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Article ; Online: Organ donation after extracorporeal cardiopulmonary resuscitation: a nationwide retrospective cohort study.

Yumoto, Tetsuya / Tsukahara, Kohei / Obara, Takafumi / Hongo, Takashi / Nojima, Tsuyoshi / Naito, Hiromichi / Nakao, Atsunori

Critical care (London, England)

2024 Volume 28, Issue 1, Page(s) 160

Abstract: Background: Limited data are available on organ donation practices and recipient outcomes, particularly when comparing donors who experienced cardiac arrest and received extracorporeal cardiopulmonary resuscitation (ECPR) followed by veno-arterial ... ...

Abstract	Background: Limited data are available on organ donation practices and recipient outcomes, particularly when comparing donors who experienced cardiac arrest and received extracorporeal cardiopulmonary resuscitation (ECPR) followed by veno-arterial extracorporeal membrane oxygenation (ECMO) decannulation, versus those who experienced cardiac arrest without receiving ECPR. This study aims to explore organ donation practices and outcomes post-ECPR to enhance our understanding of the donation potential after cardiac arrest. Methods: We conducted a nationwide retrospective cohort study using data from the Japan Organ Transplant Network database, covering all deceased organ donors between July 17, 2010, and August 31, 2022. We included donors who experienced at least one episode of cardiac arrest. During the study period, patients undergoing ECMO treatment were not eligible for a legal diagnosis of brain death. We compared the timeframes associated with each donor's management and the long-term graft outcomes of recipients between ECPR and non-ECPR groups. Results: Among 370 brain death donors with an episode of cardiac arrest, 26 (7.0%) received ECPR and 344 (93.0%) did not; the majority were due to out-of-hospital cardiac arrests. The median duration of veno-arterial ECMO support after ECPR was 3 days. Patients in the ECPR group had significantly longer intervals from admission to organ procurement compared to those not receiving ECPR (13 vs. 9 days, P = 0.005). Lung graft survival rates were significantly lower in the ECPR group (log-rank test P = 0.009), with no significant differences in other organ graft survival rates. Of 160 circulatory death donors with an episode of cardiac arrest, 27 (16.9%) received ECPR and 133 (83.1%) did not. Time intervals from admission to organ procurement following circulatory death and graft survival showed no significant differences between ECPR and non-ECPR groups. The number of organs donated was similar between the ECPR and non-ECPR groups, regardless of brain or circulatory death. Conclusions: This nationwide study reveals that lung graft survival was lower in recipients from ECPR-treated donors, highlighting the need for targeted research and protocol adjustments in post-ECPR organ donation.
MeSH term(s)	Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Cardiopulmonary Resuscitation/methods ; Cardiopulmonary Resuscitation/statistics & numerical data ; Tissue and Organ Procurement/methods ; Tissue and Organ Procurement/statistics & numerical data ; Tissue and Organ Procurement/trends ; Extracorporeal Membrane Oxygenation/statistics & numerical data ; Extracorporeal Membrane Oxygenation/methods ; Extracorporeal Membrane Oxygenation/trends ; Adult ; Japan/epidemiology ; Cohort Studies ; Tissue Donors/statistics & numerical data ; Heart Arrest/therapy ; Heart Arrest/mortality ; Aged ; Brain Death
Language	English
Publishing date	2024-05-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-024-04949-5
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Radiation in an emergency situation: attempting to respect the patient's beliefs as reported by a minor.

Yumoto, Tetsuya / Hongo, Takashi / Koide, Yasuhiro / Obara, Takafumi / Tsukahara, Kohei / Naito, Hiromichi / Nakao, Atsunori

BMC medical ethics

2023 Volume 24, Issue 1, Page(s) 80

Abstract: Background: Each individual's unique health-related beliefs can greatly impact the patient-clinician relationship. When there is a conflict between the patient's preferences and recommended medical care, it can create a serious ethical dilemma, ... ...

Abstract	Background: Each individual's unique health-related beliefs can greatly impact the patient-clinician relationship. When there is a conflict between the patient's preferences and recommended medical care, it can create a serious ethical dilemma, especially in an emergency setting, and dramatically alter this important relationship. Case presentation: A 56-year-old man, who remained comatose after out-of-hospital cardiac arrest, was rushed to our hospital. The patient was scheduled for emergency coronary angiography when his adolescent daughter reported that she and her father held sincere beliefs against radiation exposure. We were concerned that she did not fully understand the potential consequences if her father did not receive the recommended treatment. A physician provided her with in depth information regarding the risks and benefits of the treatment. While we did not want to disregard her statement, we opted to save the patient's life due to concerns about the validity of her report. Conclusions: Variations in beliefs regarding medical care force clinicians to incorporate patient beliefs into medical practice. However, an emergency may require a completely different approach. When faced with a patient in a life-threatening condition and unconscious, we should take action to prioritize saving their life, unless we are highly certain about the validity of their advance directives.
MeSH term(s)	Humans ; Middle Aged ; Advance Directives ; Male ; Coronary Angiography ; Radiation Exposure/ethics ; Emergency Medicine/ethics
Language	English
Publishing date	2023-10-04
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2041552-7
ISSN	1472-6939 ; 1472-6939
ISSN (online)	1472-6939
ISSN	1472-6939
DOI	10.1186/s12910-023-00962-5
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Organ Donation after Extracorporeal Cardiopulmonary Resuscitation and Brain Death.

Obara, Takafumi / Yumoto, Tetsuya / Aoshima, Kenji / Tsukahara, Kohei / Naito, Hiromichi / Nakao, Atsunori

Acta medica Okayama

2023 Volume 77, Issue 1, Page(s) 117–120

Abstract: A 38-year-old primipara Japanese woman suffered cardiac arrest due to a pulmonary thromboembolism 1 day after undergoing a cesarean section. Extracorporeal cardiopulmonary resuscitation was initiated and extracorporeal membrane oxygenation support was ... ...

Abstract	A 38-year-old primipara Japanese woman suffered cardiac arrest due to a pulmonary thromboembolism 1 day after undergoing a cesarean section. Extracorporeal cardiopulmonary resuscitation was initiated and extracorporeal membrane oxygenation support was needed for 24 h. Despite intensive care, the patient was diagnosed with brain death on day 6. With the family's consent, comprehensive end-of-life care including organ donation was discussed based on our hospital's policy. The family decided to donate her organs. Specific training and education are required for emergency physicians to optimize the process of incorporating organ donation into end-of-life care while respecting the patient's and family's wishes.
MeSH term(s)	Humans ; Female ; Pregnancy ; Adult ; Brain Death ; Cesarean Section ; Cardiopulmonary Resuscitation ; Heart Arrest/therapy ; Tissue and Organ Procurement
Language	English
Publishing date	2023-02-27
Publishing country	Japan
Document type	Case Reports
ZDB-ID	188415-3
ISSN	0386-300X ; 0001-6152
ISSN	0386-300X ; 0001-6152
DOI	10.18926/AMO/64372
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Article ; Online: Transcranial doppler ultrasound in a 3-month-old infant with brain death.

Hiraoka, Tomohiro / Obara, Takafumi / Hongo, Takashi / Nojima, Tsuyoshi / Tsukahara, Kohei / Yumoto, Tetsuya / Nakao, Atsunori

Pediatrics international : official journal of the Japan Pediatric Society

2023 Volume 65, Issue 1, Page(s) e15587

MeSH term(s)	Humans ; Infant ; Brain Death/diagnostic imaging ; Ultrasonography, Doppler, Transcranial ; Cerebrovascular Circulation ; Brain/diagnostic imaging
Language	English
Publishing date	2023-08-24
Publishing country	Australia
Document type	Journal Article
ZDB-ID	1470376-2
ISSN	1442-200X ; 1328-8067
ISSN (online)	1442-200X
ISSN	1328-8067
DOI	10.1111/ped.15587
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Article ; Online: Plastic Bronchitis in a Five-Year-Old Boy Treated Using Extracorporeal Membrane Oxygenation; a Case Report.

Nojima, Tsuyoshi / Naito, Hiromichi / Obara, Takafumi / Tsukahara, Kohei / Nakao, Atsunori

Archives of academic emergency medicine

2021 Volume 9, Issue 1, Page(s) e16

Abstract: Plastic bronchitis is an uncommon disorder marked by the production of bronchial casts and acute respiratory failure development. In pediatric cases, influenza infection sometimes results in the obstruction of bronchi and leads to this potentially life- ... ...

Abstract	Plastic bronchitis is an uncommon disorder marked by the production of bronchial casts and acute respiratory failure development. In pediatric cases, influenza infection sometimes results in the obstruction of bronchi and leads to this potentially life-threatening condition. We report the case of a five-year-old boy with plastic bronchitis related to influenza A infection, which could only be recovered by the use of extracorporeal membrane oxygenation (ECMO). ECMO could effectively provide sufficient oxygenation for patients suffering from severe reversible acute respiratory failure. If patients infected with the influenza virus present acute respiratory distress with total lung atelectasis, clinicians should consider the diagnosis of plastic bronchitis and the subsequent treatment interventions with ECMO in a severe cases.
Language	English
Publishing date	2021-01-27
Publishing country	Iran
Document type	Case Reports
ISSN	2645-4904
ISSN (online)	2645-4904
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Reusable Medical Isolation Gowns with a Liquid Barrier: Washing Gowns in the Coronavirus Disease 2019 Pandemic Era?

Naito, Hiromichi / Tsukahara, Kohei / Takao, Soshi / Yorifuji, Takashi / Nakao, Atsunori

JMA journal

2021 Volume 5, Issue 1, Page(s) 107–108

Abstract: Healthcare providers are at risk of exposure to SARS-CoV-2 via droplets, respiratory secretions, and contact with contaminated surfaces. Personal protective equipment (PPE) is necessary for primary reliable prevention to treat patients with coronavirus ... ...

Abstract	Healthcare providers are at risk of exposure to SARS-CoV-2 via droplets, respiratory secretions, and contact with contaminated surfaces. Personal protective equipment (PPE) is necessary for primary reliable prevention to treat patients with coronavirus disease 2019 (COVID-19). However, PPE shortages have had a significant impact on every medical facility, and outpatient clinics are especially vulnerable to shortages of medical supplies. During the first stage of the pandemic, efforts were made to reduce the use of medical supplies. Guidance and strategies were proposed to ration the use of PPE, including reusing it. However, reuse (wash) of isolation gowns has not been practically promoted despite these suggestions. Further, reusable products may have advantages for economic and ecologic reasons. We developed an adult universally sized, long-sleeved, 100% polyester, reusable/washable gown with liquid barrier protection. The isolation gown can be worn repeatedly through washing and subsequent disinfection, and it can withstand washing in 80°C hot water for 10 min and/or immersion in 0.05%-0.1% sodium hypochlorite for 30 min and then dried. This new gown's liquid barrier performance is at Association for the Advancement of Medical Instrumentation level 1, even after 20 repeated uses with low cost. The choice of barrier level for gowns should be made based on the risk of contamination. However, the healthcare setting for COVID-19 patients varies greatly with not fully elucidated transmissibility. The newly made reusable isolation gown can be one option for treating COVID-19 patients especially in low-risk settings with economical advantage. Further, preparedness for reuse may have critical implications in extreme shortage. Reconsideration should be focused on reusable gowns with liquid barrier performance and their appropriate use.
Language	English
Publishing date	2021-12-15
Publishing country	Japan
Document type	Journal Article
ZDB-ID	3053329-6
ISSN	2433-3298 ; 2433-328X
ISSN (online)	2433-3298
ISSN	2433-328X
DOI	10.31662/jmaj.2021-0075
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Article: Unrecognized Orbital Images Cause Diagnostic Confusion: Silicone Oil and Implanted Silicone Encircling Bands.

Nojima, Tsuyoshi / Obara, Takafumi / Tsukahara, Kohei / Nakao, Atsunori / Naito, Hiromichi

Case reports in emergency medicine

2021 Volume 2021, Page(s) 9940395

Abstract: Introduction: Most physicians are not familiar with postoperative changes to the orbit, so radiologists and clinicians may sometimes find it challenging to conduct a proper radiological assessment of the globe of the eye and orbital abnormalities. We ... ...

Abstract	Introduction: Most physicians are not familiar with postoperative changes to the orbit, so radiologists and clinicians may sometimes find it challenging to conduct a proper radiological assessment of the globe of the eye and orbital abnormalities. We present a patient with head trauma who had surgery for retinal detachment with implantation of silicone encircling bands. This case report may help clinicians recognize imaging characteristics after ophthalmic surgery to prevent misdiagnosis and unnecessary workup. Conclusion: Implanted ophthalmic devices, for example, silicone oil, appear similar to hemorrhages on CT and magnetic resonance imaging and cause diagnostic confusion. When in doubt, it is useful to assess the clinical presentation and obtain an accurate medical history.
Language	English
Publishing date	2021-06-21
Publishing country	United States
Document type	Case Reports
ZDB-ID	2684646-9
ISSN	2090-6498 ; 2090-648X
ISSN (online)	2090-6498
ISSN	2090-648X
DOI	10.1155/2021/9940395
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Article ; Online: Successfully treated case of severe hypothermia secondary to myxedema coma.

Yamamoto, Hirotsugu / Hongo, Takashi / Nojima, Tsuyoshi / Obara, Takafumi / Kosaki, Yoshinori / Ageta, Kohei / Tsukahara, Kohei / Yumoto, Tetsuya / Nakao, Atsunori / Naito, Hiromichi

Acute medicine & surgery

2023 Volume 10, Issue 1, Page(s) e828

Abstract: Background: Myxedema coma is an extremely rare but fatal endocrine emergency that requires urgent recognition and treatment. We describe a case of severe hypothermia that rapidly deteriorated to cardiac arrest that was attributed to myxedema coma.: ... ...

Abstract	Background: Myxedema coma is an extremely rare but fatal endocrine emergency that requires urgent recognition and treatment. We describe a case of severe hypothermia that rapidly deteriorated to cardiac arrest that was attributed to myxedema coma. Case presentation: A 52-year-old man without a history of hypothyroidism was transferred to our emergency department due to coma and profound hypothermia. The patient developed cardiac arrest immediately after hospital arrival but return of spontaneous circulation was achieved shortly after resuscitation. The patient was noted to have generalized, nonpitting edema, dry skin, severe respiratory acidosis, hyponatremia, and elevated creatinine kinase, which was indicative of hypothyroidism. Myxedema coma was confirmed by a thyroid profile. The patient was successfully treated with intravenous levothyroxine and glucocorticoid. Conclusion: Although myxedema coma is a rare cause of severe hypothermia, emergency physicians should be familiar with its clinical features and management.
Language	English
Publishing date	2023-03-14
Publishing country	United States
Document type	Case Reports
ZDB-ID	2751184-4
ISSN	2052-8817 ; 2052-8817
ISSN (online)	2052-8817
ISSN	2052-8817
DOI	10.1002/ams2.828
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Article: An Unusual Presentation of Chest Pain and Laryngeal Discomfort in a Pregnant Woman: A Case Report and Literature Review.

Sasanami, Misa / Iida, Atsuyoshi / Iwamuro, Masaya / Hirai, Ryousuke / Obara, Takashi / Tsukahara, Kohei / Yumoto, Tetsuya / Naito, Hiromichi / Nakao, Atsunori

Acta medica Okayama

2023 Volume 77, Issue 4, Page(s) 429–431

Abstract: Intramural esophageal dissection (IED), characterized by bleeding into the submucosal space, leads to mucosal separation and dissection. The most prevalent symptoms are sudden chest or retrosternal pain, hematemesis, and dysphagia. Therefore, acute ... ...

Abstract	Intramural esophageal dissection (IED), characterized by bleeding into the submucosal space, leads to mucosal separation and dissection. The most prevalent symptoms are sudden chest or retrosternal pain, hematemesis, and dysphagia. Therefore, acute coronary syndrome and aortic dissection are among its most notable differential diagnoses. A 31-year-old pregnant woman presented with acute chest pain, laryngeal discomfort, and hematemesis. Emergency esophagogastroscopy revealed longitudinal mucosal dissection (upper esophagus to esophagogastric junction). The patient was successfully treated by avoiding the ingestion of solid foods. Clinicians should consider a diagnosis of IED for pregnant patients with acute chest pain, especially if hematemesis is present.
MeSH term(s)	Female ; Pregnancy ; Humans ; Adult ; Hematemesis ; Pregnant Women ; Chest Pain/etiology ; Diagnosis, Differential ; Esophagoscopy
Language	English
Publishing date	2023-08-28
Publishing country	Japan
Document type	Review ; Case Reports
ZDB-ID	188415-3
ISSN	0386-300X ; 0001-6152
ISSN	0386-300X ; 0001-6152
DOI	10.18926/AMO/65755
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Article: Association of Prehospital Physician Presence During Pediatric Out-of-Hospital Cardiac Arrest With Neurologic Outcomes.

Obara, Takafumi / Yumoto, Tetsuya / Nojima, Tsuyoshi / Hongo, Takashi / Tsukahara, Kohei / Matsumoto, Naomi / Yorifuji, Takashi / Nakao, Atsunori / Elmer, Jonathan / Naito, Hiromichi

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2023 Volume 24, Issue 5, Page(s) e244–e252

Abstract: Objectives: To examine the association of prehospital physician presence with neurologic outcomes of pediatric patients with out-of-hospital cardiac arrest (OHCA).: Design: Retrospective cohort study.: Setting: Data from the Japanese Association ... ...

Abstract	Objectives: To examine the association of prehospital physician presence with neurologic outcomes of pediatric patients with out-of-hospital cardiac arrest (OHCA). Design: Retrospective cohort study. Setting: Data from the Japanese Association for Acute Medicine-OHCA Registry. Interventions: None. Patients: Pediatric patients (age 17 yr old or younger) registered in the database between June 2014 and December 2019. Measurement and main results: We used logistic regression models with stabilized inverse probability of treatment weighting (IPTW) to estimate the associated treatment effect of a prehospital physician with 1-month neurologically intact survival. Secondary outcomes included in-hospital return of spontaneous circulation (ROSC) and 1-month survival after OHCA. A total of 1,187 patients (276 in the physician presence group and 911 in the physician absence group) were included (median age 3 yr [interquartile range 0-14 yr]; 723 [61%] male). Comparison of the physician presence group, versus the physician absence, showed 1-month favorable neurologic outcomes of 8.3% (23/276) versus 3.6% (33/911). Physician presence was associated with greater odds of 1-month neurologically intact survival after stabilized IPTW adjustment (adjusted odds ratio [aOR] 1.98, 95% CI 1.08-3.66). We also found an association in the secondary outcome between physician presence, opposed to absence, and in-hospital ROSC (aOR 1.48, 95% CI 1.08-2.04). However, we failed to identify an association with 1-month survival (aOR 1.49, 95% CI 0.97-2.88). Conclusions: Among pediatric patients with OHCA, prehospital physician presence, compared with absence, was associated almost two-fold greater odds of 1-month favorable neurologic outcomes.
MeSH term(s)	Humans ; Male ; Child ; Child, Preschool ; Adolescent ; Female ; Retrospective Studies ; Out-of-Hospital Cardiac Arrest/therapy ; Emergency Medical Services ; Cardiopulmonary Resuscitation ; Registries ; Physicians
Language	English
Publishing date	2023-02-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000003206
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