BackgroundThe gut flora is crucially involved in host homeostasis. However, the

IntroductionWe tested two hypotheses that disseminated intravascular coagulation (DIC) and acute coagulopathy of trauma-shock (ACOTS) in the early phase of trauma are similar disease entities and that the DIC score on admission can be used to predict the prognosis of patients with coagulopathy of trauma.MethodsWe conducted a retrospective study of 562 trauma patients, including 338 patients whose data were obtained immediately after admission to the emergency department. We collected serial data for the platelet counts, global markers of coagulation and fibrinolysis, and antithrombin levels. DIC was diagnosed according to the Japanese Association for Acute Medicine (JAAM) DIC scoring system, and ACOTS was defined as a prothrombin-time ratio of >1.2.ResultsThe higher levels of fibrin/fibrinogen degradation products (FDP) and D-dimer and greater FDP/D-dimer ratios in the DIC patients suggested DIC with the fibrinolytic phenotype. The DIC patients with the fibrinolytic phenotype exhibited persistently lower platelet counts and fibrinogen levels, increased prothrombin time ratios, higher FDP and D-dimer levels, and lower antithrombin levels compared with the non-DIC patients on arrival to the emergency department and during the early stage of trauma. Almost all ACOTS patients met the criteria for a diagnosis of DIC; therefore, the same changes were observed in the platelet counts, global markers of coagulation and fibrinolysis, and antithrombin levels as noted in the DIC patients. The JAAM DIC score obtained immediately after arrival to the emergency department was an independent predictor of massive transfusion and death due to trauma and correlated with the amount of blood transfused.ConclusionsPatients who develop DIC with the fibrinolytic phenotype during the early stage of trauma exhibit consumption coagulopathy associated with increased fibrin(ogen)olysis and lower levels of antithrombin. The same is true in patients with ACOTS. The JAAM DIC score can be used to predict the prognosis of patients with coagulopathy of trauma.

20% 236 (198-277) 0.82 * Critical level indicates the levels of coagulopathy with a bleeding tendency; ** the percent of calculated blood volume; r 2 , coefficient of determination. Hypofibrinogenemia develops the first and the majority of patients reach a critical level of fibrinogen by 142% blood loss of circulating blood volume, which is an unrealistic value in acutely injured trauma patients associated with massive blood loss. Modified from the reference (12). 767. . Lower: a caricature of the upper diagram. If these proposed entities by Hess and EICBT are correct, then sepsis-induced DIC should be renamed, namely, Acute Coagulopathy of Sepsis Shock (ACoSS). However, this term has not been used and it will also likely not to be used in future. The main issues in the world are reviewed and discussed

Objectives: Percutaneous cardiopulmonary bypass (PCPB) is a powerful tool for rescuing the emergency patients (pts) with out-of-hospital cardiogenic cardiac arrest (OHCCA), who are not responding to advanced cardiovascular life support (ACLS). But the system under which the decision to apply PCPB is made at the hospital and preparations then made could exceed the time limitations imposed for cerebral resuscitation. Thus, we have collaborated with the physician-manned ambulance system, and we introduced a pre-hospital PCPB order treatment strategy for patients with out-of-hospital cardiogenic cardiopulmonary arrest, who do not respond to drug administration or electrical cardioversion. Methods: In 174 pts with OHCA treated with PCPB in a single institution, from April 1991 to May 2007. 135 consecutive pts with cardiogenic cardiac arrest refractory to ACLS, who had been treated with PCPB, were included. 135 Pts were divided into two groups. Pre-hospital order groups (n=42) were treated under the pre-hospital PCPB order system, and in-hospital order groups (n=93) were treated under the decision to initiate PCPB was made at the hospital. Rate of return of spontaneous circulation (ROSC), weaning of PCPB, survival to discharge, and favorable neurological recovery were assessed. Results: Pre-hospital order groups showed increases in ROSC, weaning of PCPB, survival to discharge, and significant increases in favorable neurological recovery compared to in-hospital order groups. Conclusions: These results suggest that a pre-hospital PCPB order treatment strategy for patients after CPA significantly improves the neurological function in pts with OHCCA. Table

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