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Taira T, Inoue A, Okamoto H, Maekawa K, Hifumi T, Sakamoto T, Kuroda Y, Suga M, Nishimura T, Ijuin S, Ishihara S. Fluid balance during acute phase extracorporeal cardiopulmonary resuscitation and outcomes in OHCA patients: a retrospective multicenter cohort study. Clin Res Cardiol 2024:10.1007/s00392-024-02444-z. [PMID: 38635032 DOI: 10.1007/s00392-024-02444-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/26/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE The association between fluid balance and outcomes in patients who underwent out-of-hospital cardiac arrest (OHCA) and received extracorporeal cardiopulmonary resuscitation (ECPR) remains unknown. We aimed to examine the above relationship during the first 24 h following intensive care unit (ICU) admission. METHODS We performed a secondary analysis of the SAVE-J II study, a retrospective multicenter study involving OHCA patients aged ≥ 18 years treated with ECPR between 2013 and 2018 and who received fluid therapy following ICU admission. Fluid balance was calculated based on intravenous fluid administration, blood transfusion, and urine output. The primary outcome was in-hospital mortality. The secondary outcomes included unfavorable outcome (cerebral performance category scores of 3-5 at discharge), acute kidney injury (AKI), and need for renal replacement therapy (RRT). RESULTS Overall, 959 patients met our inclusion criteria. In-hospital mortality was 63.6%, and the proportion of unfavorable outcome at discharge was 82.0%. The median fluid balance in the first 24 h following ICU admission was 3673 mL. Multivariable analysis revealed that fluid balance was significantly associated with in-hospital mortality (odds ratio (OR), 1.04; 95% confidence interval (CI), 1.02-1.06; p < 0.001), unfavorable outcome (OR, 1.03; 95% CI, 1.01-1.06; p = 0.005), AKI (OR, 1.04; 95% CI, 1.02-1.05; p < 0.001), and RRT (OR, 1.05; 95% CI, 1.03-1.07; p < 0.001). CONCLUSIONS Excessive positive fluid balance in the first day following ICU admission was associated with in-hospital mortality, unfavorable outcome, AKI, and RRT in ECPR patients. Further investigation is warranted.
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Affiliation(s)
- Takuya Taira
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-Ku, Kobe, Hyogo, 651-0073, Japan
- Faculty of Medicine, Graduate School of Medicine, Kagawa University, Takamatsu, Kagawa, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-Ku, Kobe, Hyogo, 651-0073, Japan.
| | - Hiroshi Okamoto
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Kunihiko Maekawa
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Faculty of Medicine, Graduate School of Medicine, Kagawa University, Takamatsu, Kagawa, Japan
| | - Masafumi Suga
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-Ku, Kobe, Hyogo, 651-0073, Japan
| | - Takeshi Nishimura
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-Ku, Kobe, Hyogo, 651-0073, Japan
| | - Shinichi Ijuin
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-Ku, Kobe, Hyogo, 651-0073, Japan
| | - Satoshi Ishihara
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-Ku, Kobe, Hyogo, 651-0073, Japan
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Misumi K, Hagiwara Y, Kimura T, Hifumi T, Inoue A, Sakamoto T, Kuroda Y, Ogura T. Impact of center volume on in-hospital mortality in adult patients with out‑of‑hospital cardiac arrest resuscitated using extracorporeal cardiopulmonary resuscitation: a secondary analysis of the SAVE-J II study. Sci Rep 2024; 14:8309. [PMID: 38594325 PMCID: PMC11003956 DOI: 10.1038/s41598-024-58808-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/03/2024] [Indexed: 04/11/2024] Open
Abstract
Recently, patients with out-of-hospital cardiac arrest (OHCA) refractory to conventional resuscitation have started undergoing extracorporeal cardiopulmonary resuscitation (ECPR). However, the mortality rate of these patients remains high. This study aimed to clarify whether a center ECPR volume was associated with the survival rates of adult patients with OHCA resuscitated using ECPR. This was a secondary analysis of a retrospective multicenter registry study, the SAVE-J II study, involving 36 participating institutions in Japan. Centers were divided into three groups according to the tertiles of the annual average number of patients undergoing ECPR: high-volume (≥ 21 sessions per year), medium-volume (11-20 sessions per year), or low-volume (< 11 sessions per year). The primary outcome was survival rate at the time of discharge. Patient characteristics and outcomes were compared among the three groups. Moreover, a multivariable-adjusted logistic regression model was applied to study the impact of center ECPR volume. A total of 1740 patients were included in this study. The center ECPR volume was strongly associated with survival rate at the time of discharge; furthermore, survival rate was best in high-volume compared with medium- and low-volume centers (33.4%, 24.1%, and 26.8%, respectively; P = 0.001). After adjusting for patient characteristics, undergoing ECPR at high-volume centers was associated with an increased likelihood of survival compared to middle- (adjusted odds ratio 0.657; P = 0.003) and low-volume centers (adjusted odds ratio 0.983; P = 0.006). The annual number of ECPR sessions was associated with favorable survival rates and lower complication rates of the ECPR procedure.Clinical trial registration: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041577 (unique identifier: UMIN000036490).
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Affiliation(s)
- Kayo Misumi
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, 911-1, Takebayashi-machi, Utsunomiya, Tochigi, 321-0974, Japan
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Yoshihiro Hagiwara
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, 911-1, Takebayashi-machi, Utsunomiya, Tochigi, 321-0974, Japan
| | - Takuya Kimura
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, 911-1, Takebayashi-machi, Utsunomiya, Tochigi, 321-0974, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
| | - Takayuki Ogura
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, 911-1, Takebayashi-machi, Utsunomiya, Tochigi, 321-0974, Japan.
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Bunya N, Ohnishi H, Kasai T, Katayama Y, Kakizaki R, Nara S, Ijuin S, Inoue A, Hifumi T, Sakamoto T, Kuroda Y, Narimatsu E. Prognostic Significance of Signs of Life in Out-of-Hospital Cardiac Arrest Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation. Crit Care Med 2024; 52:542-550. [PMID: 37921512 DOI: 10.1097/ccm.0000000000006116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Signs of life (SOLs) during cardiac arrest (gasping, pupillary light reaction, or any form of body movement) are suggested to be associated with favorable neurologic outcomes in out-of-hospital cardiac arrest (OHCA). While data has demonstrated that extracorporeal cardiopulmonary resuscitation (ECPR) can improve outcomes in cases of refractory cardiac arrest, it is expected that other contributing factors lead to positive outcomes. This study aimed to investigate whether SOL on arrival is associated with neurologic outcomes in patients with OHCA who have undergone ECPR. DESIGN Retrospective multicenter registry study. SETTING Thirty-six facilities participating in the Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan II (SAVE-J II). PATIENTS Consecutive patients older than 18 years old who were admitted to the Emergency Department with OHCA between January 1, 2013, and December 31, 2018, and received ECPR. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients were classified into two groups according to the presence or absence of SOL on arrival. The primary outcome was a favorable neurologic outcome (Cerebral Performance Category 1 or 2) at discharge. Of the 2157 patients registered in the SAVE-J II database, 1395 met the inclusion criteria, and 250 (17.9%) had SOL upon arrival. Patients with SOL had more favorable neurologic outcomes than those without SOL (38.0% vs. 8.1%; p < 0.001). Multivariate analysis showed that SOL on arrival was independently associated with favorable neurologic outcomes (odds ratio, 5.65 [95% CI, 3.97-8.03]; p < 0.001). CONCLUSIONS SOL on arrival was associated with favorable neurologic outcomes in patients with OHCA undergoing ECPR. In patients considered for ECPR, the presence of SOL on arrival can assist the decision to perform ECPR.
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Affiliation(s)
- Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University, Sapporo, Japan
| | - Takehiko Kasai
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Yoichi Katayama
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Ryuichiro Kakizaki
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Satoshi Nara
- Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Shinichi Ijuin
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
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Nagashima F, Inoue S, Oda T, Hamagami T, Matsuda T, Kobayashi M, Inoue A, Hifumi T, Sakamoto T, Kuroda Y. Optimal chest compression for cardiac arrest until the establishment of ECPR: Secondary analysis of the SAVE-J II study. Am J Emerg Med 2024; 78:102-111. [PMID: 38244243 DOI: 10.1016/j.ajem.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION The widespread incorporation of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest requires the delivery of effective and high-quality chest compressions prior to the initiation of ECPR. The aim of this study was to evaluate and compare the effectiveness of mechanical and manual chest compressions until the initiation of ECPR. METHODS This study was a secondary analysis of the Japanese retrospective multicenter registry "Study of Advanced Life Support for Ventricular Fibrillation by Extracorporeal Circulation II (SAVE-J II)". Patients were divided into two groups, one receiving mechanical chest compressions and the other receiving manual chest compressions. The primary outcome measure was mortality at hospital discharge, while the secondary outcome was the cerebral performance category (CPC) score at discharge. RESULTS Of the 2157 patients enrolled in the SAVE-J II trial, 453 patients (329 in the manual compression group and 124 in the mechanical compression group) were included in the final analysis. Univariate analysis showed a significantly higher mortality rate at hospital discharge in the mechanical compression group compared to the manual compression group (odds ratio [95% CI] = 2.32 [1.34-4.02], p = 0.0026). Multivariate analysis showed that mechanical chest compressions were an independent factor associated with increased mortality at hospital discharge (adjusted odds ratio [95% CI] = 2.00 [1.11-3.58], p = 0.02). There was no statistically significant difference in CPC between the two groups. CONCLUSION For patients with out-of-hospital cardiopulmonary arrest who require ECPR, extreme caution should be used when performing mechanical chest compressions.
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Affiliation(s)
- Futoshi Nagashima
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan.
| | | | - Tomohiro Oda
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan.
| | - Tomohiro Hamagami
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan.
| | - Tomoya Matsuda
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan.
| | - Makoto Kobayashi
- Emergency Medical Center, Tottori Prefectural Central Hospital, Tottori, Japan.
| | - Akihiko Inoue
- Hyogo Emergency Medical Center, Department of Emergency and Critical Care Medicine, Hyogo, Japan.
| | - Toru Hifumi
- St. Luke's International Hospital, Department of Emergency and Critical Care Medicine, Tokyo, Japan.
| | - Tetsuya Sakamoto
- Teikyo University School of Medicine, Department of Emergency Medicine, Tokyo, Japan.
| | - Yasuhiro Kuroda
- Kagawa University Hospital, Department of Emergency, Disaster and Critical Care Medicine, Kagawa, Japan.
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Takiguchi T, Tominaga N, Hamaguchi T, Seki T, Nakata J, Yamamoto T, Tagami T, Inoue A, Hifumi T, Sakamoto T, Kuroda Y, Yokobori S. Etiology-Based Prognosis of Extracorporeal CPR Recipients After Out-of-Hospital Cardiac Arrest: A Retrospective Multicenter Cohort Study. Chest 2024; 165:858-869. [PMID: 37879561 DOI: 10.1016/j.chest.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND A better understanding of the relative contributions of various factors to patient outcomes is essential for optimal patient selection for extracorporeal CPR (ECPR) therapy for patients with out-of-hospital cardiac arrest (OHCA). However, evidence on the prognostic comparison based on the etiologies of cardiac arrest is limited. RESEARCH QUESTION What is the etiology-based prognosis of patients undergoing ECPR for OHCA? STUDY DESIGN AND METHODS This retrospective multicenter registry study involved 36 institutions in Japan and included all adult patients with OHCA who underwent ECPR between January 2013 and December 2018. The primary etiology for OHCA was determined retrospectively from all hospital-based data at each institution. We performed a multivariable logistic regression model to determine the association between etiology of cardiac arrest and two outcomes: favorable neurologic outcome and survival at hospital discharge. RESULTS We identified 1,781 eligible patients, of whom 1,405 (78.9%) had cardiac arrest because of cardiac causes. Multivariable logistic regression analysis for favorable neurologic outcome showed that accidental hypothermia (adjusted OR, 5.12; 95% CI, 2.98-8.80; P < .001) was associated with a significantly higher rate of favorable neurologic outcome than cardiac causes. Multivariable logistic regression analysis for survival showed that accidental hypothermia (adjusted OR, 5.19; 95% CI, 3.15-8.56; P < .001) had significantly higher rates of survival than cardiac causes. Acute aortic dissection/aneurysm (adjusted OR, 0.07; 95% CI, 0.02-0.28; P < .001) and primary cerebral disorders (adjusted OR, 0.12; 95% CI, 0.03-0.50; P = .004) had significantly lower rates of survival than cardiac causes. INTERPRETATION In this retrospective multicenter cohort study, although most patients with OHCA underwent ECPR for cardiac causes, accidental hypothermia was associated with favorable neurologic outcome and survival; in contrast, acute aortic dissection/aneurysm and primary cerebral disorders were associated with nonsurvival compared with cardiac causes.
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Affiliation(s)
- Toru Takiguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan; Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan.
| | - Naoki Tominaga
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takuro Hamaguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Tomohisa Seki
- Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan
| | - Jun Nakata
- Division of Cardiovascular Intensive Care, Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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Honzawa H, Taniguchi H, Abe T, Takeuchi I, Inoue A, Hifumi T, Sakamoto T, Kuroda Y. Prophylactic distal perfusion catheter and survival in patients with out-of-hospital cardiac arrest: Secondary analysis of the SAVE-J II study. Am J Emerg Med 2024; 78:69-75. [PMID: 38237215 DOI: 10.1016/j.ajem.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/14/2023] [Accepted: 01/08/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE The effect of a prophylactic distal perfusion catheter (DPC) after extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) remains unclear. Therefore, we aimed to clarify the association between prophylactic DPC and prognosis in patients with OHCA undergoing ECPR. MATERIALS AND METHODS A secondary analysis of the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J II) database was performed to compare groups of patients with and without prophylactic DPCs. A multivariate analysis of survival at discharge was performed using factors that were significant in the two-arm comparison. RESULTS A total of 2044 patients were included in the analysis after excluding those who met the exclusion criteria. Survival at discharge was observed in 548 (26.9%) patients. In total, 100 (4.9%) patients developed limb ischemia, among whom 14 (0.7%) required therapeutic intervention. Multivariate analysis showed that prophylactic DPC did not result in a significant difference in survival at discharge (odds ratio: 0.898 [0.652-1.236], p = 0.509). CONCLUSIONS The implementation of prophylactic DPC after ECPR for patients with OHCA may not contribute to survival at discharge.
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Affiliation(s)
- Hiroshi Honzawa
- Emergency Care Department, Yokohama City University Hospital, Yokohama, Japan.
| | - Hayato Taniguchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Takeru Abe
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Ichiro Takeuchi
- Emergency Care Department, Yokohama City University Hospital, Yokohama, Japan; Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University school of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
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Hamaguchi T, Takiguchi T, Seki T, Tominaga N, Nakata J, Yamamoto T, Tagami T, Inoue A, Hifumi T, Sakamoto T, Kuroda Y, Yokobori S, Study Group TSJI. Association between pupillary examinations and prognosis in patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation: a retrospective multicentre cohort study. Ann Intensive Care 2024; 14:35. [PMID: 38448746 PMCID: PMC10917711 DOI: 10.1186/s13613-024-01265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/16/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND In some cases of patients with out-of-hospital cardiac arrest (OHCA) who underwent extracorporeal cardiopulmonary resuscitation (ECPR), negative pupillary light reflex (PLR) and mydriasis upon hospital arrival serve as common early indicator of poor prognosis. However, in certain patients with poor prognoses inferred by pupil findings upon hospital arrival, pupillary findings improve before and after the establishment of ECPR. The association between these changes in pupillary findings and prognosis remains unclear. This study aimed to clarify the association of pupillary examinations before and after the establishment of ECPR in patients with OHCA showing poor pupillary findings upon hospital arrival with their outcomes. To this end, we analysed retrospective multicentre registry data involving 36 institutions in Japan, including all adult patients with OHCA who underwent ECPR between January 2013 and December 2018. We selected patients with poor prognosis inferred by pupillary examinations, negative pupillary light reflex (PLR) and pupil mydriasis, upon hospital arrival. The primary outcome was favourable neurological outcome, defined as Cerebral Performance Category 1 or 2 at hospital discharge. Multivariable logistic regression analysis was performed to evaluate the association between favourable neurological outcome and pupillary examination after establishing ECPR. RESULTS Out of the 2,157 patients enrolled in the SAVE-J II study, 723 were analysed. Among the patients analysed, 74 (10.2%) demonstrated favourable neurological outcome at hospital discharge. Multivariable analysis revealed that a positive PLR at ICU admission (odds ration [OR] = 11.3, 95% confidence intervals [CI] = 5.17-24.7) was significantly associated with favourable neurological outcome. However, normal pupil diameter at ICU admission (OR = 1.10, 95%CI = 0.52-2.32) was not significantly associated with favourable neurological outcome. CONCLUSION Among the patients with OHCA who underwent ECPR and showed poor pupillary examination findings upon hospital arrival, 10.2% had favourable neurological outcome at hospital discharge. A positive PLR after the establishment of ECPR was significantly associated with favourable neurological outcome.
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Affiliation(s)
- Takuro Hamaguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Toru Takiguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan.
- Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan.
| | - Tomohisa Seki
- Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoki Tominaga
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Jun Nakata
- Division of Cardiovascular Intensive Care, Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
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Okada Y, Nakagawa K, Tanaka H, Takahashi H, Kitamura T, Kiguchi T, Nishioka N, Kitamura N, Tagami T, Inoue A, Hifumi T, Sakamoto T, Kuroda Y, Iwami T. Overview and future prospects of out-of-hospital cardiac arrest registries in Japan. Resusc Plus 2024; 17:100578. [PMID: 38362506 PMCID: PMC10867571 DOI: 10.1016/j.resplu.2024.100578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Aim Out-of-hospital cardiac arrest (OHCA) is a life-threatening emergency with high mortality. The "chain of survival" is critical to improving patient outcomes. To develop and enhance this chain of survival, measuring and monitoring the resuscitation processes and outcomes are essential for quality assurance. In Japan, several OHCA registries have successfully been implemented at both local and national levels. We aimed to review and summarise the conception, strengths, and challenges of OHCA registries in Japan. Method and results The following representing registries in Japan were reviewed: the All-Japan Utstein registry, the Utstein Osaka Project/the Osaka-CRITICAL study, the SOS-KANTO study, the JAAM-OHCA study, and the SAVE-J II study. The All-Japan Utstein registry, operated by the Fire and Disaster Management Agency of Japan and one of the largest nationwide population-based registries in the world, collects data concerning all patients with OHCA in Japan, excluding in-hospital data. Other research- and hospital-based registries collect detailed out-of-hospital and in-hospital data. The Osaka-CRITICAL study and the SOS-KANTO study are organized at regional levels, and hospitals in the Osaka prefecture and in the Kanto area participate in these registries. The JAAM-OHCA study is managed by the Japanese Association of Acute Medicine and includes 107 hospitals throughout Japan. The Save-J II study focuses on patients with OHCA treated with extracorporeal cardiopulmonary resuscitation. Conclusion Each OHCA registry has its own philosophy, strengths, perspectives, and challenges; however, all have been successful in contributing to the improvement of emergency medical service (EMS) systems through the quality improvement process. These registries are expected to be further utilized to enhance EMS systems and improve outcomes for patients with OHCA, while also contributing to the field of resuscitation science.
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Affiliation(s)
- Yohei Okada
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koshi Nakagawa
- Graduate School of Emergency Medical System, Kokushikan University, Japan
| | - Hideharu Tanaka
- Graduate School of Emergency Medical System, Kokushikan University, Japan
| | | | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takeyuki Kiguchi
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Kisarazu-shi, Chiba, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Hyogo, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
| | - Taku Iwami
- Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Tominaga N, Takiguchi T, Seki T, Hamaguchi T, Nakata J, Yamamoto T, Tagami T, Inoue A, Hifumi T, Sakamoto T, Kuroda Y, Yokobori S. Factors associated with favourable neurological outcomes following cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A retrospective multi-centre cohort study. Resusc Plus 2024; 17:100574. [PMID: 38370315 PMCID: PMC10869306 DOI: 10.1016/j.resplu.2024.100574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/03/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024] Open
Abstract
Aim To investigate the factors associated with favourable neurological outcomes in adult patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA). Methods This retrospective observational study used secondary analysis of the SAVE-J II multicentre registry data from 36 institutions in Japan. Between 2013 and 2018, 2157 patients with OHCA who underwent ECPR were enrolled in SAVE-J II. A total of 1823 patients met the study inclusion criteria. Adult patients (aged ≥ 18 years) with OHCA, who underwent ECPR before admission to the intensive care unit, were included in our secondary analysis. The primary outcome was a favourable neurological outcome at hospital discharge, defined as a Cerebral Performance Category score of 1 or 2. We used a multivariate logistic regression model to examine the association between factors measured at the incident scene or upon hospital arrival and favourable neurological outcomes. Results Multivariable analysis revealed that shockable rhythm at the scene [odds ratio (OR); 2.11; 95% confidence interval (CI), 1.16-3.95] and upon hospital arrival (OR 2.59; 95% CI 1.60-4.30), bystander CPR (OR 1.63; 95% CI 1.03-1.88), body movement during resuscitation (OR 7.10; 95% CI 1.79-32.90), gasping (OR 4.33; 95% CI 2.57-7.28), pupillary reflex on arrival (OR 2.93; 95% CI 1.73-4.95), and male sex (OR 0.43; 95% CI 0.24-0.75) significantly correlated with neurological outcomes. Conclusions Shockable rhythm, bystander CPR, body movement during resuscitation, gasping, pupillary reflex, and sex were associated with favourable neurological outcomes in patients with OHCA treated with ECPR.
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Affiliation(s)
- Naoki Tominaga
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Toru Takiguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
- Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan
| | - Tomohisa Seki
- Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan
| | - Takuro Hamaguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Jun Nakata
- Division of Cardiovascular Intensive Care, Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Centre, Kobe, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - SAVE-J II study group Investigation Supervision
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
- Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan
- Division of Cardiovascular Intensive Care, Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Centre, Kobe, Japan
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
- Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
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10
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Suzuki M, Kinoshita K, Sakamoto T, Seo H, Doi K, Yoshimura I, Yamamoto T. Side-to-side variability in the femoral neck anteversion angle: A study of the Japanese population with osteonecrosis of the femoral head. J Orthop Sci 2024; 29:589-595. [PMID: 36878802 DOI: 10.1016/j.jos.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Side-to-side variability in the femoral neck anteversion angle (FA) reportedly varies from 0.0° to 17.3°. To investigate the side-to-side variability in the FA and the relationship between the FA and the morphology of the acetabulum in the Japanese population, we performed a three-dimensional computed tomography (CT)-based study involving patients with osteonecrosis of the femoral head (ONFH). METHODS CT data were obtained from 170 nondysplastic hips of 85 patients with ONFH. The FA and acetabular coverage parameters, including the acetabular anteversion angle, acetabular inclination angle, and acetabular sector angle in the anterior, superior, and posterior directions, were measured using three-dimensional CT. The distribution of the side-to-side variability in the FA was evaluated separately for each of the five degrees. RESULTS The mean side-to-side variability in the FA was 6.7° ± 5.3° (range, 0.2°-26.2°). The distribution of the side-to-side variability in the FA was 0.0°-5.0° in 41 patients (48.2%), 5.1°-10.0° in 25 patients (29.4%), 10.1°-15.0° in 13 patients (15.3%), 15.1°-20.0° in 4 patients (4.7%), and >20.1° in 2 patients (2.4%). There was a weak negative correlation between the FA and anterior acetabular sector angle (r = -0.282, P < 0.001) and a very weak positive correlation between the FA and acetabular anteversion angle (r = 0.181, P < 0.018). CONCLUSIONS The mean side-to-side variability in the FA was 6.7° ± 5.3° (range, 0.2°-26.2°) in Japanese nondysplastic hips, and about 20% of the patients had a side-to-side variability of >10°.
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Affiliation(s)
- Masahiro Suzuki
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Koichi Kinoshita
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tetsuya Sakamoto
- Department of Orthopedic Surgery, Fukuoka University, Chikushi Hospital, Fukuoka, Japan
| | - Hajime Seo
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kenichiro Doi
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Ichiro Yoshimura
- Faculty of Sports and Health Science, Fukuoka University, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
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11
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Fujita J, Kinoshita K, Sakamoto T, Seo H, Doi K, Yamamoto T. The role of torsional stress in the development of subchondral insufficiency fracture of the femoral head: A finite element model analysis. J Orthop Sci 2024; 29:574-584. [PMID: 36822947 DOI: 10.1016/j.jos.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Subchondral insufficiency fracture of the femoral head generally occurs without evidence of trauma or with a history of minor trauma. Insufficient bone quality is considered one cause; however, the detailed mechanism of fracture development at the subchondral area (SA) is not understood. The aim of this study was to clarify the directions of force that cause subchondral fracture using finite element model analysis. METHODS Two types of finite element models were generated from the CT data of femurs obtained from three individuals without osteoporosis (normal models) and another three with osteoporosis (osteoporosis models). Three directions of force, including compressive, shearing, and torsional, were applied to the femoral head. The distribution of von Mises stress (Mises stress) was evaluated at the SA, principal compressive trabeculae (PC), and principal tensile trabeculae. RESULTS Under compressive force, the mean Mises stress value was greatest at the PC in both the normal and osteoporosis models. Under shearing force, the mean Mises stress value tended to be greatest at the SA in the normal model and at the PC in the osteoporosis model. Under torsional force, the mean Mises stress value was greatest at the SA in both types of models. CONCLUSIONS The torsional force showed the greatest Mises stress at the SA in both the normal and osteoporosis models, suggesting the importance of torsion as a possible force responsible for subchondral insufficiency fracture development.
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Affiliation(s)
- Jun Fujita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Koichi Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Tetsuya Sakamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Hajime Seo
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Kenichiro Doi
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
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Sugimoto M, Takayama W, Inoue A, Hifumi T, Sakamoto T, Kuroda Y, Otomo Y. Impact of Lactate Clearance on Clinical and Neurological Outcomes of Patients With Out-of-Hospital Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation: A Secondary Data Analysis. Crit Care Med 2024:00003246-990000000-00300. [PMID: 38411442 DOI: 10.1097/ccm.0000000000006245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVES Serial evaluations of lactate concentration may be more useful in predicting outcomes in patients with out-of-hospital cardiac arrest (OHCA) than a single measurement. This study aimed to evaluate the impact of lactate clearance (LC) on clinical and neurologic outcomes in patients with OHCA who underwent extracorporeal cardiopulmonary resuscitation (ECPR). DESIGN Retrospective multicenter observational study. SETTING Patients with OHCA receiving ECPR at 36 hospitals in Japan between January 1, 2013, and December 31, 2018. PATIENTS This study evaluated 1227 patients, with lactateinitial assessed upon emergency department admission and lactatesecond measured subsequently. To adjust for the disparity in the time between lactate measurements, the modified 6-hour LC was defined as follows: ([lactateinitial-lactatesecond]/lactateinitial) × 100 × (6/the duration between the initial and second measurements [hr]). The patients were divided into four groups according to the modified 6-hour LC with an equivalent number of patients among LC quartiles: Q1 (LC < 18.8), Q2 (18.8 < LC < 59.9), Q3 (60.0 < LC < 101.2), and Q4 (101.2 < LC). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The 30-day survival rates increased as the 6-hour LC increased (Q1, 21.2%; Q2, 36.8%; Q3, 41.4%; Q4, 53.6%; p for trend < 0.001). In the multivariate analysis, the modified 6-hour LC was significantly associated with a 30-day survival rate (adjusted odds ratio [AOR], 1.003; 95% CI, 1.001-1.005; p < 0.001) and favorable neurologic outcome (AOR, 1.002; 95% CI, 1.000-1.004; p = 0.027). CONCLUSIONS In patients with OHCA who underwent ECPR, an increase in the modified 6-hour LC was associated with favorable clinical and neurologic outcome. Thus, LC can be a criterion to assess whether ECPR should be continued.
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Affiliation(s)
- Momoko Sugimoto
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Wataru Takayama
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Yushima, Bunkyo-ku, Tokyo, Japan
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, Fernanda de Almeida M, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Daripa Kawakami M, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, John Madar R, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Gene Ong YK, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2024; 195:109992. [PMID: 37937881 DOI: 10.1016/j.resuscitation.2023.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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14
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Nishimura T, Inoue A, Taira T, Suga M, Ijuin S, Hifumi T, Sakamoto T, Kuroda Y, Ishihara S. Intra-aortic balloon pump in patients with extracorporeal cardiopulmonary resuscitation after cardiac arrest caused by acute coronary syndrome. Resuscitation 2024; 195:110091. [PMID: 38101507 DOI: 10.1016/j.resuscitation.2023.110091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND This study evaluated the association between intra-aortic balloon pump (IABP) use in patients with out-of-hospital cardiac arrest (OHCA) caused by acute coronary syndrome (ACS) who received extracorporeal cardiopulmonary resuscitation (ECPR) and 30-day outcomes. METHODS This study was a secondary analysis of data from the SAVE-J II study, a retrospective, multicenter registry study involving 36 participating institutions in Japan. Patients with cardiac arrest caused by ACS who received ECPR were divided into two groups depending on whether or not they received IABP. The primary outcome was 30-day survival. Subgroup analysis was performed to detect what type of patients were mostly associated with improved outcomes. RESULTS Of 2,157 patients registered in the SAVE-J II study, 877 patients were enrolled in this study, 702 patients in the IABP group and 175 patients in the non-IABP group. Multivariable logistic regression analysis did not reveal a significant difference in 30-day survival (OR 1.37, 95% CI 0.91-2.07, p = 0.13). In the subgroup analysis, 30-day survival among patients without percutaneous coronary intervention (PCI) and stenosis of multiple coronary vessels were associated with IABP use. CONCLUSIONS IABP use in patients with OHCA with ACS who received ECPR is not associated with 30-day survival. The use of IABP in patients who did not have PCI and have multiple coronary vessel stenoses warrants further study.
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Affiliation(s)
- Takeshi Nishimura
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe city, Hyogo, Japan.
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe city, Hyogo, Japan
| | - Takuya Taira
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe city, Hyogo, Japan
| | - Masafumi Suga
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe city, Hyogo, Japan
| | - Shinichi Ijuin
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe city, Hyogo, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Akashicho, Chuo city, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Trauma and Critical Care Center, Teikyo University School of Medicine, Kaga, Itabashi city, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster, and Critical Care Medicine, Faculty of Medicine, Kagawa University, Takamatsu city, Kagawa, Japan
| | - Satoshi Ishihara
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe city, Hyogo, Japan
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15
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Iwami T, Nonogi H, Han Lim S, Nolan JP, Sakamoto T. Resuscitation great Kazuo Okada-sensei - Pioneer of resuscitation in Asia. Resuscitation 2024; 195:110036. [PMID: 37935277 DOI: 10.1016/j.resuscitation.2023.110036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Affiliation(s)
- Taku Iwami
- Department of Preventive Services, School of Public Health/Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Nonogi
- Faculty of Health Science, Osaka Aoyama University, Osaka, Japan
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Jerry P Nolan
- Warwick Medical School, University of Warwick, Coventry and Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Tetsuya Sakamoto
- Teikyo University School of Medicine and Showa General Hospital, Tokyo, Japan.
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Isokawa S, Hifumi T, Hirano K, Watanabe Y, Horie K, Shin K, Shirasaki K, Goto M, Inoue A, Sakamoto T, Kuroda Y, Tomita S, Otani N, Group TSJIS. Risk factors for bleeding complications in patients undergoing extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest: a secondary analysis of the SAVE-J II study. Ann Intensive Care 2024; 14:16. [PMID: 38280965 PMCID: PMC10821854 DOI: 10.1186/s13613-024-01253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Bleeding is the most common complication in out-of-hospital cardiac arrest (OHCA) patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). No studies comprehensively described the incidence rate, timing of onset, risk factors, and treatment of bleeding complications in OHCA patients receiving ECPR in a multicenter setting with a large database. This study aimed to analyze the risk factors of bleeding during the first day of admission and to comprehensively describe details of bleeding during hospitalization in patients with OHCA receiving ECPR in the SAVE-J II study database. METHODS This study was a secondary analysis of the SAVE-J II study, which is a multicenter retrospective registry study from 36 participating institutions in Japan in 2013-2018. Adult OHCA patients who received ECPR were included. The primary outcome was the risk factor of bleeding complications during the first day of admission. The secondary outcomes were the details of bleeding complications and clinical outcomes. RESULTS A total of 1,632 patients were included. Among these, 361 patients (22.1%) had bleeding complications during hospital stay, which most commonly occurred in cannulation sites (14.3%), followed by bleeding in the retroperitoneum (2.8%), gastrointestinal tract (2.2%), upper airway (1.2%), and mediastinum (1.1%). These bleeding complications developed within two days of admission, and 21.9% of patients required interventional radiology (IVR) or/and surgical interventions for hemostasis. The survival rate at discharge of the bleeding group was 27.4%, and the rate of favorable neurological outcome at discharge was 14.1%. Multivariable logistic regression analysis showed that the platelet count (< 10 × 104/μL vs > 10 × 104/μL) was significantly associated with bleeding complications during the first day of admission (adjusted odds ratio [OR]: 1.865 [1.252-2.777], p = 0.002). CONCLUSIONS In a large ECPR registry database in Japan, up to 22.1% of patients experienced bleeding complications requiring blood transfusion, IVR, or surgical intervention for hemostasis. The initial platelet count was a significant risk factor of early bleeding complications. It is necessary to lower the occurrence of bleeding complications from ECPR, and this study provided an additional standard value for future studies to improve its safety.
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Affiliation(s)
- Shutaro Isokawa
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashicho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashicho, Chuo-Ku, Tokyo, 104-8560, Japan.
| | - Keita Hirano
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yu Watanabe
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashicho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Katsuhiro Horie
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashicho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Kijong Shin
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashicho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Kasumi Shirasaki
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashicho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Masahiro Goto
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashicho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
| | | | - Norio Otani
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashicho, Chuo-Ku, Tokyo, 104-8560, Japan
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Misumi K, Hagiwara Y, Kimura T, Hifumi T, Inoue A, Sakamoto T, Kuroda Y, Ogura T. External Validation of the CAST and rCAST Score in Patients With Out-of-Hospital Cardiac Arrest Who Underwent Extracorporeal Cardiopulmonary Resuscitation: A Secondary Analysis of the SAVE-J II Study. J Am Heart Assoc 2024; 13:e031035. [PMID: 38156602 PMCID: PMC10863824 DOI: 10.1161/jaha.123.031035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/01/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Risk stratification is important in patients with post-cardiac arrest syndrome. The Post-Cardiac Arrest Syndrome for Therapeutic Hypothermia (CAST) and revised CAST (rCAST) scores have been well validated for predicting neurological outcomes, particularly for conventionally resuscitated patients with post-cardiac arrest syndrome. However, no studies have evaluated patients undergoing extracorporeal cardiopulmonary resuscitation. METHODS AND RESULTS Adult patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation were analyzed in this retrospective observational multicenter cohort study. We validated the accuracy of the CAST/rCAST scores for predicting neurological outcomes at 30 days. Moreover, we compared the predictive performance of these scores with the TiPS65 risk score derived from patients with out-of-hospital cardiac arrest who were resuscitated using extracorporeal cardiopulmonary resuscitation. A total of 1135 patients were analyzed. The proportion of patients with favorable neurological outcomes was 16.6%. In the external validation, the area under the receiver operating characteristic curve of the CAST score was significantly higher than that of the rCAST score (area under the receiver operating characteristic curve 0.677 versus 0.603; P<0.001), but there was no significant difference with that of the TiPS65 score (versus 0.633; P=0.154). Both CAST/rCAST risk scores showed good calibration (Hosmer-Lemeshow test: P=0.726 and 0.674), and the CAST score showed significantly better predictability in net reclassification compared with the rCAST (P<0.001) and TiPS65 scores (P=0.001). CONCLUSIONS The prognostic accuracy of the CAST score was significantly better than that of other risk scores in net reclassification. The CAST score may help to predict neurological outcomes in patients with out-of-hospital cardiac arrest who undergo extracorporeal cardiopulmonary resuscitation. However, the predictive value of the CAST score was not sufficiently high for clinical application. REGISTRATION URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041577; Unique identifier: UMIN000036490.
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Affiliation(s)
- Kayo Misumi
- Department of Emergency and Critical CareSaiseikai Utsunomiya HospitalUtsunomiyaJapan
- Department of CardiologySaiseikai Utsunomiya HospitalUtsunomiyaJapan
| | - Yoshihiro Hagiwara
- Department of Emergency and Critical CareSaiseikai Utsunomiya HospitalUtsunomiyaJapan
| | - Takuya Kimura
- Department of Emergency and Critical CareSaiseikai Utsunomiya HospitalUtsunomiyaJapan
| | - Toru Hifumi
- Department of Emergency and Critical Care MedicineSt. Luke’s International HospitalTokyoJapan
| | - Akihiko Inoue
- Department of Emergency and Critical Care MedicineHyogo Emergency Medical CenterKobeJapan
| | - Tetsuya Sakamoto
- Department of Emergency MedicineTeikyo University School of MedicineTokyoJapan
| | - Yasuhiro Kuroda
- Department of Emergency MedicineKagawa University School of MedicineMikiKagawaJapan
| | - Takayuki Ogura
- Department of Emergency and Critical CareSaiseikai Utsunomiya HospitalUtsunomiyaJapan
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Shoji K, Ohbe H, Kudo D, Tanikawa A, Kobayashi M, Aoki M, Hamaguchi T, Nagashima F, Inoue A, Hifumi T, Sakamoto T, Kuroda Y, Kushimoto S. Low-flow time and outcomes in out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation. Am J Emerg Med 2024; 75:37-41. [PMID: 37897919 DOI: 10.1016/j.ajem.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/07/2023] [Accepted: 10/06/2023] [Indexed: 10/30/2023] Open
Abstract
INTRODUCTION In out-of-hospital cardiac arrest (OHCA) patients with extracorporeal cardiopulmonary resuscitation (ECPR), the association between low-flow time, the duration between the initiation of conventional cardiopulmonary resuscitation and the establishment of ECPR, and outcomes has not been clearly determined. METHODS This was a secondary analysis of the retrospective multicenter registry in Japan. This study registered patients ≥18 years old who were admitted to the emergency department for OHCA and underwent ECPR between January, 2013 and December, 2018. Low-flow time was defined as the time from initiation of conventional cardiopulmonary resuscitation to the establishment of ECPR, and patients were categorized into two groups according to the visualized association of the restricted cubic spline curve. The primary outcome was survival discharge. Cubic spline analyses and multivariable logistic regression analyses were performed to assess the nonlinear associations between low-flow time and outcomes. RESULTS A total of 1,524 patients were included. The median age was 60 years, and the median low-flow time was 52 (42-53) mins. The overall survival at hospital discharge and favorable neurological outcomes were 27.8% and 14.2%, respectively. The cubic spline analysis showed a decreased trend of survival discharge rates and favorable neurological outcomes with shorter low-flow time between 20 and 60 mins, with little change between the following 60 and 80 mins. The multivariable logistic regression analyses showed that patients with long low-flow time (>40 mins) compared to those with short low-flow time (0-40 mins) had significantly worse survival (adjusted odds ratio 0.42; 95% confidence intervals, 0.31-0.57) and neurological outcomes (0.65; 0.45-0.95, respectively). CONCLUSIONS The survival discharge and neurological outcomes of patients with low-flow time shorter than 40 min are better than those of patients with longer low-flow time.
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Affiliation(s)
- Kosuke Shoji
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroyuki Ohbe
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Daisuke Kudo
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Tanikawa
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masakazu Kobayashi
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takuro Hamaguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Futoshi Nagashima
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Toyooka, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Depatment of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Almeida MF, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Ong YKG, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2023; 148:e187-e280. [PMID: 37942682 PMCID: PMC10713008 DOI: 10.1161/cir.0000000000001179] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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Kojima M, Mochida Y, Shoko T, Inoue A, Hifumi T, Sakamoto T, Kuroda Y. Association between body mass index and clinical outcomes in patients with out-of-hospital cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation: A multicenter observational study. Resusc Plus 2023; 16:100497. [PMID: 38033346 PMCID: PMC10682674 DOI: 10.1016/j.resplu.2023.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Abstract
Background We examined the association between body mass index (BMI) and outcomes in patients with out-of-hospital cardiac arrest (OHCA) undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Methods We retrospectively analyzed the database of an observational multicenter cohort in Japan. Adult patients with OHCA of cardiac etiology who received ECPR between 2013 and 2018 were categorized as follows: underweight, BMI < 18.5; normal weight, BMI = 18.5-24.9; overweight, BMI = 25-29.9; and obese, BMI ≥ 30 kg/m2. The primary outcome was in-hospital mortality; secondary outcomes were unfavorable neurological outcomes at discharge (cerebral performance category ≥ 3) and ECPR-related complications. BMI's association with outcomes was assessed using a logistic regression model adjusted for age, sex, comorbidities, witness/bystander CPR, initial rhythm, prehospital return of spontaneous circulation, and low-flow time. Results In total, 1,044 patients were analyzed. Their median age was 61 (IQR, 49-69) years; the median BMI was 24.2 (21.5-26.9) kg/m2. The overall rates of in-hospital mortality, unfavorable neurological outcome, and ECPR-related complications were 62.2%, 79.9%, and 31.7%, respectively. In multivariate analysis, the overweight and obese groups had higher in-hospital mortality odds than the normal BMI group (odds ratio [95%CI], 1.37 [1.02-1.85], p = 0.035; and 2.09 [1.31-3.39], p < 0.001, respectively). The odds ratio for unfavorable neurological outcomes increased more in the obese than in the normal BMI group (3.17 [1.69-6.49], p < 0.001). ECPR-related complications were not significantly different among groups. Conclusions In OHCA patients undergoing ECPR, a BMI ≥ 25 kg/m2 was associated with increased in-hospital mortality, and a BMI ≥ 30 kg/m2 was also associated with a worse neurological outcome.
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Affiliation(s)
- Mitsuaki Kojima
- Emergency and Critical Care Centre, Tokyo Women’s Medical University Adachi Medical Centre, 4-33-1, Kohoku, Adachi, Tokyo 123-8558, Japan
| | - Yuzuru Mochida
- Emergency and Critical Care Centre, Tokyo Women’s Medical University Adachi Medical Centre, 4-33-1, Kohoku, Adachi, Tokyo 123-8558, Japan
| | - Tomohisa Shoko
- Emergency and Critical Care Centre, Tokyo Women’s Medical University Adachi Medical Centre, 4-33-1, Kohoku, Adachi, Tokyo 123-8558, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Centre, 1-3-1 Wakinohamakaigandori, Chuo, Kobe, Hyogo 651-0073, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9-1 Akashi, Chuo, Tokyo 104-8560, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-2 Kaga, Itabashi, Tokyo 173-8606, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan
| | - SAVE-J II study group
- Emergency and Critical Care Centre, Tokyo Women’s Medical University Adachi Medical Centre, 4-33-1, Kohoku, Adachi, Tokyo 123-8558, Japan
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Centre, 1-3-1 Wakinohamakaigandori, Chuo, Kobe, Hyogo 651-0073, Japan
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9-1 Akashi, Chuo, Tokyo 104-8560, Japan
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-2 Kaga, Itabashi, Tokyo 173-8606, Japan
- Department of Emergency Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan
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Uchida M, Kikuchi M, Haruyama Y, Takiguchi T, Hifumi T, Inoue A, Sakamoto T, Kuroda Y. Association between neuromuscular blocking agent use and outcomes among out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and target temperature management: A secondary analysis of the SAVE-J II study. Resusc Plus 2023; 16:100476. [PMID: 37779884 PMCID: PMC10540044 DOI: 10.1016/j.resplu.2023.100476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 10/03/2023] Open
Abstract
Background Neuromuscular blocking agents are used to control shivering in cardiac arrest patients treated with target temperature management. However, their effect on outcomes in patients treated with extracorporeal cardiopulmonary resuscitation is unclear. Methods This study was a secondary analysis of the SAVE-J II study, a retrospective multicenter study of 2175 out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation in Japan. We classified patients into those who received neuromuscular blocking agents and those who did not and compared in-hospital mortality and incidence rates of favorable neurological outcome and in-hospital pneumonia between the groups using multivariable regression models and stabilized inverse probability weighting with propensity scores. Results Six hundred sixty patients from the SAVE-J II registry were analyzed. Neuromuscular blocking agents were used in 451 patients (68.3%). After adjusting for potential confounders, neuromuscular blocking agents use was not significantly associated with in-hospital mortality (aHR 0.88; 95% CI, 0.67-1.14), favorable neurological outcome (aOR 0.85; 95% CI, 0.60-1.11), or pneumonia (aOR 1.52; 95% CI, 0.85-2.71). The results for in-hospital mortality (aHR 0.89; 95% CI, 0.64-1.25), favorable neurological outcome (aOR 0.94; 95% CI, 0.59-1.48) and pneumonia (aOR 1.59; 95% CI, 0.74-3.41) were similar after weighting was performed. Conclusions Although data on the rationale for using neuromuscular blocking agents were unavailable, their use was not significantly associated with outcomes in out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and targeted temperature management. Neuromuscular blocking agents should be used based on individual clinical indications.
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Affiliation(s)
- Masatoshi Uchida
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Migaku Kikuchi
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University, Tochigi, Japan
| | - Toru Takiguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
| | - SAVE-J II study group
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi, Japan
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University, Tochigi, Japan
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
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Iida E, Ichihara N, Hifumi T, Shirasaki K, Horie K, Isokawa S, Inoue A, Sakamoto T, Kuroda Y, Otani N. Frequency, clinical characteristics, and outcomes of pneumonia in patients with out-of-hospital cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation. Resusc Plus 2023; 16:100474. [PMID: 37766913 PMCID: PMC10519840 DOI: 10.1016/j.resplu.2023.100474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Aim This study aimed to describe the frequency, clinical characteristics, and outcomes of pneumonia in OHCA patients treated with ECPR in a multicenter setting. Methods This is a secondary analysis of the SAVE-J II study, which was a multicenter, retrospective cohort of OHCA patients treated with ECPR. Age, sex, comorbidities, presence of witnessed CA, presence of bystander CPR, initial rhythm, cause of CA, low-flow time, initiation of targeted temperature management, details of sputum culture, pneumonia, and prophylactic antibiotic use were recorded. Pneumonia was diagnosed when the patients met all the clinical, radiologic, and microbiologic criteria acquired after hospitalization. Results In total, 1,986 patients were included in the analysis, and 947 (48%) died during the first 2 days of admission. A prophylactic antibiotic was used in 712 (35.9%) patients. Overall, the hazard of death was high on days 1 and 2 of admission, exceeding 20% on both days; 251 (12.6%) patients developed pneumonia during hospitalization, and the hazard of pneumonia development remained high (>2%) in the first 7 days of admission.Staphylococcus aureus and Klebsiella species were commonly identified in the sputum culture. Among patients who survived the first 7 days, the odds ratio (OR) of those with pneumonia and unfavorable neurological outcomes defined by cerebral performance category 3-5 was approximately 1. In those who survived the first 10 days, the OR was greater than 1 with a wide confidence interval. Conclusions This is the first study describing details of pneumonia in OHCA patients treated with ECPR using a large dataset.
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Affiliation(s)
- Eiki Iida
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Nao Ichihara
- Department of Cardiovascular Surgery, The Jikei University School of Medicine, Tokyo, Japan
- Department of Healthcare Quality Assessment, The University of Tokyo, Tokyo, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Kasumi Shirasaki
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Katsuhiro Horie
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Shutaro Isokawa
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
| | - Norio Otani
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan
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Shirakawa K, Matsuoka Y, Yamamoto Y, Inoue A, Takahashi R, Yamada Y, Ariyoshi K, Hifumi T, Sakamoto T, Kuroda Y. Neurologic outcome and location of cardiac arrest in out-of-hospital cardiac arrest patients who underwent extracorporeal cardiopulmonary resuscitation: A multicentre retrospective cohort in Japan. Resusc Plus 2023; 16:100468. [PMID: 37711681 PMCID: PMC10497793 DOI: 10.1016/j.resplu.2023.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
Aim We examined the association between the location of cardiac arrest and outcomes of patients with out-of-hospital cardiac arrest (OHCA) who underwent extracorporeal cardiopulmonary resuscitation (ECPR). Methods This was a secondary analysis of SAVE-J II, a multicentre retrospective registry with 36 participating institutions across Japan, which enrolled adult patients with OHCA who underwent ECPR. The outcomes of interest were favourable neurologic outcome at discharge. We compared the outcome between OHCA cases that occurred at residential and public locations, using a multilevel logistic regression model allowing for the random effect of each hospital. Results Among 1,744 enrolled OHCAs, 809 and 935 occurred at residential (house: 603; apartment: 206) and public (street: 260; workplace: 210; others: 465) locations, respectively. The proportion of favourable neurologic outcomes was lower in OHCAs at residential locations than those at public locations (88/781 (11.3%) vs.131/891 (14.7%); adjusted odds ratio, 0.72 [95% confidence interval, 0.53-0.99]). However, subgroup analyses for patients with EMS aged <65 years call to hospital arrival within 30 minutes or during daytime revealed less difference between residential and public locations. Conclusion When cardiac arrests occurred at residential locations, lower proportions of favourable neurologic outcomes were exhibited among patients with OHCA who underwent ECPR. However, the event's location may not affect the prognosis among appropriate and select cases when transported within a limited timeframe.
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Affiliation(s)
- Kazuhiro Shirakawa
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Yoshinori Matsuoka
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohama-kaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Ryo Takahashi
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohama-kaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Yoshie Yamada
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Koichi Ariyoshi
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9‐1 Akashi‐cho, Chuo‐ku, Tokyo 104‐8560, Japan
| | - Tetsuya Sakamoto
- Teikyo University School of Medicine, Department of Emergency Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
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Kawai S, Kobayashi D, Nishiyama C, Shimamoto T, Kiyohara K, Kitamura T, Tanaka K, Kinashi K, Koyama N, Sakamoto T, Marukawa S, Iwami T. Wider Dissemination of Simplified Chest Compression-Only Cardiopulmonary Resuscitation Training Combined With Conventional Cardiopulmonary Resuscitation Training and 10-Year Trends in Cardiopulmonary Resuscitation Performed by Bystanders in a City. Circ J 2023:CJ-23-0177. [PMID: 37981324 DOI: 10.1253/circj.cj-23-0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Little is known about how to effectively increase bystander cardiopulmonary resuscitation (CPR), so we evaluated the 10-year trend of the proportion of bystander CPR in an area with wide dissemination of chest compression-only CPR (CCCPR) training combined with conventional CPR training.Methods and Results: We conducted a descriptive study after a community intervention, using a prospective cohort from September 2010 to December 2019. The intervention consisted of disseminating CCCPR training combined with conventional CPR training in Toyonaka City since 2010. We analyzed all non-traumatic out-of-hospital cardiac arrest (OHCA) patients resuscitated by emergency medical service personnel. The primary outcome was the trend of the proportion of bystander CPR. We conducted multivariate logistic regression models and assessed the adjusted odds ratio (AOR) using a 95% confidence interval (CI) to determine bystander CPR trends. Since 2010, we have trained 168,053 inhabitants (41.9% of the total population of Toyonaka City). A total of 1,508 OHCA patients were included in the analysis. The proportion of bystander CPR did not change from 2010 (43.3%) to 2019 (40.0%; 1-year incremental AOR 1.02 [95% CI: 0.98-1.05]). CONCLUSIONS The proportion of bystander CPR did not increase even after wider dissemination of CPR training. In addition to continuing wider dissemination of CPR training, other strategies such as the use of technology are necessary to increase bystander CPR.
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Affiliation(s)
- Shunsuke Kawai
- Department of Preventive Services, School of Public Health/Graduate School of Medicine, Kyoto University
| | | | - Chika Nishiyama
- Department of Critical Care Nursing, Graduate School of Human Health Sciences, Kyoto University
| | - Tomonari Shimamoto
- Department of Preventive Services, School of Public Health/Graduate School of Medicine, Kyoto University
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | | | | | | | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine
| | | | - Taku Iwami
- Department of Preventive Services, School of Public Health/Graduate School of Medicine, Kyoto University
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25
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Adriani O, Akaike Y, Asano K, Asaoka Y, Berti E, Bigongiari G, Binns WR, Bongi M, Brogi P, Bruno A, Buckley JH, Cannady N, Castellini G, Checchia C, Cherry ML, Collazuol G, de Nolfo GA, Ebisawa K, Ficklin AW, Fuke H, Gonzi S, Guzik TG, Hams T, Hibino K, Ichimura M, Ioka K, Ishizaki W, Israel MH, Kasahara K, Kataoka J, Kataoka R, Katayose Y, Kato C, Kawanaka N, Kawakubo Y, Kobayashi K, Kohri K, Krawczynski HS, Krizmanic JF, Maestro P, Marrocchesi PS, Messineo AM, Mitchell JW, Miyake S, Moiseev AA, Mori M, Mori N, Motz HM, Munakata K, Nakahira S, Nishimura J, Okuno S, Ormes JF, Ozawa S, Pacini L, Papini P, Rauch BF, Ricciarini SB, Sakai K, Sakamoto T, Sasaki M, Shimizu Y, Shiomi A, Spillantini P, Stolzi F, Sugita S, Sulaj A, Takita M, Tamura T, Terasawa T, Torii S, Tsunesada Y, Uchihori Y, Vannuccini E, Wefel JP, Yamaoka K, Yanagita S, Yoshida A, Yoshida K, Zober WV. Direct Measurement of the Spectral Structure of Cosmic-Ray Electrons+Positrons in the TeV Region with CALET on the International Space Station. Phys Rev Lett 2023; 131:191001. [PMID: 38000434 DOI: 10.1103/physrevlett.131.191001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/31/2023] [Accepted: 10/09/2023] [Indexed: 11/26/2023]
Abstract
Detailed measurements of the spectral structure of cosmic-ray electrons and positrons from 10.6 GeV to 7.5 TeV are presented from over 7 years of observations with the CALorimetric Electron Telescope (CALET) on the International Space Station. The instrument, consisting of a charge detector, an imaging calorimeter, and a total absorption calorimeter with a total depth of 30 radiation lengths at normal incidence and a fine shower imaging capability, is optimized to measure the all-electron spectrum well into the TeV region. Because of the excellent energy resolution (a few percent above 10 GeV) and the outstanding e/p separation (10^{5}), CALET provides optimal performance for a detailed search of structures in the energy spectrum. The analysis uses data up to the end of 2022, and the statistics of observed electron candidates has increased more than 3 times since the last publication in 2018. By adopting an updated boosted decision tree analysis, a sufficient proton rejection power up to 7.5 TeV is achieved, with a residual proton contamination less than 10%. The observed energy spectrum becomes gradually harder in the lower energy region from around 30 GeV, consistently with AMS-02, but from 300 to 600 GeV it is considerably softer than the spectra measured by DAMPE and Fermi-LAT. At high energies, the spectrum presents a sharp break around 1 TeV, with a spectral index change from -3.15 to -3.91, and a broken power law fitting the data in the energy range from 30 GeV to 4.8 TeV better than a single power law with 6.9 sigma significance, which is compatible with the DAMPE results. The break is consistent with the expected effects of radiation loss during the propagation from distant sources (except the highest energy bin). We have fitted the spectrum with a model consistent with the positron flux measured by AMS-02 below 1 TeV and interpreted the electron+positron spectrum with possible contributions from pulsars and nearby sources. Above 4.8 TeV, a possible contribution from known nearby supernova remnants, including Vela, is addressed by an event-by-event analysis providing a higher proton-rejection power than a purely statistical analysis.
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Affiliation(s)
- O Adriani
- Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - Y Akaike
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
- JEM Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency, 2-1-1 Sengen, Tsukuba, Ibaraki 305-8505, Japan
| | - K Asano
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - Y Asaoka
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - E Berti
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - G Bigongiari
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - W R Binns
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - M Bongi
- Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - P Brogi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - A Bruno
- Heliospheric Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - J H Buckley
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - N Cannady
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - G Castellini
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - C Checchia
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - M L Cherry
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - G Collazuol
- Department of Physics and Astronomy, University of Padova, Via Marzolo, 8, 35131 Padova, Italy
- INFN Sezione di Padova, Via Marzolo, 8, 35131 Padova, Italy
| | - G A de Nolfo
- Heliospheric Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - K Ebisawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - A W Ficklin
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - H Fuke
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - S Gonzi
- Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - T G Guzik
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - T Hams
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
| | - K Hibino
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - M Ichimura
- Faculty of Science and Technology, Graduate School of Science and Technology, Hirosaki University, 3, Bunkyo, Hirosaki, Aomori 036-8561, Japan
| | - K Ioka
- Yukawa Institute for Theoretical Physics, Kyoto University, Kitashirakawa Oiwake-cho, Sakyo-ku, Kyoto, 606-8502, Japan
| | - W Ishizaki
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - M H Israel
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - K Kasahara
- Department of Electronic Information Systems, Shibaura Institute of Technology, 307 Fukasaku, Minuma, Saitama 337-8570, Japan
| | - J Kataoka
- School of Advanced Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku, Tokyo 169-8555, Japan
| | - R Kataoka
- National Institute of Polar Research, 10-3, Midori-cho, Tachikawa, Tokyo 190-8518, Japan
| | - Y Katayose
- Faculty of Engineering, Division of Intelligent Systems Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya, Yokohama 240-8501, Japan
| | - C Kato
- Faculty of Science, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - N Kawanaka
- Yukawa Institute for Theoretical Physics, Kyoto University, Kitashirakawa Oiwake-cho, Sakyo-ku, Kyoto, 606-8502, Japan
| | - Y Kawakubo
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - K Kobayashi
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
- JEM Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency, 2-1-1 Sengen, Tsukuba, Ibaraki 305-8505, Japan
| | - K Kohri
- Institute of Particle and Nuclear Studies, High Energy Accelerator Research Organization, 1-1 Oho, Tsukuba, Ibaraki, 305-0801, Japan
| | - H S Krawczynski
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - J F Krizmanic
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - P Maestro
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - P S Marrocchesi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - A M Messineo
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
- University of Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - J W Mitchell
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - S Miyake
- Department of Electrical and Electronic Systems Engineering, National Institute of Technology (KOSEN), Ibaraki College, 866 Nakane, Hitachinaka, Ibaraki 312-8508, Japan
| | - A A Moiseev
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - M Mori
- Department of Physical Sciences, College of Science and Engineering, Ritsumeikan University, Shiga 525-8577, Japan
| | - N Mori
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - H M Motz
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - K Munakata
- Faculty of Science, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - S Nakahira
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - J Nishimura
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - S Okuno
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - J F Ormes
- Department of Physics and Astronomy, University of Denver, Physics Building, Room 211, 2112 East Wesley Avenue, Denver, Colorado 80208-6900, USA
| | - S Ozawa
- Quantum ICT Advanced Development Center, National Institute of Information and Communications Technology, 4-2-1 Nukui-Kitamachi, Koganei, Tokyo 184-8795, Japan
| | - L Pacini
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - P Papini
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - B F Rauch
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - S B Ricciarini
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - K Sakai
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - T Sakamoto
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - M Sasaki
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - Y Shimizu
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - A Shiomi
- College of Industrial Technology, Nihon University, 1-2-1 Izumi, Narashino, Chiba 275-8575, Japan
| | - P Spillantini
- Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - F Stolzi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - S Sugita
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - A Sulaj
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - M Takita
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - T Tamura
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - T Terasawa
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - S Torii
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
| | - Y Tsunesada
- Graduate School of Science, Osaka Metropolitan University, Sugimoto, Sumiyoshi, Osaka 558-8585, Japan
- Nambu Yoichiro Institute for Theoretical and Experimental Physics, Osaka Metropolitan University, Sugimoto, Sumiyoshi, Osaka 558-8585, Japan
| | - Y Uchihori
- National Institutes for Quantum and Radiation Science and Technology, 4-9-1 Anagawa, Inage, Chiba 263-8555, Japan
| | - E Vannuccini
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - J P Wefel
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - K Yamaoka
- Nagoya University, Furo, Chikusa, Nagoya 464-8601, Japan
| | - S Yanagita
- College of Science, Ibaraki University, 2-1-1 Bunkyo, Mito, Ibaraki 310-8512, Japan
| | - A Yoshida
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - K Yoshida
- Department of Electronic Information Systems, Shibaura Institute of Technology, 307 Fukasaku, Minuma, Saitama 337-8570, Japan
| | - W V Zober
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
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Nara S, Bunya N, Ohnishi H, Sawamoto K, Uemura S, Kokubu N, Hase M, Narimatsu E, Asai Y, Tahara Y, Atsumi T, Nagao K, Morimura N, Sakamoto T. Long-term prognostic significance of gasping in out-of-hospital cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation: a post hoc analysis of a multi-center prospective cohort study. J Intensive Care 2023; 11:43. [PMID: 37803414 PMCID: PMC10559458 DOI: 10.1186/s40560-023-00692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
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.
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Affiliation(s)
- Satoshi Nara
- Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan.
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University, Sapporo, Japan
| | - Keigo Sawamoto
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan
| | - Mamoru Hase
- Cardiovascular Center, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Yasufumi Asai
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Emergency, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takahiro Atsumi
- Department of Emergency Medicine, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Ken Nagao
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Naoto Morimura
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
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Matsuo Y, Murofushi K, Kokubo M, Sakamoto T, Morita S, Hiraoka M, Nakamura M, Mizowaki T. Long-Term Results of a Multi-Institutional Study of Dynamic Tumor Tracking-Stereotactic Body Radiotherapy for Lung Tumors. Int J Radiat Oncol Biol Phys 2023; 117:S31. [PMID: 37784474 DOI: 10.1016/j.ijrobp.2023.06.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) We had conducted a multi-institutional phase II study to evaluate the safety and efficacy of dynamic tumor tracking-stereotactic body radiotherapy (DTT-SBRT) for lung tumors. The primary endpoint was 2-year local control, which was reported to be 95.2%. After the initial evaluation of the primary endpoint, the study was extended as an observational study which was designed to evaluate 5-year survival and late toxicities. We present the long-term results of DTT-SBRT for lung tumors. MATERIALS/METHODS The main eligibility criteria for the study were as follows: (1) primary or metastatic lung cancer with a diameter of 5 cm or less, and up to 3 lesions without any extrapulmonary lesions; (2) ineligibility to standard surgery, or patient's refusal of surgery; (3) ECOG-PS of 0 to 2; and (4) expected range of respiratory motion of 10 mm or more. The study included 48 patients from four institutions with the median age of 80 years (range, 49-90 years). Forty-two patients had primary non-small-cell lung cancer, and 6 patients had metastatic lung tumors. Forty-eight tumors (median diameter, 23.5 mm; range, 5-47 mm) in 48 patients were targeted for DTT-SBRT using a gimbal-mounted linear accelerator. Prior to treatment planning, spherical gold markers were placed around the tumor to detect internal tumor motion using fluoroscopy. The prescribed dose was 50 Gy in four fractions. Treatment beams were delivered with DTT according to a 4D model that predicts internal tumor motion with abdominal wall motion. DTT-SBRT was successfully delivered to all but one patient who had poor correlation between abdominal wall and tumor motion. RESULTS Median follow-up period at data cutoff was 5.0 years (interquartile range, 3.1-6.3 years). Twenty-nine patients died; the causes of death were cancer-specific in 10 patients, comorbidity in 14 patients (pulmonary disease, renal failure, cerebral infarction, other malignancies, etc.), and unknown in 5 patients without cancer recurrence. Overall survival at 5 years was 51.5% (95% confidence interval [CI], 36.5-64.6%). Progression-free survival and local control at 5 years were 41.0% (95% CI, 27.0-54.5%) and 92.6% (95% CI, 78.7-97.6%), respectively. There were no grade 4-5 toxicities. One patient (2%) developed grade 3 radiation pneumonitis at 3 months. Grade 2 toxicities were observed in 9 patients (19%), including dyspnea, radiation pneumonitis, pleural effusion, rib fracture, and dermatitis. CONCLUSION Dynamic tumor tracking SBRT achieved the long-term efficacy with low incidence of severe toxicities in lung tumors with respiratory motion. In this elderly patient cohort, non-cancer deaths were observed more than cancer-specific deaths.
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Affiliation(s)
- Y Matsuo
- Department of Radiation Oncology and Image-applied therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Murofushi
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - M Kokubo
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - T Sakamoto
- Department of Radiation Oncology, Kyoto Katsura Hospital, Kyoto, Japan
| | - S Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - M Hiraoka
- Department of Radiation Oncology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - M Nakamura
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Mizowaki
- Department of Radiation Oncology and Image-applied therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Sakuraya M, Hifumi T, Inoue A, Sakamoto T, Kuroda Y. Neurological outcomes and reperfusion strategies in out-of-hospital cardiac arrest patients due to pulmonary embolism who underwent venoarterial extracorporeal membrane oxygenation: A post-hoc analysis of a multicenter retrospective cohort study. Resuscitation 2023; 191:109926. [PMID: 37544497 DOI: 10.1016/j.resuscitation.2023.109926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION This study aimed to evaluate the effect of different reperfusion strategies on neurological outcomes in patients with pulmonary embolism who received venoarterial extracorporeal membrane oxygenation (VA-ECMO) for out-of-hospital cardiac arrest (OHCA). METHODS This was a post-hoc analysis of a multicenter retrospective cohort study conducted in 36 institutions in Japan over six years. We included patients who underwent VA-ECMO and were diagnosed with pulmonary embolism caused by OHCA. Neurological outcomes were evaluated on the basis of the cerebral performance category at hospital discharge. We also assessed the association between reperfusion strategies and successful separation from ECMO. RESULTS Among the 78 included patients, approximately half were successfully weaned from ECMO. Hospital mortality and favorable neurological outcomes at hospital discharge were 60.3% and 17.9%, respectively. Thirty-one patients (39.7%) underwent reperfusion strategies after ECMO, including 13 who received systemic thrombolytic therapy and 18 who underwent mechanical reperfusion strategy. After adjusting for prespecified covariates using the competing risk model, reperfusion strategies increased ECMO separation rate (systemic thrombolytic therapy: subdistribution hazard ratio [sHR] 2.24, 95% confidence interval [CI] 1.21-4.17, P = 0.011; mechanical reperfusion strategy: sHR 1.70, 95% CI 0.86-3.41, P = 0.129) compared with anticoagulation therapy alone, whereas higher cardiac Sequential Organ Failure Assessment score decreased ECMO separation rate (sHR 0.81, 95% CI 0.67-0.97, P = 0.020). CONCLUSIONS Favorable neurological outcomes were observed in less than 20% of patients with OHCA due to pulmonary embolism undergoing ECMO. Reperfusion strategies may be associated with shorter ECMO durations in these patients. CLINICAL TRIAL REGISTRATION https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041577 (unique identifier: UMIN000036490).
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Affiliation(s)
- Masaaki Sakuraya
- JA Hiroshima General Hospital, Department of Emergency and Intensive Care Medicine, Jigozen 1-3-3, Hatsukaichi, Hiroshima 738-8503, Japan; Shiga University, Graduate School of Data Science, 1-1-1 Banba, Hikone, Shiga 522-8522, Japan.
| | - Toru Hifumi
- St. Luke's International Hospital, Department of Emergency and Critical Care Medicine, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan.
| | - Akihiko Inoue
- Hyogo Emergency Medical Center, Department of Emergency and Critical Care Medicine, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan.
| | - Tetsuya Sakamoto
- Teikyo University School of Medicine, Department of Emergency Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
| | - Yasuhiro Kuroda
- Kagawa University Hospital, Department of Emergency, Disaster and Critical Care Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
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Kokubo M, Kishi N, Matsuo Y, Ogura M, Araki N, Fujii K, Okumura S, Nakamatsu K, Kishi T, Atsuta T, Sakamoto T, Otsu S, Katagiri T, Narabayashi M, Fujishiro S, Iizuka Y, Ozasa H, Hirai T, Mizowaki T. Major Cardiovascular Events after Chemoradiotherapy with or without Durvalumab in Patients with Stage III Non-Small Cell Lung Cancer: Supplementary Analysis. Int J Radiat Oncol Biol Phys 2023; 117:e30-e31. [PMID: 37785096 DOI: 10.1016/j.ijrobp.2023.06.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) RTOG 0617 showed that cardiac events are relatively common after high-dose thoracic radiotherapy. The aim of this study was to investigate the incidence and risk of major cardiovascular events (MACE) after concurrent chemoradiotherapy (CCRT) with or without durvalumab in patients with stage III non-small cell lung cancer (NSCLC) using the data from a multi-institutional study in Japan. MATERIALS/METHODS Patients who received CCRT for stage III NSCLC between July 2018 and July 2019 were enrolled in a multi-institutional study in Japan. MACE was defined as follows: symptomatic pericardial effusion, acute coronary syndrome, pericarditis, significant arrhythmia, and heart failure. The cumulative incidence of MACE, accounting for death as a competing risk, was calculated. Pre-existing coronary heart disease (CHD) included coronary artery disease, congestive heart failure, peripheral vascular disease, stroke, and extensive coronary artery calcification. The association between patient/treatment-related factors and MACE was assessed by multivariate analysis. RESULTS Among 178 patients with a median follow-up period of 42.5 months, 13 patients developed MACEs. The 3-year cumulative incidence of MACE was 6.9% (95% confidence interval [CI], 4.0-11.9%). Univariate analysis showed that female sex and mean heart dose (MHD) were marginally associated (3-year cumulative incidence, male 5.6% vs. female 12.1%; P = 0.12; MHD ≥ 6.3 Gy 4.8% vs. < 6.3 Gy 9.1%; P = 0.13), and pre-existing CHD was significantly associated with an increased risk of MACE (no CHD 4.3% vs. CHD 16.8%; P = 0.026). Consolidation durvalumab was not associated with an increased risk of MACE (no durvalumab 5.2% vs. durvalumab 7.4%; P = 0.89). Multivariate analysis showed that pre-existing CHD was significantly associated with MACE (hazard ratio, 4.22; 95% CI, 1.30-13.7; P = 0.016). CONCLUSION The incidence of MACE based on the real-world data in Japan was lower than previously reported. Pre-existing CHD was associated with an increased risk of MACE after CCRT in patients with stage III NSCLC, whereas the administration of consolidation durvalumab was not associated with an increased risk of MACE.
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Affiliation(s)
- M Kokubo
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - N Kishi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Y Matsuo
- Department of Radiation Oncology and Image-applied therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - M Ogura
- Department of Radiation Oncology, Kishiwada City Hospital, Kishiwada, Japan
| | - N Araki
- Department of Radiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - K Fujii
- Department of Radiation Oncology, Kurashiki Central Hospital, Kurashiki, Japan
| | - S Okumura
- Department of Radiation Oncology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - K Nakamatsu
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - T Kishi
- Department of Radiation Oncology, Osaka Red Cross Hospital, Osaka, Japan
| | - T Atsuta
- Department of Radiology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - T Sakamoto
- Department of Radiation Oncology, Kyoto Katsura Hospital, Kyoto, Japan
| | - S Otsu
- Department of Radiation Oncology, Kyoto City Hospital, Kyoto, Japan
| | - T Katagiri
- Department of Radiation Oncology, Tenri Hospital, Tenri, Japan
| | - M Narabayashi
- Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, Japan
| | - S Fujishiro
- Department of Radiation Oncology, Shinko Hospital, Kobe, Japan
| | - Y Iizuka
- Department of Radiation Oncology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - H Ozasa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Mizowaki
- Department of Radiation Oncology and Image-applied therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kishi N, Matsuo Y, Ogura M, Kokubo M, Araki N, Fujii K, Okumura S, Nakamatsu K, Kishi T, Atsuta T, Sakamoto T, Otsu S, Katagiri T, Narabayashi M, Fujishiro S, Iizuka Y, Ozasa H, Hirai T, Mizowaki T. Real-World Study of Overall Survival in Patients with Stage III Non-Small Cell Lung Cancer Treated with Chemoradiotherapy with or without Durvalumab and an Exploratory Analysis of Effective Radiation Dose to the Immune Cells. Int J Radiat Oncol Biol Phys 2023; 117:e29-e30. [PMID: 37785070 DOI: 10.1016/j.ijrobp.2023.06.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To investigate the real-world data on overall survival (OS) in patients with stage III non-small cell lung cancer (NSCLC) treated with concurrent chemoradiotherapy (CCRT) with or without consolidation durvalumab, and to perform an exploratory analysis on effective radiation dose to the immune cells (EDIC). MATERIALS/METHODS In our multi-institutional retrospective study, patients who received CCRT between July 2018 and July 2019 for stage III NSCLC in Japan were investigated. EDIC was estimated using mean lung dose, mean heart dose, body volume, body mean dose, and body weight, as reported in the secondary analysis of RTOG 0617. The cut-off value of EDIC was calculated using the maximally selected log-rank statistics. RESULTS One hundred and seventy-eight patients were eligible for the analysis (136 patients, CCRT with consolidation durvalumab [CCRT+D] cohort; 42 patients, CCRT cohort). The median follow-up period was 42.5 months. Three-year OS rates were 59.8% in the overall cohort: 60.5% in the CCRT+D cohort, and 58.0% in the CCRT cohort with no significant difference (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.45-1.27; P = 0.29). Univariate analysis showed that ECOG-PS, smoking history, histology, EGFR mutational status, gross tumor volume and EDIC were significantly associated with OS. Multivariate analysis showed that ECOG-PS 2, gross tumor volume ≥ 57 cm3 and EDIC ≥ 4.4 Gy were associated with poor OS. Among 21 EGFR-mutated patients, 3 year-OS rates were 64.7% in the CCRT+D cohort and 100% in the CCRT cohort, while 3 year-OS rates were 68.8% and 58.7% among 90 EGFR wild-type patients. Three-year OS rates were 64.6% and 47.6% for EDIC < 4.4 Gy and EDIC ≥ 4.4 Gy in the overall cohort (HR, 1.82; 95% CI, 1.14-2.90; P = 0.015). In the subgroup analysis, 66.3% vs. 44.4% in the CCRT+D cohort (HR, 2.01; 95% CI, 1.17-3.47; P = 0.016), and 59.0% vs. 56.1% in the CCRT cohort (HR, 1.20; 95% CI, 0.48-3.01; P = 0.70), respectively. CONCLUSION Our real-world data in Japan showed that there was no significant difference in OS between the CCRT+D cohort and the CCRT cohort. High EDIC could be a risk for poor OS in patients treated with CCRT and consolidation durvalumab compared with those treated with CCRT.
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Affiliation(s)
- N Kishi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Y Matsuo
- Department of Radiation Oncology and Image-applied therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - M Ogura
- Department of Radiation Oncology, Kishiwada City Hospital, Kishiwada, Japan
| | - M Kokubo
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - N Araki
- Department of Radiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - K Fujii
- Department of Radiation Oncology, Kurashiki Central Hospital, Kurashiki, Japan
| | - S Okumura
- Department of Radiation Oncology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - K Nakamatsu
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - T Kishi
- Department of Radiation Oncology, Osaka Red Cross Hospital, Osaka, Japan
| | - T Atsuta
- Department of Radiology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - T Sakamoto
- Department of Radiation Oncology, Kyoto Katsura Hospital, Kyoto, Japan
| | - S Otsu
- Department of Radiation Oncology, Kyoto City Hospital, Kyoto, Japan
| | - T Katagiri
- Department of Radiation Oncology, Tenri Hospital, Tenri, Japan
| | - M Narabayashi
- Department of Radiology, Japanese Red Cross Fukui Hospital, Fukui, Japan
| | - S Fujishiro
- Department of Radiation Oncology, Shinko Hospital, Kobe, Japan
| | - Y Iizuka
- Department of Radiation Oncology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - H Ozasa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Mizowaki
- Department of Radiation Oncology and Image-applied therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Nakatsutsumi K, Endo A, Costantini TW, Takayama W, Morishita K, Otomo Y, Inoue A, Hifumi T, Sakamoto T, Kuroda Y. Time-saving effect of real-time ultrasound-guided cannulation for extracorporeal cardiopulmonary resuscitation: A multicenter retrospective cohort study. Resuscitation 2023; 191:109927. [PMID: 37544499 DOI: 10.1016/j.resuscitation.2023.109927] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR), a bridge to treatments for cardiac arrest patients, can be technically challenging and requires expertise. While ultrasound guidance is frequently used for vascular access, its effects on cannulation time in patients treated with ECPR are poorly defined. We hypothesized that real-time ultrasound guidance would contribute to faster and safer cannulation for ECPR. METHODS This nationwide, multicenter, retrospective study analyzed data from 36 Japanese institutions. Patients who were over age 18 years and underwent ECPR between January 1, 2013, and December 31, 2018, were included. Patients who underwent open surgical vascular access were excluded. Cannulation time and outcomes of patients who underwent real-time ultrasound-guided cannulation (i.e., ultrasound-guided group) were compared to those cannulated without the use of real-time ultrasound guidance (control group) using propensity score matching analysis. RESULTS The ultrasound-guided group comprised 510 cases, whereas the control group comprised 941 cases. Of those, 443 propensity score-matched pairs were evaluated. Cannulation time in the ultrasound-guided group was 2.5 minutes shorter than in the control group [difference, -2.5 minutes; 95% Confidence interval (CI), -3.7 to -1.3, p < 0.001]. The incidence of catheter-related complications and the incidence of the poor neurological outcomes (Cerebral Performance Category ≥3) did not differ between groups [Odds ratio (OR), 1.51; 95% CI, 0.64-3.74; OR, 1.08; 95% CI, 0.83-1.59]. CONCLUSION Real-time ultrasound-guided cannulation was associated with shorter cannulation time of ECPR.
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Affiliation(s)
- Keita Nakatsutsumi
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan; Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of California, San Diego, CA, USA.
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan; Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, Japan
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of California, San Diego, CA, USA
| | - Wataru Takayama
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Koji Morishita
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan; National Hospital Organization Disaster Medical Center, 3256 Tachikawa-shi Midorimachi, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Chuo-ku Kobe, Hyogo, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Chuo-ku, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Itabashi-ku, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
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Adriani O, Akaike Y, Asano K, Asaoka Y, Berti E, Bigongiari G, Binns WR, Bongi M, Brogi P, Bruno A, Buckley JH, Cannady N, Castellini G, Checchia C, Cherry ML, Collazuol G, de Nolfo GA, Ebisawa K, Ficklin AW, Fuke H, Gonzi S, Guzik TG, Hams T, Hibino K, Ichimura M, Ioka K, Ishizaki W, Israel MH, Kasahara K, Kataoka J, Kataoka R, Katayose Y, Kato C, Kawanaka N, Kawakubo Y, Kobayashi K, Kohri K, Krawczynski HS, Krizmanic JF, Maestro P, Marrocchesi PS, Messineo AM, Mitchell JW, Miyake S, Moiseev AA, Mori M, Mori N, Motz HM, Munakata K, Nakahira S, Nishimura J, Okuno S, Ormes JF, Ozawa S, Pacini L, Papini P, Rauch BF, Ricciarini SB, Sakai K, Sakamoto T, Sasaki M, Shimizu Y, Shiomi A, Spillantini P, Stolzi F, Sugita S, Sulaj A, Takita M, Tamura T, Terasawa T, Torii S, Tsunesada Y, Uchihori Y, Vannuccini E, Wefel JP, Yamaoka K, Yanagita S, Yoshida A, Yoshida K, Zober WV. Erratum: Charge-Sign Dependent Cosmic-Ray Modulation Observed with the Calorimetric Electron Telescope on the International Space Station [Phys. Rev. Lett. 130, 211001 (2023)]. Phys Rev Lett 2023; 131:109902. [PMID: 37739390 DOI: 10.1103/physrevlett.131.109902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Indexed: 09/24/2023]
Abstract
This corrects the article DOI: 10.1103/PhysRevLett.130.211001.
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Kinoshita S, Kinoshita K, Sakamoto T, Seo H, Suzuki M, Yamamoto T. Sequential Intraoperative Evaluation of Rotational Stability of Cementless Stem in Total Hip Arthroplasty: A Broach-Based Study. J Clin Med 2023; 12:5444. [PMID: 37685511 PMCID: PMC10487492 DOI: 10.3390/jcm12175444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/05/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
In cementless total hip arthroplasty, the rotational stability of the stem is generally confirmed in a one-time manual evaluation by the surgeon. This study was performed to evaluate the sequential intraoperative changes in rotational stability using a torque wrench. Primary total hip arthroplasty was performed on 52 consecutive hips using a single wedge stem design. Intraoperative evaluation of rotational stability was uniformly performed using a torque wrench. Evaluations were performed immediately after broach insertion and immediately before the final insertion of the stem (after placement of the acetabular cup). Immediately after the insertion of the broach, rotational stability was checked and confirmed to be fully stabilized using a torque wrench in all cases, and the stability was maintained in 17 of 52 (33%) hips immediately before the final insertion of the stem. Among the hips showing instability, 11 of 35 (31%) broaches were upsized, while the remaining 24 hips achieved stabilization through deeper insertion of the broach. In conclusion, the rotational stability achieved immediately after the insertion of the broach was not necessarily maintained during surgery, indicating that rotational stability may need to be checked at multiple time points intraoperatively.
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Affiliation(s)
| | | | | | | | | | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan; (S.K.); (K.K.); (T.S.); (H.S.); (M.S.)
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Nakashima T, Otani T, Kato S, Arai M, Inoue A, Hifumi T, Sakamoto T, Kuroda Y, Tahara Y. Postprocedural Coronary Perfusion and Mortality in Patients With Acute Myocardial Infarction and Extracorporeal Cardiopulmonary Resuscitation. J Am Coll Cardiol 2023; 82:85-87. [PMID: 37380308 DOI: 10.1016/j.jacc.2023.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/28/2023] [Accepted: 04/25/2023] [Indexed: 06/30/2023]
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Naito H, Sakuraya M, Hongo T, Takada H, Yumoto T, Yorifuji T, Hifumi T, Inoue A, Sakamoto T, Kuroda Y, Nakao A. Prevalence, reasons, and timing of decisions to withhold/withdraw life-sustaining therapy for out-of-hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation. Crit Care 2023; 27:252. [PMID: 37370155 DOI: 10.1186/s13054-023-04534-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is rapidly becoming a common treatment strategy for patients with refractory cardiac arrest. Despite its benefits, ECPR raises a variety of ethical concerns when the treatment is discontinued. There is little information about the decision to withhold/withdraw life-sustaining therapy (WLST) for out-of-hospital cardiac arrest (OHCA) patients after ECPR. METHODS We conducted a secondary analysis of data from the SAVE-J II study, a retrospective, multicenter study of ECPR in Japan. Adult patients who underwent ECPR for OHCA with medical causes were included. The prevalence, reasons, and timing of WLST decisions were recorded. Outcomes of patients with or without WLST decisions were compared. Further, factors associated with WLST decisions were examined. RESULTS We included 1660 patients in the analysis; 510 (30.7%) had WLST decisions. The number of WLST decisions was the highest on the first day and WSLT decisions were made a median of two days after ICU admission. Reasons for WLST were perceived unfavorable neurological prognosis (300/510 [58.8%]), perceived unfavorable cardiac/pulmonary prognosis (105/510 [20.5%]), inability to maintain extracorporeal cardiopulmonary support (71/510 [13.9%]), complications (10/510 [1.9%]), exacerbation of comorbidity before cardiac arrest (7/510 [1.3%]), and others. Patients with WLST had lower 30-day survival (WLST vs. no-WLST: 36/506 [7.1%] vs. 386/1140 [33.8%], p < 0.001). Primary cerebral disorders as cause of cardiac arrest and higher severity of illness at intensive care unit admission were associated with WLST decisions. CONCLUSION For approximately one-third of ECPR/OHCA patients, WLST was decided during admission, mainly because of perceived unfavorable neurological prognoses. Decisions and neurological assessments for ECPR/OHCA patients need further analysis.
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Affiliation(s)
- Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Kita, Okayama, 700-8558, Japan.
| | - Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-0042, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Kita, Okayama, 700-8558, Japan
| | - Hiroaki Takada
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori, Tachikawa, Tokyo, 190-0014, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Kita, Okayama, 700-8558, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Science, 2-5-1 Shikata, Kita, Okayama, 700-8558, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Akashi, Chuo, Tokyo, 104-8560, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakihamakaigandori, Chuo, Kobe, Hyogo, 651-0073, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster, and Critical Care Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Kita, Okayama, 700-8558, Japan
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Adriani O, Akaike Y, Asano K, Asaoka Y, Berti E, Bigongiari G, Binns WR, Bongi M, Brogi P, Bruno A, Buckley JH, Cannady N, Castellini G, Checchia C, Cherry ML, Collazuol G, de Nolfo GA, Ebisawa K, Ficklin AW, Fuke H, Gonzi S, Guzik TG, Hams T, Hibino K, Ichimura M, Ioka K, Ishizaki W, Israel MH, Kasahara K, Kataoka J, Kataoka R, Katayose Y, Kato C, Kawanaka N, Kawakubo Y, Kobayashi K, Kohri K, Krawczynski HS, Krizmanic JF, Maestro P, Marrocchesi PS, Messineo AM, Mitchell JW, Miyake S, Moiseev AA, Mori M, Mori N, Motz HM, Munakata K, Nakahira S, Nishimura J, Okuno S, Ormes JF, Ozawa S, Pacini L, Papini P, Rauch BF, Ricciarini SB, Sakai K, Sakamoto T, Sasaki M, Shimizu Y, Shiomi A, Spillantini P, Stolzi F, Sugita S, Sulaj A, Takita M, Tamura T, Terasawa T, Torii S, Tsunesada Y, Uchihori Y, Vannuccini E, Wefel JP, Yamaoka K, Yanagita S, Yoshida A, Yoshida K, Zober WV. Charge-Sign Dependent Cosmic-Ray Modulation Observed with the Calorimetric Electron Telescope on the International Space Station. Phys Rev Lett 2023; 130:211001. [PMID: 37295105 DOI: 10.1103/physrevlett.130.211001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/16/2023] [Accepted: 04/13/2023] [Indexed: 06/12/2023]
Abstract
We present the observation of a charge-sign dependent solar modulation of galactic cosmic rays (GCRs) with the Calorimetric Electron Telescope onboard the International Space Station over 6 yr, corresponding to the positive polarity of the solar magnetic field. The observed variation of proton count rate is consistent with the neutron monitor count rate, validating our methods for determining the proton count rate. It is observed by the Calorimetric Electron Telescope that both GCR electron and proton count rates at the same average rigidity vary in anticorrelation with the tilt angle of the heliospheric current sheet, while the amplitude of the variation is significantly larger in the electron count rate than in the proton count rate. We show that this observed charge-sign dependence is reproduced by a numerical "drift model" of the GCR transport in the heliosphere. This is a clear signature of the drift effect on the long-term solar modulation observed with a single detector.
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Affiliation(s)
- O Adriani
- Department of Physics, University of Florence, Via Sansone, 1 - 50019, Sesto Fiorentino, Italy
- INFN Sezione di Firenze, Via Sansone, 1 - 50019, Sesto Fiorentino, Italy
| | - Y Akaike
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
- JEM Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency, 2-1-1 Sengen, Tsukuba, Ibaraki 305-8505, Japan
| | - K Asano
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - Y Asaoka
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - E Berti
- INFN Sezione di Firenze, Via Sansone, 1 - 50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - G Bigongiari
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3 - 56127 Pisa, Italy
| | - W R Binns
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, Saint Louis, Missouri 63130-4899, USA
| | - M Bongi
- Department of Physics, University of Florence, Via Sansone, 1 - 50019, Sesto Fiorentino, Italy
- INFN Sezione di Firenze, Via Sansone, 1 - 50019, Sesto Fiorentino, Italy
| | - P Brogi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3 - 56127 Pisa, Italy
| | - A Bruno
- Heliospheric Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - J H Buckley
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, Saint Louis, Missouri 63130-4899, USA
| | - N Cannady
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - G Castellini
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - C Checchia
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3 - 56127 Pisa, Italy
| | - M L Cherry
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - G Collazuol
- Department of Physics and Astronomy, University of Padova, Via Marzolo, 8, 35131 Padova, Italy
- INFN Sezione di Padova, Via Marzolo, 8, 35131 Padova, Italy
| | - G A de Nolfo
- Heliospheric Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - K Ebisawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - A W Ficklin
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - H Fuke
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - S Gonzi
- Department of Physics, University of Florence, Via Sansone, 1 - 50019, Sesto Fiorentino, Italy
- INFN Sezione di Firenze, Via Sansone, 1 - 50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - T G Guzik
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - T Hams
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
| | - K Hibino
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - M Ichimura
- Faculty of Science and Technology, Graduate School of Science and Technology, Hirosaki University, 3, Bunkyo, Hirosaki, Aomori 036-8561, Japan
| | - K Ioka
- Yukawa Institute for Theoretical Physics, Kyoto University, Kitashirakawa Oiwake-cho, Sakyo-ku, Kyoto 606-8502, Japan
| | - W Ishizaki
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - M H Israel
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, Saint Louis, Missouri 63130-4899, USA
| | - K Kasahara
- Department of Electronic Information Systems, Shibaura Institute of Technology, 307 Fukasaku, Minuma, Saitama 337-8570, Japan
| | - J Kataoka
- School of Advanced Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku, Tokyo 169-8555, Japan
| | - R Kataoka
- National Institute of Polar Research, 10-3, Midori-cho, Tachikawa, Tokyo 190-8518, Japan
| | - Y Katayose
- Faculty of Engineering, Division of Intelligent Systems Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya, Yokohama 240-8501, Japan
| | - C Kato
- Faculty of Science, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - N Kawanaka
- Yukawa Institute for Theoretical Physics, Kyoto University, Kitashirakawa Oiwake-cho, Sakyo-ku, Kyoto 606-8502, Japan
| | - Y Kawakubo
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - K Kobayashi
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
- JEM Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency, 2-1-1 Sengen, Tsukuba, Ibaraki 305-8505, Japan
| | - K Kohri
- Institute of Particle and Nuclear Studies, High Energy Accelerator Research Organization, 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - H S Krawczynski
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, Saint Louis, Missouri 63130-4899, USA
| | - J F Krizmanic
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - P Maestro
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3 - 56127 Pisa, Italy
| | - P S Marrocchesi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3 - 56127 Pisa, Italy
| | - A M Messineo
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3 - 56127 Pisa, Italy
- University of Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3 - 56127 Pisa, Italy
| | - J W Mitchell
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - S Miyake
- Department of Electrical and Electronic Systems Engineering, National Institute of Technology (KOSEN), Ibaraki College, 866 Nakane, Hitachinaka, Ibaraki 312-8508, Japan
| | - A A Moiseev
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - M Mori
- Department of Physical Sciences, College of Science and Engineering, Ritsumeikan University, Shiga 525-8577, Japan
| | - N Mori
- INFN Sezione di Firenze, Via Sansone, 1 - 50019, Sesto Fiorentino, Italy
| | - H M Motz
- Faculty of Science and Engineering, Global Center for Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku, Tokyo 169-8555, Japan
| | - K Munakata
- Faculty of Science, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - S Nakahira
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - J Nishimura
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - S Okuno
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - J F Ormes
- Department of Physics and Astronomy, University of Denver, Physics Building, Room 211, 2112 East Wesley Avenue, Denver, Colorado 80208-6900, USA
| | - S Ozawa
- Quantum ICT Advanced Development Center, National Institute of Information and Communications Technology, 4-2-1 Nukui-Kitamachi, Koganei, Tokyo 184-8795, Japan
| | - L Pacini
- INFN Sezione di Firenze, Via Sansone, 1 - 50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - P Papini
- INFN Sezione di Firenze, Via Sansone, 1 - 50019, Sesto Fiorentino, Italy
| | - B F Rauch
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, Saint Louis, Missouri 63130-4899, USA
| | - S B Ricciarini
- INFN Sezione di Firenze, Via Sansone, 1 - 50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - K Sakai
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - T Sakamoto
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - M Sasaki
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - Y Shimizu
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - A Shiomi
- College of Industrial Technology, Nihon University, 1-2-1 Izumi, Narashino, Chiba 275-8575, Japan
| | - P Spillantini
- Department of Physics, University of Florence, Via Sansone, 1 - 50019, Sesto Fiorentino, Italy
| | - F Stolzi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3 - 56127 Pisa, Italy
| | - S Sugita
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - A Sulaj
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3 - 56127 Pisa, Italy
| | - M Takita
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - T Tamura
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - T Terasawa
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - S Torii
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
| | - Y Tsunesada
- Graduate School of Science, Osaka Metropolitan University, Sugimoto, Sumiyoshi, Osaka 558-8585, Japan
- Nambu Yoichiro Institute for Theoretical and Experimental Physics, Osaka Metropolitan University, Sugimoto, Sumiyoshi, Osaka 558-8585, Japan
| | - Y Uchihori
- National Institutes for Quantum and Radiation Science and Technology, 4-9-1 Anagawa, Inage, Chiba 263-8555, Japan
| | - E Vannuccini
- INFN Sezione di Firenze, Via Sansone, 1 - 50019, Sesto Fiorentino, Italy
| | - J P Wefel
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - K Yamaoka
- Nagoya University, Furo, Chikusa, Nagoya 464-8601, Japan
| | - S Yanagita
- College of Science, Ibaraki University, 2-1-1 Bunkyo, Mito, Ibaraki 310-8512, Japan
| | - A Yoshida
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - K Yoshida
- Department of Electronic Information Systems, Shibaura Institute of Technology, 307 Fukasaku, Minuma, Saitama 337-8570, Japan
| | - W V Zober
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, Saint Louis, Missouri 63130-4899, USA
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Kaneko T, Yanagida K, Matsui K, Kawai T, Yamada Y, Ishii K, Kurozumi T, Suzuki T, Watanabe Y, Kawano H, Sakamoto T, Nakagawa T. Predictive Factors of Lower Urinary Tract Injuries and Spontaneous Voiding Failure After Pelvic Fractures. In Vivo 2023; 37:1323-1327. [PMID: 37103070 DOI: 10.21873/invivo.13212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND/AIM This study aimed to describe the voiding patterns of patients after surgical treatment of pelvic fractures and determine the predictive factors of lower urinary tract injuries (LUTIs) and spontaneous voiding failure among patients with surgically treated pelvic fractures at a tertiary trauma center in Japan. PATIENTS AND METHODS We retrospectively assessed patients with surgically treated pelvic fractures in our tertiary trauma center during May 2009-April 2021. We excluded patients who died during hospitalization and who had indwelling catheter prior to the injury. Patients' LUTIs and spontaneous voiding failure at discharge were recorded. Multivariate analysis was performed to assess the predictive factors of LUTIs and spontaneous voiding failure at discharge. RESULTS In total, 334 eligible patients were identified. Among them, 301 patients (90%) voided spontaneously with or without diapers at discharge. Thirty-three patients required some form of catheterization for bladder drainage. LUTIs were found to be associated with chronological age [odds ratio (OR)=0.96; 95% confidence interval (CI)=0.92-0.99; p=0.024] and pelvic ring fracture (OR=12.0; 95%CI=1.39-255.2; p=0.024). Spontaneous voiding failure was associated with intensive care unit admission (OR=7.17; 95%CI=1.49-34.4; p=0.004). CONCLUSION Overall, 10% of patients with surgically treated pelvic fractures were not able to void spontaneously at discharge. Spontaneous voiding failure after pelvic fractures was related to injury severity.
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Affiliation(s)
- Tomoyuki Kaneko
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan;
| | - Kazuki Yanagida
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Matsui
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yukio Yamada
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Keisuke Ishii
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Taketo Kurozumi
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Suzuki
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshinobu Watanabe
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
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Adriani O, Akaike Y, Asano K, Asaoka Y, Berti E, Bigongiari G, Binns WR, Bongi M, Brogi P, Bruno A, Buckley JH, Cannady N, Castellini G, Checchia C, Cherry ML, Collazuol G, de Nolfo GA, Ebisawa K, Ficklin AW, Fuke H, Gonzi S, Guzik TG, Hams T, Hibino K, Ichimura M, Ioka K, Ishizaki W, Israel MH, Kasahara K, Kataoka J, Kataoka R, Katayose Y, Kato C, Kawanaka N, Kawakubo Y, Kobayashi K, Kohri K, Krawczynski HS, Krizmanic JF, Maestro P, Marrocchesi PS, Messineo AM, Mitchell JW, Miyake S, Moiseev AA, Mori M, Mori N, Motz HM, Munakata K, Nakahira S, Nishimura J, Okuno S, Ormes JF, Ozawa S, Pacini L, Papini P, Rauch BF, Ricciarini SB, Sakai K, Sakamoto T, Sasaki M, Shimizu Y, Shiomi A, Spillantini P, Stolzi F, Sugita S, Sulaj A, Takita M, Tamura T, Terasawa T, Torii S, Tsunesada Y, Uchihori Y, Vannuccini E, Wefel JP, Yamaoka K, Yanagita S, Yoshida A, Yoshida K, Zober WV. Direct Measurement of the Cosmic-Ray Helium Spectrum from 40 GeV to 250 TeV with the Calorimetric Electron Telescope on the International Space Station. Phys Rev Lett 2023; 130:171002. [PMID: 37172251 DOI: 10.1103/physrevlett.130.171002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/03/2023] [Indexed: 05/14/2023]
Abstract
We present the results of a direct measurement of the cosmic-ray helium spectrum with the CALET instrument in operation on the International Space Station since 2015. The observation period covered by this analysis spans from October 13, 2015, to April 30, 2022 (2392 days). The very wide dynamic range of CALET allowed for the collection of helium data over a large energy interval, from ∼40 GeV to ∼250 TeV, for the first time with a single instrument in low Earth orbit. The measured spectrum shows evidence of a deviation of the flux from a single power law by more than 8σ with a progressive spectral hardening from a few hundred GeV to a few tens of TeV. This result is consistent with the data reported by space instruments including PAMELA, AMS-02, and DAMPE and balloon instruments including CREAM. At higher energy we report the onset of a softening of the helium spectrum around 30 TeV (total kinetic energy). Though affected by large uncertainties in the highest energy bins, the observation of a flux reduction turns out to be consistent with the most recent results of DAMPE. A double broken power law is found to fit simultaneously both spectral features: the hardening (at lower energy) and the softening (at higher energy). A measurement of the proton to helium flux ratio in the energy range from 60 GeV/n to about 60 TeV/n is also presented, using the CALET proton flux recently updated with higher statistics.
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Affiliation(s)
- O Adriani
- Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- INFN Sezione di Firenze, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - Y Akaike
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
- JEM Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency, 2-1-1 Sengen, Tsukuba, Ibaraki 305-8505, Japan
| | - K Asano
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - Y Asaoka
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - E Berti
- INFN Sezione di Firenze, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - G Bigongiari
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - W R Binns
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - M Bongi
- Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- INFN Sezione di Firenze, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - P Brogi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - A Bruno
- Heliospheric Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - J H Buckley
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - N Cannady
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - G Castellini
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - C Checchia
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - M L Cherry
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - G Collazuol
- Department of Physics and Astronomy, University of Padova, Via Marzolo, 8, 35131 Padova, Italy
- INFN Sezione di Padova, Via Marzolo, 8, 35131 Padova, Italy
| | - G A de Nolfo
- Heliospheric Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - K Ebisawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - A W Ficklin
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - H Fuke
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - S Gonzi
- Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- INFN Sezione di Firenze, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - T G Guzik
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - T Hams
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
| | - K Hibino
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - M Ichimura
- Faculty of Science and Technology, Graduate School of Science and Technology, Hirosaki University, 3, Bunkyo, Hirosaki, Aomori 036-8561, Japan
| | - K Ioka
- Yukawa Institute for Theoretical Physics, Kyoto University, Kitashirakawa Oiwake-cho, Sakyo-ku, Kyoto, 606-8502, Japan
| | - W Ishizaki
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - M H Israel
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - K Kasahara
- Department of Electronic Information Systems, Shibaura Institute of Technology, 307 Fukasaku, Minuma, Saitama 337-8570, Japan
| | - J Kataoka
- School of Advanced Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku, Tokyo 169-8555, Japan
| | - R Kataoka
- National Institute of Polar Research, 10-3, Midori-cho, Tachikawa, Tokyo 190-8518, Japan
| | - Y Katayose
- Faculty of Engineering, Division of Intelligent Systems Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya, Yokohama 240-8501, Japan
| | - C Kato
- Faculty of Science, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - N Kawanaka
- Yukawa Institute for Theoretical Physics, Kyoto University, Kitashirakawa Oiwake-cho, Sakyo-ku, Kyoto, 606-8502, Japan
| | - Y Kawakubo
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - K Kobayashi
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
- JEM Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency, 2-1-1 Sengen, Tsukuba, Ibaraki 305-8505, Japan
| | - K Kohri
- Institute of Particle and Nuclear Studies, High Energy Accelerator Research Organization, 1-1 Oho, Tsukuba, Ibaraki, 305-0801, Japan
| | - H S Krawczynski
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - J F Krizmanic
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - P Maestro
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - P S Marrocchesi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - A M Messineo
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
- University of Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - J W Mitchell
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - S Miyake
- Department of Electrical and Electronic Systems Engineering, National Institute of Technology (KOSEN), Ibaraki College, 866 Nakane, Hitachinaka, Ibaraki 312-8508, Japan
| | - A A Moiseev
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - M Mori
- Department of Physical Sciences, College of Science and Engineering, Ritsumeikan University, Shiga 525-8577, Japan
| | - N Mori
- INFN Sezione di Firenze, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - H M Motz
- Faculty of Science and Engineering, Global Center for Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku, Tokyo 169-8555, Japan
| | - K Munakata
- Faculty of Science, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - S Nakahira
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - J Nishimura
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - S Okuno
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - J F Ormes
- Department of Physics and Astronomy, University of Denver, Physics Building, Room 211, 2112 East Wesley Avenue, Denver, Colorado 80208-6900, USA
| | - S Ozawa
- Quantum ICT Advanced Development Center, National Institute of Information and Communications Technology, 4-2-1 Nukui-Kitamachi, Koganei, Tokyo 184-8795, Japan
| | - L Pacini
- INFN Sezione di Firenze, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - P Papini
- INFN Sezione di Firenze, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - B F Rauch
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - S B Ricciarini
- INFN Sezione di Firenze, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019, Sesto Fiorentino, Italy
| | - K Sakai
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - T Sakamoto
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - M Sasaki
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - Y Shimizu
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - A Shiomi
- College of Industrial Technology, Nihon University, 1-2-1 Izumi, Narashino, Chiba 275-8575, Japan
| | - P Spillantini
- Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - F Stolzi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - S Sugita
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - A Sulaj
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - M Takita
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - T Tamura
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - T Terasawa
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - S Torii
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
| | - Y Tsunesada
- Graduate School of Science, Osaka Metropolitan University, Sugimoto, Sumiyoshi, Osaka 558-8585, Japan
- Nambu Yoichiro Institute for Theoretical and Experimental Physics, Osaka Metropolitan University, Sugimoto, Sumiyoshi, Osaka 558-8585, Japan
| | - Y Uchihori
- National Institutes for Quantum and Radiation Science and Technology, 4-9-1 Anagawa, Inage, Chiba 263-8555, Japan
| | - E Vannuccini
- INFN Sezione di Firenze, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - J P Wefel
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - K Yamaoka
- Nagoya University, Furo, Chikusa, Nagoya 464-8601, Japan
| | - S Yanagita
- College of Science, Ibaraki University, 2-1-1 Bunkyo, Mito, Ibaraki 310-8512, Japan
| | - A Yoshida
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - K Yoshida
- Department of Electronic Information Systems, Shibaura Institute of Technology, 307 Fukasaku, Minuma, Saitama 337-8570, Japan
| | - W V Zober
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
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Yumoto T, Hongo T, Hifumi T, Inoue A, Sakamoto T, Kuroda Y, Yorifuji T, Nakao A, Naito H. Association between prehospital advanced life support by emergency medical services personnel and neurological outcomes among adult out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation: A secondary analysis of the SAVE-J II study. J Am Coll Emerg Physicians Open 2023; 4:e12948. [PMID: 37064164 PMCID: PMC10090941 DOI: 10.1002/emp2.12948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 04/18/2023] Open
Abstract
Study Objective Early deployment of extracorporeal cardiopulmonary resuscitation (ECPR) is critical in treating refractory out-of-hospital cardiac arrest (OHCA) patients who are potential candidates for ECPR. The effect of prehospital advanced life support (ALS), including epinephrine administration or advanced airway, compared with no ALS in this setting remains unclear. This study's objective was to determine the association between any prehospital ALS care and outcomes of patients who received ECPR with emergency medical services-treated OHCA. Methods This was a secondary analysis of data from the Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J) II study. Patients were separated into 2 groups-those who received prehospital ALS (ALS group) and those did not receive prehospital ALS (no ALS group). Multiple logistic regression analysis was used to investigate the association between prehospital ALS and favorable neurological outcomes (defined as Cerebral Performance Category scores 1-2) at hospital discharge. Results A total of 1289 patients were included, with 644 patients in the ALS group and 645 patients in the no ALS group. There were fewer favorable neurological outcomes at hospital discharge in the ALS group compared with the no ALS group (10.4 vs 19.8%, p <0.001). A multiple logistic regression analysis revealed that any prehospital ALS care (adjusted odds ratios 0.47; 95% confidence interval 0.34-0.66; p <0.001) was associated with unfavorable neurological outcomes at hospital discharge. Conclusion Prehospital ALS was associated with worse neurological outcomes at hospital discharge in patients treated with ECPR for OHCA. Further prospective studies are required to determine the clinical implications of these findings.
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Affiliation(s)
- Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayama Kita‐kuOkayamaJapan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayama Kita‐kuOkayamaJapan
| | - Toru Hifumi
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalChuo‐kuTokyoJapan
| | - Akihiko Inoue
- Department of Emergency, Disaster and Critical Care MedicineHyogo Emergency Medical CenterChuo‐kuKobeJapan
| | - Tetsuya Sakamoto
- Department of Emergency MedicineTeikyo University School of MedicineItabashi‐KuTokyoJapan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster, and Critical Care MedicineKagawa University HospitalMiki‐cho, Kita‐gunKagawaJapan
| | - Takashi Yorifuji
- Department of Epidemiology, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayama Kita‐kuOkayamaJapan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayama Kita‐kuOkayamaJapan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayama Kita‐kuOkayamaJapan
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Shibahashi K, Hifumi T, Sugiyama K, Inoue A, Sakamoto T, Kuroda Y. Comparison of sedation using propofol versus midazolam in patients admitted to the intensive care unit after extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a multicentre observational study. Eur Heart J Acute Cardiovasc Care 2023; 12:246-256. [PMID: 36795623 DOI: 10.1093/ehjacc/zuad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/30/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Optimal sedation regimens for patients after extracorporeal cardiopulmonary resuscitation (ECPR) remain unclear. This study compared the outcomes of patients who received propofol and midazolam for sedation post-ECPR for out-of-hospital cardiac arrest (OHCA). METHODS A retrospective cohort study analysed data from the Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan, including patients admitted to 36 intensive care units (ICU) in Japan post-ECPR for OHCA of cardiac aetiology between 2013 and 2018. One-to-one propensity score-matched analysis compared outcomes between patients post-ECPR for OHCA who received exclusive treatment with a continuous propofol infusion (propofol users) and those who received exclusive treatment with a continuous midazolam infusion (midazolam users). The cumulative incidence and competing risk methodology were used to compare the time to liberation from mechanical ventilation and ICU discharge. RESULTS Propensity score-matching created 109 matched pairs of propofol and midazolam users with balanced baseline characteristics. Competing risk analysis for the 30-day ICU period showed no significant difference in the probability of liberation from mechanical ventilation (0.431 vs. 0.422, P = 0.882) and ICU discharge (0.477 vs. 0.440, P = 0.634). Furthermore, there was no significant difference in the proportion of 30-day survival (0.399 vs. 0.398, P = 0.999), 30-day favourable neurological outcome (0.176 vs. 0.185, P = 0.999), and vasopressor requirement within 24-h post-ICU admission (0.651 vs. 0.670, P = 0.784). CONCLUSIONS This multicentre cohort study revealed no significant differences in mechanical ventilation duration, ICU stay length, survival, neurological outcomes, and vasopressor requirement between propofol and midazolam users admitted to the ICU after ECPR for OHCA.
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Affiliation(s)
- Keita Shibahashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Phil Chung S, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar J, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Gene Ong YK, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Pediatrics 2023; 151:189896. [PMID: 36325925 DOI: 10.1542/peds.2022-060463] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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Shirasaki K, Hifumi T, Goto M, Shin K, Horie K, Isokawa S, Inoue A, Sakamoto T, Kuroda Y, Imai R, Otani N. Clinical characteristics and outcomes after extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients with an initial asystole rhythm. Resuscitation 2023; 183:109694. [PMID: 36646370 DOI: 10.1016/j.resuscitation.2023.109694] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/29/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
AIM This study aimed to describe the characteristics of cases of out-of-hospital cardiac arrest (OHCA) with an initial asystole rhythm in which extracorporeal cardiopulmonary resuscitation (ECPR) was introduced and discuss the clinical indications for ECPR in such patients. METHODS This was a secondary analysis of the SAVE-J II study, a retrospective, multicentre, registry study involving 36 participating institutions in Japan. Patients with an initial asystole rhythm were selected. Favourable neurological outcomes (cerebral performance categories 1-2) constituted the primary outcome. RESULTS In total, 202 patients met the inclusion criteria, with favourable neurological outcomes at hospital discharge in 12 patients (5.9%). Causes of cardiac arrest with favourable neurological outcomes were hypothermia (7 cases), acute coronary syndrome (2 cases), arrhythmia (2 cases), and pulmonary embolism (1 case). Among patients with non-hypothermia (temperature ≥32 °C) on hospital arrival with the cardiac rhythm of asystole or pulseless electrical activity (PEA) on arrival, all 107 patients (66 asystole, 41 PEA) who lacked one or more of the requirements (witness; bystander CPR; signs of life or pupil < 5 mm) had unfavourable neurological outcomes. All 5 cases with favourable neurological outcomes, except for 1 case with a short duration of no-flow time that was highly suspected based on the patient's history, met all the requirements on hospital arrival. CONCLUSIONS A total of 202 ECPR cases with an initial asystole rhythm, including 12 patients with favourable neurological outcomes, were described. Even if the initial cardiac rhythm is asystole, ECPR could be considered if certain conditions are met.
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Affiliation(s)
- Kasumi Shirasaki
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan.
| | - Masahiro Goto
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Kijong Shin
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Katsuhiro Horie
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Shutaro Isokawa
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
| | - Ryosuke Imai
- Department of Pulmonary Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Norio Otani
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
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Kinoshita S, Ishimatsu T, Suzuki M, Seo H, Sakamoto T, Kinoshita K, Yamamoto T. Femoral nerve status during the anterolateral approach for total hip arthroplasty: Motor-evoked potential analysis and an influencing factor. J Orthop Sci 2023; 28:152-155. [PMID: 34716063 DOI: 10.1016/j.jos.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/02/2021] [Accepted: 09/29/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Femoral nerve palsy is an uncommon but serious complication during the anterolateral approach for total hip arthroplasty. One of the reported reasons for femoral nerve palsy is retractor-induced intraoperative damage after retractor placement on the anterior wall of the acetabulum. The present study aimed to clarify the femoral nerve status during anterolateral approach total hip arthroplasty using motor-evoked potential analysis and to identify risk factors influencing the nerve status. METHODS From June 2019 to September 2020, 32 hips in 31 patients underwent primary total hip arthroplasty via the anterolateral approach. The integrity of the femoral nerve was tested by the motor-evoked potential at three time points: preoperatively as a control (first period), immediately after retractor placement on the anterior wall of the acetabulum (second period), and after the procedure (third period). In the second period, the hips were divided into the following two groups: a <50% femoral nerve amplitude group and a ≥50% group. The iliopsoas muscle volume was evaluated by measuring the muscle cross-sectional area on preoperative computed tomography images, and compared between the two groups. RESULTS The mean amplitude of the femoral nerve was significantly reduced from 100% in the first period to 35% in the second period (p < 0.01), but then significantly recovered to 54% in the third period (p < 0.01). In 26 (81%) hips, the femoral nerve amplitude was <50% in the second period. The muscle cross-sectional area of the iliopsoas muscle in the <50% group was significantly smaller than that in the ≥50% group (p < 0.05). CONCLUSIONS The mean amplitude of the femoral nerve was significantly reduced to 35% in the second period, and the iliopsoas muscle volume was considered to influence this femoral nerve status.
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Affiliation(s)
- Sakae Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Tetsuro Ishimatsu
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Masahiro Suzuki
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hajime Seo
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Tetsuya Sakamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Koichi Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
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Tsuda Y, Yoshigoe A, Ogawa S, Sakamoto T, Yamamoto Y, Yamamoto Y, Takakuwa Y. Roles of excess minority carrier recombination and chemisorbed O 2 species at SiO 2/Si interfaces in Si dry oxidation: Comparison between p-Si(001) and n-Si(001) surfaces. J Chem Phys 2022; 157:234705. [PMID: 36550047 DOI: 10.1063/5.0109558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This study provides experimental evidence for the following: (1) Excess minority carrier recombination at SiO2/Si interfaces is associated with O2 dissociative adsorption; (2) the x-ray induced enhancement of SiO2 growth is not caused by the band flattening resulting from the surface photovoltaic effect but by the electron-hole pair creation resulting from core level photoexcitation for the spillover of bulk Si electronic states toward the SiO2 layer; and (3) a metastable chemisorbed O2 species plays a decisive role in combining two types of the single- and double-step oxidation reaction loops. Based on experimental results, the unified Si oxidation reaction model mediated by point defect generation [S. Ogawa et al., Jpn. J. Appl. Phys., Part 1 59, SM0801 (2020)] is extended from the viewpoints of (a) the excess minority carrier recombination at the oxidation-induced vacancy site and (b) the trapping-mediated adsorption through the chemisorbed O2 species at the SiO2/Si interface.
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Affiliation(s)
- Yasutaka Tsuda
- Materials Sciences Research Center, Japan Atomic Energy Agency, 1-1-1 Kouto, Sayo 679-5148, Japan
| | - Akitaka Yoshigoe
- Materials Sciences Research Center, Japan Atomic Energy Agency, 1-1-1 Kouto, Sayo 679-5148, Japan
| | - Shuichi Ogawa
- International Center for Synchrotron Radiation Innovation Smart, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai 980-8577, Japan
| | - Tetsuya Sakamoto
- Materials Sciences Research Center, Japan Atomic Energy Agency, 1-1-1 Kouto, Sayo 679-5148, Japan
| | - Yoshiki Yamamoto
- Electrical and Electronics Engineering, Fukui College, National Institute of Technology, Geshi-cho, Sabae 916-8507, Japan
| | - Yukio Yamamoto
- Electrical and Electronics Engineering, Fukui College, National Institute of Technology, Geshi-cho, Sabae 916-8507, Japan
| | - Yuji Takakuwa
- Materials Sciences Research Center, Japan Atomic Energy Agency, 1-1-1 Kouto, Sayo 679-5148, Japan
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Ong YKG, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM, Cartledge S, Dawson JA, Elgohary MM, Ersdal HL, Finan E, Flaatten HI, Flores GE, Fuerch J, Garg R, Gately C, Goh M, Halamek LP, Handley AJ, Hatanaka T, Hoover A, Issa M, Johnson S, Kamlin CO, Ko YC, Kule A, Leone TA, MacKenzie E, Macneil F, Montgomery W, O’Dochartaigh D, Ohshimo S, Palazzo FS, Picard C, Quek BH, Raitt J, Ramaswamy VV, Scapigliati A, Shah BA, Stewart C, Strand ML, Szyld E, Thio M, Topjian AA, Udaeta E, Vaillancourt C, Wetsch WA, Wigginton J, Yamada NK, Yao S, Zace D, Zelop CM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2022; 146:e483-e557. [PMID: 36325905 DOI: 10.1161/cir.0000000000001095] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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46
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Adriani O, Akaike Y, Asano K, Asaoka Y, Berti E, Bigongiari G, Binns WR, Bongi M, Brogi P, Bruno A, Buckley JH, Cannady N, Castellini G, Checchia C, Cherry ML, Collazuol G, de Nolfo GA, Ebisawa K, Ficklin AW, Fuke H, Gonzi S, Guzik TG, Hams T, Hibino K, Ichimura M, Ioka K, Ishizaki W, Israel MH, Kasahara K, Kataoka J, Kataoka R, Katayose Y, Kato C, Kawanaka N, Kawakubo Y, Kobayashi K, Kohri K, Krawczynski HS, Krizmanic JF, Maestro P, Marrocchesi PS, Messineo AM, Mitchell JW, Miyake S, Moiseev AA, Mori M, Mori N, Motz HM, Munakata K, Nakahira S, Nishimura J, Okuno S, Ormes JF, Ozawa S, Pacini L, Papini P, Rauch BF, Ricciarini SB, Sakai K, Sakamoto T, Sasaki M, Shimizu Y, Shiomi A, Spillantini P, Stolzi F, Sugita S, Sulaj A, Takita M, Tamura T, Terasawa T, Torii S, Tsunesada Y, Uchihori Y, Vannuccini E, Wefel JP, Yamaoka K, Yanagita S, Yoshida A, Yoshida K, Zober WV. Cosmic-Ray Boron Flux Measured from 8.4 GeV/n to 3.8 TeV/n with the Calorimetric Electron Telescope on the International Space Station. Phys Rev Lett 2022; 129:251103. [PMID: 36608255 DOI: 10.1103/physrevlett.129.251103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
We present the measurement of the energy dependence of the boron flux in cosmic rays and its ratio to the carbon flux in an energy interval from 8.4 GeV/n to 3.8 TeV/n based on the data collected by the Calorimetric Electron Telescope (CALET) during ∼6.4 yr of operation on the International Space Station. An update of the energy spectrum of carbon is also presented with an increase in statistics over our previous measurement. The observed boron flux shows a spectral hardening at the same transition energy E_{0}∼200 GeV/n of the C spectrum, though B and C fluxes have different energy dependences. The spectral index of the B spectrum is found to be γ=-3.047±0.024 in the interval 25<E<200 GeV/n. The B spectrum hardens by Δγ_{B}=0.25±0.12, while the best fit value for the spectral variation of C is Δγ_{C}=0.19±0.03. The B/C flux ratio is compatible with a hardening of 0.09±0.05, though a single power-law energy dependence cannot be ruled out given the current statistical uncertainties. A break in the B/C ratio energy dependence would support the recent AMS-02 observations that secondary cosmic rays exhibit a stronger hardening than primary ones. We also perform a fit to the B/C ratio with a leaky-box model of the cosmic-ray propagation in the Galaxy in order to probe a possible residual value λ_{0} of the mean escape path length λ at high energy. We find that our B/C data are compatible with a nonzero value of λ_{0}, which can be interpreted as the column density of matter that cosmic rays cross within the acceleration region.
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Affiliation(s)
- O Adriani
- Department of Physics Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - Y Akaike
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
- JEM Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency, 2-1-1 Sengen, Tsukuba, Ibaraki 305-8505, Japan
| | - K Asano
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - Y Asaoka
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - E Berti
- Department of Physics Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - G Bigongiari
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - W R Binns
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - M Bongi
- Department of Physics Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - P Brogi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - A Bruno
- Heliospheric Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - J H Buckley
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - N Cannady
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - G Castellini
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019 Sesto, Fiorentino, Italy
| | - C Checchia
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - M L Cherry
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - G Collazuol
- Department of Physics and Astronomy, University of Padova, Via Marzolo, 8, 35131 Padova, Italy
- INFN Sezione di Padova, Via Marzolo, 8, 35131 Padova, Italy
| | - G A de Nolfo
- Heliospheric Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - K Ebisawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - A W Ficklin
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - H Fuke
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - S Gonzi
- Department of Physics Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - T G Guzik
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - T Hams
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
| | - K Hibino
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - M Ichimura
- Faculty of Science and Technology, Graduate School of Science and Technology, Hirosaki University, 3, Bunkyo, Hirosaki, Aomori 036-8561, Japan
| | - K Ioka
- Yukawa Institute for Theoretical Physics, Kyoto University, Kitashirakawa Oiwakecho, Sakyo, Kyoto 606-8502, Japan
| | - W Ishizaki
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - M H Israel
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - K Kasahara
- Department of Electronic Information Systems, Shibaura Institute of Technology, 307 Fukasaku, Minuma, Saitama 337-8570, Japan
| | - J Kataoka
- Waseda Research Institute for Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku, Tokyo 169-8555, Japan
| | - R Kataoka
- National Institute of Polar Research, 10-3, Midori-cho, Tachikawa, Tokyo 190-8518, Japan
| | - Y Katayose
- Faculty of Engineering, Division of Intelligent Systems Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya, Yokohama 240-8501, Japan
| | - C Kato
- Faculty of Science, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - N Kawanaka
- Yukawa Institute for Theoretical Physics, Kyoto University, Kitashirakawa Oiwakecho, Sakyo, Kyoto 606-8502, Japan
| | - Y Kawakubo
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - K Kobayashi
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
- JEM Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency, 2-1-1 Sengen, Tsukuba, Ibaraki 305-8505, Japan
| | - K Kohri
- Institute of Particle and Nuclear Studies, High Energy Accelerator Research Organization, 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - H S Krawczynski
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - J F Krizmanic
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - P Maestro
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - P S Marrocchesi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - A M Messineo
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
- University of Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - J W Mitchell
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - S Miyake
- Department of Electrical and Electronic Systems Engineering, National Institute of Technology, Ibaraki College, 866 Nakane, Hitachinaka, Ibaraki 312-8508 Japan
| | - A A Moiseev
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - M Mori
- Department of Physical Sciences, College of Science and Engineering, Ritsumeikan University, Shiga 525-8577, Japan
| | - N Mori
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - H M Motz
- Faculty of Science and Engineering, Global Center for Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku, Tokyo 169-8555, Japan
| | - K Munakata
- Faculty of Science, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - S Nakahira
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - J Nishimura
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - S Okuno
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - J F Ormes
- Department of Physics and Astronomy, University of Denver, Physics Building, Room 211, 2112 East Wesley Avenue, Denver, Colorado 80208-6900, USA
| | - S Ozawa
- Quantum ICT Advanced Development Center, National Institute of Information and Communications Technology, 4-2-1 Nukui-Kitamachi, Koganei, Tokyo 184-8795, Japan
| | - L Pacini
- Department of Physics Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019 Sesto, Fiorentino, Italy
| | - P Papini
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - B F Rauch
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - S B Ricciarini
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019 Sesto, Fiorentino, Italy
| | - K Sakai
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - T Sakamoto
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - M Sasaki
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - Y Shimizu
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - A Shiomi
- College of Industrial Technology, Nihon University, 1-2-1 Izumi, Narashino, Chiba 275-8575, Japan
| | - P Spillantini
- Department of Physics Department of Physics, University of Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - F Stolzi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - S Sugita
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - A Sulaj
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - M Takita
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - T Tamura
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - T Terasawa
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - S Torii
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
| | - Y Tsunesada
- Graduate School of Science, Osaka Metropolitan University, 3-3-138, Sugimoto, Sumiyoshi, Osaka 558-8585, Japan
- Nambu Yoichiro Institute for Theoretical and Experimental Physics, Osaka Metropolitan University, 3-3-138, Sugimoto, Sumiyoshi, Osaka 558-8585, Japan
| | - Y Uchihori
- National Institutes for Quantum and Radiation Science and Technology, 4-9-1 Anagawa, Inage, Chiba 263-8555, Japan
| | - E Vannuccini
- INFN Sezione di Florence, Via Sansone, 1-50019, Sesto Fiorentino, Italy
| | - J P Wefel
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - K Yamaoka
- Nagoya University, Furo, Chikusa, Nagoya 464-8601, Japan
| | - S Yanagita
- College of Science, Ibaraki University, 2-1-1 Bunkyo, Mito, Ibaraki 310-8512, Japan
| | - A Yoshida
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - K Yoshida
- Department of Electronic Information Systems, Shibaura Institute of Technology, 307 Fukasaku, Minuma, Saitama 337-8570, Japan
| | - W V Zober
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
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Otani T, Hifumi T, Inoue A, Abe T, Sakamoto T, Kuroda Y. Transient return of spontaneous circulation related to favourable outcomes in out-of-hospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation: A secondary analysis of the SAVE-J II study. Resusc Plus 2022; 12:100300. [PMID: 36157919 PMCID: PMC9494238 DOI: 10.1016/j.resplu.2022.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/03/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022] Open
Abstract
Aim This study aimed to investigate the relationship between transient return of spontaneous circulation (ROSC) before extracorporeal membrane oxygenation (ECMO) initiation and outcomes in out-of-hospital cardiac arrest (OHCA) patients, who were resuscitated with extracorporeal cardiopulmonary resuscitation (ECPR). Methods This study was a secondary analysis of the SAVE-J II study, which was a retrospective multicentre registry study involving 36 participating institutions in Japan. We classified patients into two groups according to the presence or absence of transient ROSC before ECMO initiation. Transient ROSC was defined as any palpable pulse of ≥1 min before ECMO initiation. The primary outcome was favourable neurological outcomes (cerebral performance categories 1–2). Results Of 2,157 patients registered in the SAVE-J II study, 1,501 met the study inclusion criteria; 328 (22%) experienced transient ROSC before ECMO initiation. Patients with transient ROSC had better outcomes than those without ROSC (favourable neurological outcome, 26% vs 12%, P < 0.001; survival to hospital discharge, 46% vs 24%, respectively; P < 0.001). A Kaplan–Meier plot showed better survival in the transient ROSC group (log-rank test, P < 0.001). In multiple logistic analyses, transient ROSC was significantly associated with favourable neurological outcomes and survival (favourable neurological outcomes, adjusted odds ratio, 3.34 [95% confidence interval, 2.35–4.73]; survival, adjusted odds ratio, 3.99 [95% confidence interval, 2.95–5.40]). Conclusions In OHCA patients resuscitated with ECPR, transient ROSC before ECMO initiation was associated with favourable outcomes. Hence, transient ROSC is a predictor of improved outcomes after ECPR.
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Affiliation(s)
- Takayuki Otani
- Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima-city, Hiroshima 730-8518, Japan
- Corresponding author at: Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima-city, Hiroshima 730-8518, Japan.
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe 651-0073, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, 1187-299 Kaname, Tsukuba, Ibaraki 300-2622, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8577, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo 173-8606, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Phil Chung S, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Gene Ong YK, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM, Cartledge S, Dawson JA, Elgohary MM, Ersdal HL, Finan E, Flaatten HI, Flores GE, Fuerch J, Garg R, Gately C, Goh M, Halamek LP, Handley AJ, Hatanaka T, Hoover A, Issa M, Johnson S, Kamlin CO, Ko YC, Kule A, Leone TA, MacKenzie E, Macneil F, Montgomery W, O’Dochartaigh D, Ohshimo S, Stefano Palazzo F, Picard C, Quek BH, Raitt J, Ramaswamy VV, Scapigliati A, Shah BA, Stewart C, Strand ML, Szyld E, Thio M, Topjian AA, Udaeta E, Vaillancourt C, Wetsch WA, Wigginton J, Yamada NK, Yao S, Zace D, Zelop CM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2022; 181:208-288. [PMID: 36336195 DOI: 10.1016/j.resuscitation.2022.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimising pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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Suzuki M, Kinoshita K, Sakamoto T, Seo H, Kinoshita S, Yoshimura I, Yamamoto T. Utility of anterior wall of greater trochanter in predicting femoral anteversion angle: a three-dimensional computed tomography-based simulation study. J Orthop Surg Res 2022; 17:412. [PMID: 36088332 PMCID: PMC9464406 DOI: 10.1186/s13018-022-03313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background The femoral anteversion angle is an important factor in performing surgery in the proximal part of the femur. Predicting the femoral anteversion angle based on the morphology of the proximal femur is clinically useful. The purpose of this study was to investigate whether an anatomical landmark can be used to predict the femoral anteversion angle intraoperatively. Materials and methods We analysed CT data obtained from 100 hips in 69 patients with osteonecrosis of the femoral head with no more than 2 mm collapse and no evidence of osteoarthritic changes. The measured variables were the femoral anteversion angle, the femoral neck-shaft angle, and the AW angle (defined as the angle between the femoral shaft axis and the tangential line of the anterior wall of the greater trochanter). The correlations between variables were also investigated. Multiple regression analysis by the forced input method was performed for the degree of femoral anteversion angle, using sex and the AW angle as explanatory variables. Results On CT, the mean femoral anteversion angle was 14.8° ± 10.8°, the mean AW angle was 17.5° ± 8.0°, and the mean femoral neck-shaft angle was 127.3° ± 5.4°. There was a positive correlation between the femoral anteversion angle and the AW angle. The approximation equations based on the multiple regression analysis were as follows: male femoral anteversion angle = AW angle × 0.7 − 0.7 and female femoral anteversion angle = AW angle × 0.7 + 4.3. Conclusions Femoral anteversion angle can be predicted based on the AW angle of the greater trochanter.
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50
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Adriani O, Akaike Y, Asano K, Asaoka Y, Berti E, Bigongiari G, Binns WR, Bongi M, Brogi P, Bruno A, Buckley JH, Cannady N, Castellini G, Checchia C, Cherry ML, Collazuol G, Ebisawa K, Ficklin AW, Fuke H, Gonzi S, Guzik TG, Hams T, Hibino K, Ichimura M, Ioka K, Ishizaki W, Israel MH, Kasahara K, Kataoka J, Kataoka R, Katayose Y, Kato C, Kawanaka N, Kawakubo Y, Kobayashi K, Kohri K, Krawczynski HS, Krizmanic JF, Maestro P, Marrocchesi PS, Messineo AM, Mitchell JW, Miyake S, Moiseev AA, Mori M, Mori N, Motz HM, Munakata K, Nakahira S, Nishimura J, de Nolfo GA, Okuno S, Ormes JF, Ozawa S, Pacini L, Papini P, Rauch BF, Ricciarini SB, Sakai K, Sakamoto T, Sasaki M, Shimizu Y, Shiomi A, Spillantini P, Stolzi F, Sugita S, Sulaj A, Takita M, Tamura T, Terasawa T, Torii S, Tsunesada Y, Uchihori Y, Vannuccini E, Wefel JP, Yamaoka K, Yanagita S, Yoshida A, Yoshida K, Zober WV. Observation of Spectral Structures in the Flux of Cosmic-Ray Protons from 50 GeV to 60 TeV with the Calorimetric Electron Telescope on the International Space Station. Phys Rev Lett 2022; 129:101102. [PMID: 36112450 DOI: 10.1103/physrevlett.129.101102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
A precise measurement of the cosmic-ray proton spectrum with the Calorimetric Electron Telescope (CALET) is presented in the energy interval from 50 GeV to 60 TeV, and the observation of a softening of the spectrum above 10 TeV is reported. The analysis is based on the data collected during ∼6.2 years of smooth operations aboard the International Space Station and covers a broader energy range with respect to the previous proton flux measurement by CALET, with an increase of the available statistics by a factor of ∼2.2. Above a few hundred GeV we confirm our previous observation of a progressive spectral hardening with a higher significance (more than 20 sigma). In the multi-TeV region we observe a second spectral feature with a softening around 10 TeV and a spectral index change from -2.6 to -2.9 consistently, within the errors, with the shape of the spectrum reported by DAMPE. We apply a simultaneous fit of the proton differential spectrum which well reproduces the gradual change of the spectral index encompassing the lower energy power-law regime and the two spectral features observed at higher energies.
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Affiliation(s)
- O Adriani
- Department of Physics, University of Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
- INFN Sezione di Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
| | - Y Akaike
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
- JEM Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency, 2-1-1 Sengen, Tsukuba, Ibaraki 305-8505, Japan
| | - K Asano
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - Y Asaoka
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - E Berti
- Department of Physics, University of Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
- INFN Sezione di Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
| | - G Bigongiari
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - W R Binns
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - M Bongi
- Department of Physics, University of Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
- INFN Sezione di Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
| | - P Brogi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - A Bruno
- Heliospheric Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - J H Buckley
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - N Cannady
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - G Castellini
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019 Sesto Fiorentino, Italy
| | - C Checchia
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - M L Cherry
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - G Collazuol
- Department of Physics and Astronomy, University of Padova, Via Marzolo, 8, 35131 Padova, Italy
- INFN Sezione di Padova, Via Marzolo, 8, 35131 Padova, Italy
| | - K Ebisawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - A W Ficklin
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - H Fuke
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - S Gonzi
- Department of Physics, University of Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
- INFN Sezione di Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
| | - T G Guzik
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - T Hams
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
| | - K Hibino
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - M Ichimura
- Faculty of Science and Technology, Graduate School of Science and Technology, Hirosaki University, 3, Bunkyo, Hirosaki, Aomori 036-8561, Japan
| | - K Ioka
- Yukawa Institute for Theoretical Physics, Kyoto University, Kitashirakawa Oiwake-cho, Sakyo-ku, Kyoto 606-8502, Japan
| | - W Ishizaki
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - M H Israel
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - K Kasahara
- Department of Electronic Information Systems, Shibaura Institute of Technology, 307 Fukasaku, Minuma, Saitama 337-8570, Japan
| | - J Kataoka
- School of Advanced Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku, Tokyo 169-8555, Japan
| | - R Kataoka
- National Institute of Polar Research, 10-3, Midori-cho, Tachikawa, Tokyo 190-8518, Japan
| | - Y Katayose
- Faculty of Engineering, Division of Intelligent Systems Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya, Yokohama 240-8501, Japan
| | - C Kato
- Faculty of Science, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - N Kawanaka
- Yukawa Institute for Theoretical Physics, Kyoto University, Kitashirakawa Oiwake-cho, Sakyo-ku, Kyoto 606-8502, Japan
| | - Y Kawakubo
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - K Kobayashi
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
- JEM Utilization Center, Human Spaceflight Technology Directorate, Japan Aerospace Exploration Agency, 2-1-1 Sengen, Tsukuba, Ibaraki 305-8505, Japan
| | - K Kohri
- Institute of Particle and Nuclear Studies, High Energy Accelerator Research Organization, 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - H S Krawczynski
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - J F Krizmanic
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - P Maestro
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - P S Marrocchesi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - A M Messineo
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
- University of Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - J W Mitchell
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - S Miyake
- Department of Electrical and Electronic Systems Engineering, National Institute of Technology (KOSEN), Ibaraki College, 866 Nakane, Hitachinaka, Ibaraki 312-8508, Japan
| | - A A Moiseev
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - M Mori
- Department of Physical Sciences, College of Science and Engineering, Ritsumeikan University, Shiga 525-8577, Japan
| | - N Mori
- INFN Sezione di Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
| | - H M Motz
- Faculty of Science and Engineering, Global Center for Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku, Tokyo 169-8555, Japan
| | - K Munakata
- Faculty of Science, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - S Nakahira
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - J Nishimura
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency, 3-1-1 Yoshinodai, Chuo, Sagamihara, Kanagawa 252-5210, Japan
| | - G A de Nolfo
- Heliospheric Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - S Okuno
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - J F Ormes
- Department of Physics and Astronomy, University of Denver, Physics Building, Room 211, 2112 East Wesley Avenue, Denver, Colorado 80208-6900, USA
| | - S Ozawa
- Quantum ICT Advanced Development Center, National Institute of Information and Communications Technology, 4-2-1 Nukui-Kitamachi, Koganei, Tokyo 184-8795, Japan
| | - L Pacini
- Department of Physics, University of Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
- INFN Sezione di Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019 Sesto Fiorentino, Italy
| | - P Papini
- INFN Sezione di Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
| | - B F Rauch
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
| | - S B Ricciarini
- INFN Sezione di Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
- Institute of Applied Physics (IFAC), National Research Council (CNR), Via Madonna del Piano, 10, 50019 Sesto Fiorentino, Italy
| | - K Sakai
- Center for Space Sciences and Technology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, USA
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
| | - T Sakamoto
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - M Sasaki
- Astroparticle Physics Laboratory, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Center for Research and Exploration in Space Sciences and Technology, NASA/GSFC, Greenbelt, Maryland 20771, USA
- Department of Astronomy, University of Maryland, College Park, Maryland 20742, USA
| | - Y Shimizu
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - A Shiomi
- College of Industrial Technology, Nihon University, 1-2-1 Izumi, Narashino, Chiba 275-8575, Japan
| | - P Spillantini
- Department of Physics, University of Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
| | - F Stolzi
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - S Sugita
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - A Sulaj
- Department of Physical Sciences, Earth and Environment, University of Siena, via Roma 56, 53100 Siena, Italy
- INFN Sezione di Pisa, Polo Fibonacci, Largo B. Pontecorvo, 3-56127 Pisa, Italy
| | - M Takita
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - T Tamura
- Kanagawa University, 3-27-1 Rokkakubashi, Kanagawa, Yokohama, Kanagawa 221-8686, Japan
| | - T Terasawa
- Institute for Cosmic Ray Research, The University of Tokyo, 5-1-5 Kashiwa-no-Ha, Kashiwa, Chiba 277-8582, Japan
| | - S Torii
- Waseda Research Institute for Science and Engineering, Waseda University, 17 Kikuicho, Shinjuku, Tokyo 162-0044, Japan
| | - Y Tsunesada
- Graduate School of Science, Osaka Metropolitan University, Sugimoto, Sumiyoshi, Osaka 558-8585, Japan
- Nambu Yoichiro Institute for Theoretical and Experimental Physics, Osaka Metropolitan University, Sugimoto, Sumiyoshi, Osaka 558-8585, Japan
| | - Y Uchihori
- National Institutes for Quantum and Radiation Science and Technology, 4-9-1 Anagawa, Inage, Chiba 263-8555, Japan
| | - E Vannuccini
- INFN Sezione di Florence, Via Sansone, 1-50019 Sesto Fiorentino, Italy
| | - J P Wefel
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana 70803, USA
| | - K Yamaoka
- Nagoya University, Furo, Chikusa, Nagoya 464-8601, Japan
| | - S Yanagita
- College of Science, Ibaraki University, 2-1-1 Bunkyo, Mito, Ibaraki 310-8512, Japan
| | - A Yoshida
- College of Science and Engineering, Department of Physics and Mathematics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo, Sagamihara, Kanagawa 252-5258, Japan
| | - K Yoshida
- Department of Electronic Information Systems, Shibaura Institute of Technology, 307 Fukasaku, Minuma, Saitama 337-8570, Japan
| | - W V Zober
- Department of Physics and McDonnell Center for the Space Sciences, Washington University, One Brookings Drive, St. Louis, Missouri 63130-4899, USA
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