) who achieve prehospital return of spontaneous circulation (ROSC) has not been validated. This study was designed to evaluate ventilation and oxygenation for each AAM technique (supraglottic devices [SGA] or endotracheal intubation [ETI]) using arterial blood gas (ABG) results immediately after hospital arrival.MethodsThis observational cohort study, using data from the Japanese Association for Acute Medicine OHCA Registry, included patients with OHCA with prehospital and hospital arrival ROSC between July 1, 2014, and December 31, 2019. The primary outcomes were the partial pressure of carbon dioxide in the arterial blood (PaCO2) and partial pressure of oxygen in the arterial blood (PaO2) in the initial ABG at the hospital for each AAM technique (SGA or ETI) performed by paramedics. The secondary outcome was favorable neurological outcome (cerebral performance category [CPC] 1 or 2) for specific PaCO2 levels, which were defined as good ventilation (PaCO2 ≤45 mmHg) and insufficient ventilation (PaCO2 >45 mmHg).ResultsThis study included 1,527 patients. Regarding AAM, 1,114 and 413 patients were ventilated using SGA and ETI, respectively. The median PaCO2 and PaO2 levels were 74.50 mmHg and 151.35 mmHg in the SGA group, while 66.30 mmHg and 173.50 mmHg in the ETI group. PaCO2 was significantly lower in the ETI group than in the SGA group (12.55 mmHg; 95% CI 15.27 to 8.20, P-value < 0.001), while no significant difference was found in PaO2 by multivariate linear regression analysis. After stabilizing inverse probability of weighting (IPW), the adjusted odds ratio for favorable neurological outcome at 1 month was significant in the good ventilation group compared to the insufficient ventilation cohort (adjusted odds ratio = 2.12, 95%CI: 1.40 to 3.19, P value < 0.001).ConclusionThe study showed that in OHCA patients with prehospital ROSC, the PaCO2 levels in the initial ABG were lower in the group with AAM by ETI than in the SGA group. Furthermore, patients with prehospital ROSC and PaCO2 ≤45 mmHg on arrival had an increased odds of favorable neurological outcome after stabilized IPW adjustment.

DOI： 10.1080/10903127.2023.2260479

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background During the coronavirus disease 2019 (COVID-19) pandemic period, an extended total activity time (TAT) in emergency cases has been reported, especially in febrile patients. A brief selection time (ST) regarding the transport of patients to designated hospitals is vital to achieving a good outcome. However, to our knowledge, no studies have reported the impact of the COVID-19 pandemic on the ST. We therefore examined the impact of a fever on the ST for the transportation of emergency patients during the COVID-19 pandemic. Method We analyzed emergency medical services (EMS) data in Sapporo between January 2015 and December 2020. The primary outcome was the ST for the emergency destination of patients. The secondary outcomes were the number of inquiries, time from emergency call to arrival at the scene [call-to-scene time (CST)], time from arrival at the hospital to return base [arrival-to-return time (ART)], and TAT. We used a multivariable linear regression model to estimate the difference-in-differences effect. Results A total of 383,917 patients who were transported to the hospital were enrolled within the study period. The mean ST was 5.8 min in 2019 and 7.1 min in 2020. The difference-in-differences analyses showed that the mean ST increased by 2.52 min (p<0.001), the mean ART by 3.10 min (p<0.001), and the mean TAT by 7.27 min (p<0.001) for patients with a fever during the COVID-19 period. Conclusions This study showed that febrile patients had a longer ST, ART, and TAT during the 2020 COVID-19 period. Considering the COVID-19 pandemic and the threat of future pandemics, regional infection control and information-sharing should be conducted to reduce the EMS activity time.

DOI： 10.2169/internalmedicine.1852-23

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: : Burnout among emergency medical technicians is a serious problem affecting delivery of quality emergency medical services. Although the repetitive nature of the job and lower education level requirements for technicians have been reported as risk factors, little is known about the influence of burden of responsibility, degree of supervisor support, and home environment on burnout among emergency medical technicians. This study aimed to test the hypothesis that burden of responsibility, degree of supervisor support, and home environment increase burnout probability. METHODS: : A web-based survey was conducted among emergency medical technicians in Hokkaido, Japan from July 26, 2021 to September 13, 2021. A total of 21 facilities were randomly selected from 42 fire stations. Prevalence of burnout was measured using the Maslach Burnout-Human Services Survey Inventory. Burden of responsibility was measured using a visual analog scale. Occupational background was also measured. Supervisor support was measured using the Brief Job Stress Questionnaire. Family-work negative spillover was measured using the Survey Work-Home Interaction-NijmeGen-Japanese. The cutoff value for burnout syndrome was defined as emotional exhaustion ≥ 27 and/or depersonalization ≥ 10. RESULTS: : A total of 700 survey respondents were included, and 27 surveys with missing data were excluded. The suspected burnout frequency was 25.6%. Covariates were adjusted using multilevel logistic regression model analysis, and low supervisor support (OR,1.421; 95% CI:1.136-1.406, p < .001) and high family-work negative spillover (OR:1.264, 95% CI:1.285-1.571, p < .001) were independent factors that predicted higher probability of burnout. CONCLUSION: : This study indicated that focusing on improvement of supervisor support for emergency medical technicians and creating supportive home environments may assist in reducing burnout frequency.

DOI： 10.15441/ceem.22.389

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background This study aimed to investigate the prevalence, location, and characteristics of new-onset chronic pain by using a new definition in long-term survivors after discharge from a tertiary emergency center. Materials and methods We conducted a single-center ambidirectional cohort study from January to May 2022. A survey of patients was conducted by postal mail two to 2.5 years after their discharge from a tertiary emergency center. We used the Brief Pain Inventory to investigate chronic pain parameters, and the painDETECT questionnaire to investigate neuropathic pain. Patient information during hospitalization was collected retrospectively from medical records. Results The survey was sent to 78 patients, 63 (81%) of whom responded and were included in the analysis. Nine of the 63 patients (14%) had new-onset chronic pain. Of these, six (67%) had chronic pain of moderate or severe intensity which interfered with daily life. The most frequent location of chronic pain was the foot/ankle (n=4, 44%). Neuropathic pain was present in four (44%) patients with new-onset chronic pain. Conclusion New-onset chronic pain may occur for up to two to 2.5 years after discharge from a tertiary emergency center, and this may interfere with daily life. Therefore, a follow-up system for chronic pain is warranted.

DOI： 10.7759/cureus.35382

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The purpose of this study was to develop and validate an emergency medical technician (EMT) care patient satisfaction scale to measure patient satisfaction with prehospital emergency care. To date, patient satisfaction surveys of EMTs have been performed subjectively, e using each facility's questionnaire, without the use of a validated patient satisfaction scale. However, no specific scale has been devised to assess patient satisfaction with EMTs. The study population comprised patients who used an ambulance between November 2020 and May 2021 (N = 202). A survey instrument was administered to participants who provided informed consent. In the process of validating the patient satisfaction scale, an exploratory factor analysis (EFA) of construct validity was performed. The results of the EFA showed a factor structure consisting of five factors: "teamwork", "explanation and communication", "physical treatment and psychological support", "quickness of transport", and "environment in the ambulance". In addition, domain and summary scores showed good internal reliability (Cronbach's range = 0.82-0.94). The patient satisfaction scale developed in this study was designed and validated considering the role of EMTs and patients' needs for prehospital care. This scale may be useful in the development of assessments and interventions to improve patient satisfaction with EMTs.

DOI： 10.3934/publichealth.2023011

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To investigate the relationship between prehospital advanced airway management (AAM) and neurological outcomes in patients with asphyxia-related out-of-hospital cardiac arrest (OHCA). METHODS: We retrospectively analyzed data from the Japanese Association for Acute Medicine OHCA registry between June 2014 and December 2017. Patients with asphyxia-related cardiac arrest aged ≥18 years were included. The primary outcome was a 1-month favorable neurological outcome (cerebral performance category [CPC] 1-2). RESULTS: Of the 34,754 patients in the 2014-2017 JAAM-OHCA Registry, 1956 were included in our analysis. Cerebral performance category 1-2 was observed in 31 patients (1.6%), while CPC 3-5 was observed in 1925 patients (98.4%). Although prehospital AAM was associated with unfavorable neurological outcomes (odds ratio [OR], 0.269; 95% confidence interval [CI], 0.114-0.633; p = 0.003) in the univariate analysis, the association was not significant in the multivariate analysis. Compared with the AAM group, the non-AAM group showed increased rates of cardiac arrest after emergency medical service contact (4.3 vs. 7.2%, p = 0.009) and Glasgow Coma Scale ≥4 at hospital admission (1.9% vs. 4.7%, p = 0.004). Among the 903 patients for whom the time to return of spontaneous circulation (ROSC) could be calculated, the time from witnessed cardiac arrest to ROSC was significantly shorter (median, 8.5 vs. 37.0 min; p < 0.001) for those with favorable neurological outcomes than for those without. CONCLUSION: Prehospital AAM is not associated with improved neurological outcomes among those with asphyxia-related OHCA. However, the time from cardiac arrest to the first ROSC was significantly shorter among those with favorable outcomes.

DOI： 10.1002/ams2.912

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Since the response to lung recruitment varies greatly among patients receiving mechanical ventilation, lung recruitability should be assessed before recruitment maneuvers. The pressure-volume curve (PV curve) and recruitment-to-inflation ratio (R/I ratio) can be used bedside for evaluating lung recruitability and individualing positive end-expiratory pressure (PEEP). Lung tissue recruitment on computed tomography has been correlated with normalized maximal distance (NMD) of the quasi-static PV curve. NMD is the maximal distance between the inspiratory and expiratory limb of the PV curve normalized to the maximal volume. However, the relationship between the different parameters of hysteresis of the quasi-static PV curve and R/I ratio for recruitability is unknown. METHODS: We analyzed the data of 33 patients with severe coronavirus disease 2019 (COVID-19) who received invasive mechanical ventilation. Respiratory waveform data were collected from the ventilator using proprietary acquisition software. We examined the relationship of the R/I ratio, quasi-static PV curve items such as NMD, and respiratory system compliance (Crs). RESULTS: The median R/I ratio was 0.90 [interquartile range (IQR), 0.70-1.15] and median NMD was 41.0 [IQR, 37.1-44.1]. The NMD correlated significantly with the R/I ratio (rho = 0.74, P < 0.001). Sub-analysis showed that the NMD and R/I ratio did not correlate with Crs at lower PEEP (- 0.057, P = 0.75; and rho = 0.15, P = 0.41, respectively). On the contrary, the ratio of Crs at higher PEEP to Crs at lower PEEP (Crs ratio (higher/lower)) moderately correlated with NMD and R/I ratio (rho = 0.64, P < 0.001; and rho = 0.67, P < 0.001, respectively). CONCLUSIONS: NMD of the quasi-static PV curve and R/I ratio for recruitability assessment are highly correlated. In addition, NMD and R/I ratio correlated with the Crs ratio (higher/lower). Therefore, NMD and R/I ratio could be potential indicators of recruitability that can be performed at the bedside.

DOI： 10.1186/s13613-022-01081-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.brainres.2022.147949

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記述言語：英語  

BACKGROUND: In patients with coronavirus disease (COVID-19) due to severe acute respiratory syndrome coronavirus 2 infection, pneumomediastinum has been increasingly reported in cases of noninvasive oxygen therapy, including high-flow nasal cannula, and invasive mechanical ventilation. However, its pathogenesis is still not understood. CASE PRESENTATION: We report two cases of pneumomediastinum in acute respiratory distress syndrome (ARDS) caused by COVID-19. In both cases, control of spontaneous breathing with neuromuscular blocking agents resulted in resolution of pneumoperitoneum. CONCLUSION: The improvement of pneumomediastinum with control of spontaneous breathing suggested patient self-inflicted lung injury as a possible mechanism in this case series. In ARDS cases with pneumomediastinum, in addition to controlling plateau pressure with conventional lung protective ventilation, spontaneous breathing should be controlled if the patient's inspiratory effort is suspected to be strong.

DOI： 10.1002/ams2.796

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Prolonged cardiac arrest (CA) may lead to neurologic deficit in survivors. Good outcome is especially rare when CA was unwitnessed. However, accidental hypothermia is a very specific cause of CA. Our goal was to describe the outcomes of patients who suffered from unwitnessed hypothermic cardiac arrest (UHCA) supported with Extracorporeal Life Support (ECLS). We included consecutive patients' cohorts identified by systematic literature review concerning patients suffering from UHCA and rewarmed with ECLS. Patients were divided into four subgroups regarding the mechanism of cooling, namely: air exposure; immersion; submersion; and avalanche. A statistical analysis was performed in order to identify the clinical parameters associated with good outcome (survival and absence of neurologic impairment). A total of 221 patients were included into the study. The overall survival rate was 27%. Most of the survivors (83%), had no neurologic deficit. Asystole was the presenting CA rhythm in 48% survivors, of which 79% survived with good neurologic outcome. Variables associated with survival included the following: female gender (P < .001); low core temperature (P = .005); non-asphyxia-related mechanism of cooling (P < .001); pulseless electrical activity as an initial rhythm (P < .001); high blood pH (P < .001); low lactate levels (P = .003); low serum potassium concentration (P < .001); and short resuscitation duration (P = .004). Severely hypothermic patients with unwitnessed CA may survive with good neurologic outcome, including those presenting as asystole. The initial blood pH, potassium, and lactate concentration may help predict outcome in hypothermic CA.

DOI： 10.1111/aor.13818

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

<title>Abstract</title>
Whether central apnoea or hypopnoea can be induced by organophosphorus poisoning remains unknown to date. By using the acute brainstem slice method and multi-electrode array system, we established a paraoxon (a typical acetylcholinesterase inhibitor) poisoning model to investigate the time-dependent changes in respiratory burst amplitudes of the pre-Bötzinger complex (respiratory rhythm generator). We then determined whether pralidoxime or atropine, which are antidotes of paraoxon, could counteract the effects of paraoxon. Herein, we showed that paraoxon significantly decreased the respiratory burst amplitude of the pre-Bötzinger complex (<italic>p</italic> &lt; 0.05). Moreover, pralidoxime and atropine could suppress the decrease in amplitude by paraoxon (<italic>p</italic> &lt; 0.05). Paraoxon directly impaired the pre-Bötzinger complex, and the findings implied that this impairment caused central apnoea or hypopnoea. Pralidoxime and atropine could therapeutically attenuate the impairment. This study is the first to prove the usefulness of the multi-electrode array method for electrophysiological and toxicological studies in the mammalian brainstem.

その他リンク： http://www.nature.com/articles/s41598-020-73003-5

DOI： 10.1038/s41598-020-73003-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: The HOPE score, based on covariates available at hospital admission, predicts the probability of in-hospital survival after extracorporeal life support (ECLS) rewarming of a given hypothermic cardiac arrest patient with accidental hypothermia. Our goal was to externally validate the HOPE score. METHODS: We included consecutive hypothermic arrested patients who underwent rewarming with ECLS. The sample comprised 122 patients. The six independent predictors of survival included in the HOPE score were collected for each patient: age, sex, mechanism of hypothermia, core temperature at admission, serum potassium level at admission and duration of CPR. The primary outcome parameter was survival to hospital discharge. RESULTS: Overall, 51 of the 122 included patients survived, resulting in an empirical (global) probability of survival of 42% (95% CI = [33-51%]). This was close to the average HOPE survival probability of 38% calculated for patients from the validation cohort, while the Hosmer-Lemeshow test comparing empirical and HOPE (i.e. estimated) probabilities of survival was not significant (p = 0.08), suggesting good calibration. The corresponding area under the receiver operating characteristic curve was 0.825 (95% CI = [0.753-0.897]), confirming the excellent discrimination of the model. The negative predictive value of a HOPE score cut-off of <0.10 was excellent (97%). CONCLUSIONS: This study provides the first external validation of the HOPE score reaching good calibration and excellent discrimination. Clinically, the prediction of the HOPE score remains accurate in the validation sample. The HOPE score may replace serum potassium in the future as the triage tool when considering ECLS rewarming of a hypothermic cardiac arrest victim.

DOI： 10.1016/j.resuscitation.2019.03.017

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BioMed Central Ltd.  

DOI： 10.1186/s12245-018-0205-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer London  

DOI： 10.1186/s12245-017-0131-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

CASE: Sibutramine is a weight loss agent that was withdrawn from the market in the USA and European Union because it increases adverse events in patients with cardiovascular diseases. However, non-prescription weight loss pills containing sibutramine can be still easily purchased over the Internet. UNLABELLED: A 21-year-old woman without history of cardiovascular diseases developed cardiac arrest. She was a user of a weight loss pills, containing sibutramine and hypokalemia-inducing agents, imported from Thailand over the Internet. OUTCOME: She was successfully resuscitated without any neurological deficits by using extracorporeal membrane oxygenation for refractory ventricular fibrillation. CONCLUSION: This case indicates that sibutramine can cause cardiac arrest even in subjects without pre-existing cardiovascular disease when combined with agents that promote QT prolongation.

DOI： 10.1002/ams2.275

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000449368

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/nyas.13111

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Organophosphorus (OP) pesticide poisoning is a significant problem worldwide. Research into new antidotes for these acetylcholinesterase inhibitors, and even optimal doses for current therapies, is hindered by a lack of standardized animal models. In this study, we sought to characterize the effects of the OP pesticide parathion on acetylcholinesterase in a Wistar rat model that included comprehensive medical care. Methods. Male Wistar rats were intubated and mechanically ventilated and then poisoned with between 20 mg/kg and 60 mg/kg of intravenous parathion. Upon developing signs of poisoning, the rats were treated with standard critical care, including atropine, pralidoxime chloride, and midazolam, for up to 48 hours. Acetylcholinesterase activity was determined serially for up to 8 days after poisoning. Results. At all doses of parathion, maximal depression of acetylcholinesterase occurred at 3 hours after poisoning. Acetylcholinesterase recovered to nearly 50% of baseline activity by day 4 in the 20 mg/kg cohort and by day 5 in the 40 and 60 mg/kg cohorts. At day 8, most rats' acetylcholinesterase had recovered to roughly 70% of baseline. These data should be useful in developing rodent models of acute OP pesticide poisoning.

DOI： 10.1155/2016/4576952

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier  

DOI： 10.1016/j.jacme.2015.09.002

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jemermed.2014.10.003

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記述言語：日本語  

J-GLOBAL

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.ajem.2013.12.023

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記述言語：日本語   出版者・発行元：日本集団災害医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/1865-1380-5-9

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記述言語：日本語   出版者・発行元：日本集団災害医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1128/AAC.00110-10

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記述言語：日本語  

DOI： 10.3893/jjaam.20.221

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