So far, there remains a controversy regarding the efficacy of epinephrine (Ep) in patients with cardiopulmonary arrest (CPA). In this study, we evaluated the importance of the plasma levels of catecholamines prior to the administration of Ep in patients with CPA. Patients with out-of-hospital cardiac arrest (OHCA) who were transferred to Gunma University Hospital were enrolled prospectively between July 2014 and July 2017. The levels of catecholamines [Ep, norepinephrine (NEp), and dopamine] and vasopressin (antidiuretic hormone) in the plasma were measured using blood samples of cardiogenic patients with OHCA not treated with Ep. Patients were divided into two groups: the return of spontaneous circulation [ROSC(+)] group and the no return of spontaneous circulation [ROSC(−)] group. The plasma levels of these agents and the conditions of resuscitation were compared between these two groups. 48 patients with cardiogenic CPA had not been treated with Ep prior to obtaining the blood samples. The ROSC(+) and ROSC(−) groups included 14 and 34 patients, respectively. The frequency of prehospital defibrillation was significantly higher in the ROSC(+) group. However, the prehospital resuscitation time was significantly shorter in the ROSC(+) group. Moreover, the levels of Ep and NEp in the plasma were significantly lower in the ROSC(+) group. The increased levels of Ep in the plasma may not be associated with the acquisition of ROSC in patients with cardiogenic CPA.

Coagulation biomarkers, and hemoglobin and lactate levels could be useful to predict the existence of arterial extravasation due to pelvic fracture. The ratio of FDP to fibrinogen and the ratio of D-dimer to fibrinogen were the most accurate markers. Coagulation biomarkers may enable more rapid and specific treatment for pelvic fracture.

Purpose To evaluate the effectiveness of intensive care for the elderly trauma patients aged 80 years and older. Methods Trauma patients admitted to the intensive care unit (ICU) through the emergency room (ER) at our hospital between January 2013 and December 2016 were analyzed. Patients were divided into two groups: patients aged 80 and older (group E) and <80 years old (group Y). Clinical courses and the total treatment costs were compared between the two groups. Data are shown as median (interquartile range). Results A hundred and seven trauma patients were included in the study. There were 26 patients in group E and 81 patients in group Y. There was no significant difference in Injury Severity Score (ISS) (group E, 19 (13, 32); group Y, 17 (14, 25); p=0.708); however, the probability of survival (Ps) was significantly lower in group E (group E, 0.895 (0.757, 0.950); group Y, 0.955 (0.878, 0.986); p=0.004). The duration of ICU stay (days) was significantly longer in group E (10 (5, 23)) than in group Y (4 (3, 9); p=0.001), and the total hospital stay (days) was longer in group E (33 (13, 57)) than in group Y (22 (12, 42); p=0.179). The hospital mortality was higher in group E (11.5%) than in group Y (6.2%) without a significant difference (p=0.365). The total treatment costs were significantly higher in group E ($23,558 (12,456, 42,790) with $1 = ¥110.57) than in group Y ($16,538 (7,412, 25,422); p=0.023). Conclusions Elderly trauma patients require longer-term treatment including ICU stay and greater cost with higher hospital mortality compared with young trauma patients.

No abstract

No abstract