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We aimed to identify distinct trajectories of end-tidal carbon dioxide (EtCOThis was a secondary analysis of a prospectively collected database on adult patients with OHCA who had been resuscitated in the emergency department of a tertiary medical center between 2015 and 2020. The primary outcome was the return of spontaneous circulation (ROSC). Group-based trajectory modelling was used to identify the EtCOThe study comprised 655 patients with OHCA. In the primary analysis, three distinct EtCOThree distinct EtCO

Aim Survival is the most consistently captured outcome across countries for out-of-hospital cardiac arrests (OHCA), with return of spontaneous circulation (ROSC) representing the earliest endpoint for ‘unbiased’ initial resuscitation success. The ROSC after cardiac arrest (RACA) score was developed to predict ROSC and has been validated in several European countries. In this study, we aimed to evaluate the performance of RACA in a Pan-Asian population. Methods We conducted a retrospective analysis of data collected in the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. We included OHCA cases from seven communities (Japan, South Korea, Malaysia, Singapore, Taiwan, Thailand, and United Arab Emirates) between January 2009 and December 2012. Paediatric cases, cases that were conveyed by non-emergency medical services (EMS), and cases with incomplete records were excluded from the study. Results The RACA score showed similar discrimination performance as the original German study and various European validation studies. However, it had poor calibration with the original constant regression coefficient, which was primarily due to the low ROSC rate (8.2%) in the PAROS cohort. The calibration performance of RACA significantly improved after the constant coefficient was modified to adjust for the disparity in ROSC rates between Asia and Europe. Conclusion This is the largest validation study of the RACA score. RACA consistently performs well in both Pan-Asian and European communities and can thus be a valuable tool for evaluating EMS systems. However, to implement it, the constant coefficient has to be modified in the RACA formula with local historical data.

Aim To summarise and compare the prognostic accuracy of the blood biomarkers of brain injury, including NSE and S-100B, for neurological outcomes in adult post-cardiac arrest patients. Methods We systematically searched PubMed and Embase databases from their inception to March 2019. We selected studies providing sufficient data of prognostic values of NSE or S-100B to predict neurological outcomes in adult post-cardiac arrest patients. We adopted QUADAS-2 to assess risk of bias and a Bayesian bivariate random-effects meta-analysis model to synthesise the prognostic data. The study protocol was registered with PROSPERO (CRD42018084933). Results We included 42 studies involving 4806 patients in the meta-analysis. The NSE was associated with a pooled sensitivity of 0.56 (95% credible interval [CrI], 0.47–0.65) and pooled specificity of 0.99 (95% CrI, 0.98–1.00). The S-100B was associated with a pooled sensitivity of 0.63 (95% CrI, 0.46–0.78) and pooled specificity of 0.97 (95% CrI, 0.92–1.00). The heterogeneity for NSE (I2, 22.4%) and S-100B (I2, 16.1%) was low and publication bias was not significant. In subgroup analyses, both biomarkers were associated with high specificity across all subgroups with regard to different populations (i.e. whether patients were out-of-hospital cardiac arrest or whether patients received targeted temperature management), different timings of measurement, and different timings of outcome assessment. Conclusions The prognostic performance was comparable between NSE and S-100B. Both biomarkers may be integrated into a multimodal neuroprognostication algorithm for post-cardiac arrest patients and institution-specific cut-off points for both biomarkers should be established.

We describe a Klebsiella pneumoniae-related liver abscess and unrecognized epidural abscess with or without endophthalmitis in 2 nondiabetic patients, both of whom suffered neurologic complications after invasive procedure. Although rare, we should keep these types of cases in mind when making a diagnosis in patients with both liver abscess and complaint of neck pain.

Emergency medical dispatchers are the entry points to the emergency medical services (EMS). The overall performances of the dispatchers are imperative determinants of the emergency medical services dispatching system. There is little data on the cultural and language impacts on emergency medical dispatch.This study examined the emotional content and cooperation score (ECCS) among Mandarin Chinese speaking callers for cardiac arrests, and evaluated the performances of emergency medical services dispatching system in Taipei.This retrospective, observational study examined dispatching audio recordings obtained from the Taipei City Fire Department Dispatching Center between January 2004 to April 2004. The tapes of call relating to adult (ageor=18 years), non-traumatic cases with a presumed or field diagnosis of out-of-hospital cardiac arrest (OHCA) underwent systemic review. The caller's ECCS and the dispatcher's performances, including interview skills, provision of telephone-assisted cardiopulmonary resuscitation (T-CPR), and dispatcher's ability to identify OHCA were examined. Interrater reliability for determining ECCS and interview skills were assessed using kappa statistic.A total of 199 audio recordings were reviewed. A mean ECCS of 1.42+/-0.64 (95% CI: 1.33-1.51) demonstrated that most callers were emotionally stable and cooperative when calling for help, even when facing cardiac arrest patients. There was a good association between ECCS and the sex of the callers (male 1.32 versus female 1.49; p0.05). In 82% of interviews, the interview skills of the dispatchers was high (4 or 5 points); while in one fifth the interview skills were suboptimal. About one third of the cases were provided with T-CPR by the dispatchers. The sensitivity and positive predictive value (PPV) for predicting OHCA by dispatchers were 96.9% and 97.9%, respectively. A kappa value of 0.65 and 0.68 were obtained for the interrater reliability of ECCS and interview skills.Most callers were found to be emotional stable and cooperative with dispatcher's interrogations when calling for cardiac arrest victims in this Mandarin speaking population. The dispatchers have shown satisfactory interview skills in approaching emergency calls and a good ability to identify OHCA. There is a low rate of T-CPR offered to the callers in the investigation. Efforts should be made to address the deficiencies in order to maximise the function of the EMS.

Summary Introduction Implementing prehospital advanced life support (ALS) services requires more medical and societal resources in training and equipment. The actual demand for ALS services in our communities was not clear. To ensure good use of expensive resources, it is important to evaluate the demand and appropriateness of ALS services before full-scale implementation takes place. Objective To evaluate the rate and characteristics of demand for ALS, and the appropriateness of ALS dispatch of the emergency medical service (EMS) system in metropolitan Taipei City. Methods A retrospective, cross-sectional analysis of the EMS records of Taipei City Fire Department from April 1999 to December 2000 was conducted. Stratified random sampling of all EMS records in the second week of January, April, July and October of 2000 were obtained, along with the corresponding ALS dispatch records. Retrospective ALS demand criteria, including the chief complaints, mechanisms of injury/illness, initial vital signs and types of care rendered, were developed to estimate the rate of ALS demand. ALS demand is expressed as the percentage of cases fulfilling ALS criteria over the total number of EMS cases. Appropriate ALS dispatches were those ALS dispatches determined as fulfilling the ALS demand criteria. Results Among the sampled 5433 EMS cases, 490 (9.02%) were determined as a demand for ALS care. ALS demands varied from region to region, and were higher during winter months and afternoon rush hours. There were 175 actual ALS dispatches, accounting for 3.22% of the sampled EMS services. The triage performance was suboptimal: the appropriateness of ALS dispatch was 37.14%; the overtriage rate was 72.86%. Conclusion Around nine percent of EMS calls demand ALS services. The current triage performance for proper ALS dispatch was suboptimal. A correct ALS dispatch protocol and more dispatcher training programmes should be established in the communities to ensure best use of valuable ALS resources.

Tension pneumoperitoneum is a potentially lethal complication of numerous iatrogenic procedures, including upper gastrointestinal (UGI) endoscopy. We report a 69-year-old man with UGI bleeding who developed tension pneumoperitoneum and cardiac arrest after UGI endoscopy. He was successfully resuscitated with needle decompression. Emergency surgery revealed a perforated gastric ulcer, and subtotal gastrectomy with Billroth II anastomosis was performed. Recovery was smooth and he was discharged from the hospital 18 days later. Tension pneumoperitoneum should be suspected in all patients who develop circulatory collapse with acutely distended abdomen after UGI endoscopy. Early identification relies on a high index of suspicion. Prompt treatment with needle decompression should not be delayed for confirmatory radiography once the clinical diagnosis is made.

34-year-old male plumber presented to the Emerency Department (ED) for sudden onset of painful eft infraorbital swelling when he was blowing his ose. Two days before presentation, the patient struck is left eye on a pipe protruding from a wall when bruptly turning his head to the left. Due to the hollow tructure of the pipe, the injury was seemingly limited o an abrasion and contusion in the periorbital area ith sparing of the globe. After the injury, he visited n ophthalmologic clinic and treatment with topical edications was prescribed. On physical examination, there was superficial brasion over the left infraorbital region. The area ppeared swollen with palpable crepitus. Visual acuity as 20/20 in both eyes. Extraocular movements and unduscopic examinations of both eyes were normal. n orbital computed tomography (CT) scan showed bnormal air accumulated in the infraorbital area (Figre 1). A small medial orbital wall (lamina papyracea) racture was also noted with protrusion of soft tissue nto the ethmoid sinus (Figure 2). Oral antibiotic and nalgesic agents were prescribed and he was advised