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Article ; Online: Spontaneous Non-Traumatic Clostridium perfringens Sepsis.

Hifumi, Toru

2019 Volume 73, Issue 3, Page(s) 177–180

Abstract: Clostridium species are gram-positive, spore-forming, anaerobic rods normally found in the soil and gastrointestinal tract of humans and animals. Spontaneous sepsis due to C. perfringens is not caused by injury, which sets it apart from the classical gas ...

Abstract	Clostridium species are gram-positive, spore-forming, anaerobic rods normally found in the soil and gastrointestinal tract of humans and animals. Spontaneous sepsis due to C. perfringens is not caused by injury, which sets it apart from the classical gas gangrene that typically follows trauma. Spontaneous C. perfringens sepsis often develops as a rapidly progressive intravascular hemolysis and metabolic acidosis, with high mortality rates of over 70% with standard intensive care. In such cases, alpha toxin secreted by C. perfringens is considered the main toxin responsible for intravascular hemolysis, disseminated intravascular coagulopathy, and multiple organ failure. Theta-toxin causes a cytokine cascade, which results in peripheral vasodilation similar to that seen in septic shock. For C. perfringens infections, antibiotics, such as high-dose penicillin, and surgical drainage as early as possible are the principal treatments of choice. However, considering the current mortality rate of sepsis, outcomes have not improved with the current standard treatment for C. perfringens infections. Monoclonal antibody against theta toxin in combination with gas gangrene antitoxin presents a promising therapeutic option.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Antitoxins/therapeutic use ; Clostridium Infections/blood ; Clostridium Infections/physiopathology ; Clostridium Infections/therapy ; Humans ; Sepsis/microbiology ; Sepsis/mortality ; Sepsis/therapy
Chemical Substances	Anti-Bacterial Agents ; Antitoxins
Language	English
Publishing date	2019-12-25
Publishing country	Japan
Document type	Journal Article ; Review
ZDB-ID	1478383-6
ISSN	1884-2836 ; 1344-6304
ISSN (online)	1884-2836
ISSN	1344-6304
DOI	10.7883/yoken.JJID.2019.382
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Article ; Online: The difference in the association between included ECPR patients and neurological outcomes.

Hifumi, Toru / Inoue, Akihiko / Otani, Norio

Critical care (London, England)

2023 Volume 27, Issue 1, Page(s) 39

MeSH term(s)	Humans ; Out-of-Hospital Cardiac Arrest ; Cohort Studies ; Extracorporeal Membrane Oxygenation ; Temperature ; Cardiopulmonary Resuscitation
Language	English
Publishing date	2023-01-25
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-023-04302-2
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Article ; Online: Attempt for a Recombinant Thrombomodulin Alpha Treatment in a Rat Disseminated Intravascular Coagulation Model Using Yamakagashi (

Yamamoto, Akihiko / Ito, Takashi / Hifumi, Toru

Toxins

2022 Volume 14, Issue 5

Abstract: Yamakagashi ( ...

Abstract	Yamakagashi (
MeSH term(s)	Animals ; Anticoagulants/therapeutic use ; Antivenins/therapeutic use ; Colubridae ; Disseminated Intravascular Coagulation ; Humans ; Rats ; Thrombomodulin/therapeutic use ; Venoms/therapeutic use
Chemical Substances	Anticoagulants ; Antivenins ; Thrombomodulin ; Venoms
Language	English
Publishing date	2022-05-02
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2518395-3
ISSN	2072-6651 ; 2072-6651
ISSN (online)	2072-6651
ISSN	2072-6651
DOI	10.3390/toxins14050322
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Article ; Online: 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.

Sugimoto, Momoko / Takayama, Wataru / Inoue, Akihiko / Hifumi, Toru / Sakamoto, Tetsuya / Kuroda, Yasuhiro / Otomo, Yasuhiro

Critical care medicine

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 ... ...

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.
Language	English
Publishing date	2024-02-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000006245
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Article ; Online: A Case of Sudden Cardiac Arrest After Brainstem Infarction.

Suzuki, Takahiro / Hifumi, Toru / Goto, Masahiro / Isokawa, Shutaro / Otani, Norio

Therapeutic hypothermia and temperature management

2023 Volume 13, Issue 2, Page(s) 87–89

Abstract: Research on the causes of sudden cardiac arrest (CA) after ischemic stroke, especially disruption of the autonomic nervous system's central control, has recently focused more on the widespread cortical and subcortical network than on autonomic circuits ... ...

Abstract	Research on the causes of sudden cardiac arrest (CA) after ischemic stroke, especially disruption of the autonomic nervous system's central control, has recently focused more on the widespread cortical and subcortical network than on autonomic circuits at the spinal and brainstem level. However, no clinical case of sudden CA requiring cardiopulmonary resuscitation (CPR) after brainstem infarction has been reported. We report a case of a 78-year-old woman who died suddenly from a brainstem infarction. Her husband heard a falling sound and found her unresponsive and lying with agonal breathing. The initial cardiac rhythm was pulseless electrical activity confirmed by emergency medical technicians. Recovery of spontaneous circulation was achieved after CPR. Basilar artery occlusion was shown on computed tomography, but no other findings that could have caused CA were found. Targeted temperature management was initiated, but she died on hospital day 22. Brainstem infarction may cause sudden CA; therefore, definitive treatment may achieve better outcomes.
MeSH term(s)	Humans ; Female ; Aged ; Cardiopulmonary Resuscitation/methods ; Hypothermia, Induced ; Heart Arrest/etiology ; Heart Arrest/therapy ; Death, Sudden, Cardiac ; Brain Stem Infarctions/complications ; Brain Stem Infarctions/diagnostic imaging ; Brain Stem Infarctions/therapy
Language	English
Publishing date	2023-02-03
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2609342-X
ISSN	2153-7933 ; 2153-7658
ISSN (online)	2153-7933
ISSN	2153-7658
DOI	10.1089/ther.2022.0064
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Article ; Online: 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.

Sakuraya, Masaaki / Hifumi, Toru / Inoue, Akihiko / Sakamoto, Tetsuya / Kuroda, Yasuhiro

Resuscitation

2023 Volume 191, Page(s) 109926

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 ... ...

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).
MeSH term(s)	Humans ; Out-of-Hospital Cardiac Arrest/etiology ; Out-of-Hospital Cardiac Arrest/therapy ; Extracorporeal Membrane Oxygenation ; Retrospective Studies ; Pulmonary Embolism/complications ; Pulmonary Embolism/therapy ; Reperfusion
Language	English
Publishing date	2023-08-05
Publishing country	Ireland
Document type	Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	189901-6
ISSN	1873-1570 ; 0300-9572
ISSN (online)	1873-1570
ISSN	0300-9572
DOI	10.1016/j.resuscitation.2023.109926
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Article ; Online: Association between body mass index and clinical outcomes in patients with out-of-hospital cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation: A multicenter observational study.

Kojima, Mitsuaki / Mochida, Yuzuru / Shoko, Tomohisa / Inoue, Akihiko / Hifumi, Toru / Sakamoto, Tetsuya / Kuroda, Yasuhiro

Resuscitation plus

2023 Volume 16, Page(s) 100497

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 ... ...

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/m 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/m Conclusions: In OHCA patients undergoing ECPR, a BMI ≥ 25 kg/m
Language	English
Publishing date	2023-11-09
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-5204
ISSN (online)	2666-5204
DOI	10.1016/j.resplu.2023.100497
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Article ; Online: Long-term psychiatric disorders in families of severe COVID-19 patients.

Shirasaki, Kasumi / Hifumi, Toru / Sekiguchi, Moe / Isokawa, Shutaro / Nakao, Yusuke / Tanaka, Shinobu / Hashiuchi, Shinsuke / Imai, Ryosuke / Otani, Norio

Acute medicine & surgery

2024 Volume 11, Issue 1, Page(s) e926

Abstract: Aim: The present study aimed to describe in detail the changes to and assess the risk factors for poor long-term outcomes of psychiatric disorders in families of COVID-19 patients.: Methods: A single-center, retrospective study using questionnaires. ... ...

Abstract	Aim: The present study aimed to describe in detail the changes to and assess the risk factors for poor long-term outcomes of psychiatric disorders in families of COVID-19 patients. Methods: A single-center, retrospective study using questionnaires. Family members of patients admitted to the intensive care unit (ICU) with severe COVID-19 participated. Psychiatric disorders refer to the psychological distress such as anxiety, depression, and posttraumatic stress disorder (PTSD) experienced by the patient's family. Results: Forty-six family members completed the survey and were analyzed. Anxiety, depression, and PTSD occurred in 24%, 33%, and 2% of family members, respectively, and psychiatric disorders occurred in 39%. On multivariable analysis, living in the same house with the patient was independently associated with a lower risk of psychiatric disorders in families of COVID-19 patients (OR, 0.180; 95% CI, 0.036-0.908; Conclusion: Approximately 40% of family members had long-term psychiatric disorders, and some of them overcame the psychiatric disorders, and some newly developed psychiatric disorders over the one-year follow-up. Living in the same house with the patient was possibly significantly associated with the reduction of long-term symptoms of psychiatric disorders, but this result must be interpreted with care. Further large studies are needed to examine the factors associated with the long-term mental status of family members.
Language	English
Publishing date	2024-01-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2751184-4
ISSN	2052-8817 ; 2052-8817
ISSN (online)	2052-8817
ISSN	2052-8817
DOI	10.1002/ams2.926
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Article ; Online: Postintensive care syndrome family: A comprehensive review.

Shirasaki, Kasumi / Hifumi, Toru / Nakanishi, Nobuto / Nosaka, Nobuyuki / Miyamoto, Kyohei / Komachi, Miyuki H / Haruna, Junpei / Inoue, Shigeaki / Otani, Norio

Acute medicine & surgery

2024 Volume 11, Issue 1, Page(s) e939

Abstract: Families of critically ill patients are predisposed to tremendous burdens when their relatives are admitted to the intensive care unit (ICU). Postintensive care syndrome family (PICS-F) can be described as a devastated life, encompassing psychological, ... ...

Abstract	Families of critically ill patients are predisposed to tremendous burdens when their relatives are admitted to the intensive care unit (ICU). Postintensive care syndrome family (PICS-F) can be described as a devastated life, encompassing psychological, physical, and socioeconomical burdens that begin with the emotional impact experienced by the family when the patient is admitted to the ICU. PICS-F was primarily proposed as a clinically significant psychological impairment, but it needs to be extended beyond the psychological impairment of the family to include physical and socioeconomical impairments in the future. The prevalence of physiological problems including depression, anxiety and post-traumatic syndrome is 20-40%, and that of non-physiological problems including fatigue is 15% at 6 months after the ICU stay. Assessment of PICS-F was frequently conducted at 3- or 6-month points, although the beginning of the evaluation was based on different assessment points among each of the studies. Families of ICU patients need to be given and understand accurate information, such as the patient's diagnosis, planned care, and prognosis. Prevention of PICS-F requires a continuous bundle of multifaceted and/or multidisciplinary interventions including providing a family information leaflet, ICU diary, communication facilitators, supportive grief care, and follow-up, for the patient and families from during the ICU stay to after discharge from the ICU. This is the first comprehensive review of PICS-F to address the concept, risk factors, assessment tools, prevalence, and management to prevent PICS-F to facilitate acute care physicians' understanding of PICS-F.
Language	English
Publishing date	2024-03-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2751184-4
ISSN	2052-8817 ; 2052-8817
ISSN (online)	2052-8817
ISSN	2052-8817
DOI	10.1002/ams2.939
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Article ; Online: Prophylactic distal perfusion catheter and survival in patients with out-of-hospital cardiac arrest: Secondary analysis of the SAVE-J II study.

Honzawa, Hiroshi / Taniguchi, Hayato / Abe, Takeru / Takeuchi, Ichiro / Inoue, Akihiko / Hifumi, Toru / Sakamoto, Tetsuya / Kuroda, Yasuhiro

The American journal of emergency medicine

2024 Volume 78, Page(s) 69–75

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 ... ...

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.
MeSH term(s)	Humans ; Out-of-Hospital Cardiac Arrest/therapy ; Extracorporeal Membrane Oxygenation ; Treatment Outcome ; Perfusion ; Cardiopulmonary Resuscitation ; Catheters ; Retrospective Studies
Language	English
Publishing date	2024-01-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2024.01.009
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