Scand J Trauma Resus
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Scand J Trauma Resus · Apr 2020
Review Case ReportsTherapeutic management of severe hypothermia with veno-arterial ECMO: where do we stand? Case report and review of the current literature.
Severe accidental hypothermia is associated with high morbidity and mortality. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides an efficient rewarming method with complete cardiopulmonary support. The use of VA-ECMO for this indication has greatly improved the vital and functional prognosis of patients. ⋯ The recent international publications and groups of experts recommend the use of VA ECMO as the gold standard therapy to treat severe hypothermia. Therefore, it seems suitable to update the current knowledge on the topic by analysing the latest international publications. The performance of this technique calls into question ethical and economic factors. Two distinct medical teams tried to identify and regroup prognosis factors in predictive survival scores. They raise the question of the utility of these scores in clinical practice. Indeed, according to which survival rate should we proceed to prolonged resuscitation and implement VA-ECMO? Additional studies will be needed for external approval of these survival scores, and additional reflection by experts will be required.
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Scand J Trauma Resus · Apr 2020
Observational StudyLongitudinal analysis of health status the first year after trauma in severely injured patients.
While survival rates after a trauma are increasing a considerable part of the trauma population are still at risk for both short and long term disabilities. Little is known about prognostic factors over time after a severe trauma. The aim of the present prospective cohort study was to examine trauma and patient related prognostic factors for a lower health status over time after a severe trauma. ⋯ Lower pre-injury health status, longer hospital length of stay, higher ISS, and comorbidities were significant prognostic factors for a lower health status during one year after a severe injury. A younger age and an extremity injury were short-term prognostic factors and unemployment before trauma and comorbidities were long-term prognostic factors. Even after twelve months patients in our population reported more problems in all EQ-5D dimensions when compared to the Dutch reference population.
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Scand J Trauma Resus · Apr 2020
ReviewWhat clinical crew competencies and qualifications are required for helicopter emergency medical services? A review of the literature.
Patients served by Helicopter Emergency Medical Services (HEMS) tend to be acutely injured or unwell and in need of stabilisation followed by rapid and safe transport. It is therefore hypothesised that a particular clinical crew composition is required to provide appropriate HEMS patient care. A literature review was performed to test this hypothesis. ⋯ HEMS clinical crews tended to have a wider range of competencies and experience than ground-based crews, and most studies suggested a patient outcome benefit to HEMS provision. The conclusions that can be drawn are limited due to study quality and the possibility that the literature reviewed was weighted towards particular crewing models (i.e. primarily doctor-staffed) and countries. There is a need for trial-based studies that directly compare patient outcomes between different HEMS crews with different competencies and qualifications.
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Scand J Trauma Resus · Apr 2020
Including oxygen supplement in the early warning score: a prediction study comparing TOKS, modified TOKS and NEWS in a cohort of emergency patients.
Early warning scores (EWS) are widely used in emergency departments and on general wards to detect critical illness and deterioration. TOKS ("Tidlig Opsporing af Kritisk Sygdom") is an early warning score used in Central Denmark Region to monitor hospitalized patients. The objective of this study is to investigate whether inclusion of supplement in the TOKS algorithm (modified TOKS; mTOKS), would improve the ability to predict 7-day mortality. Secondarily, we compare the discriminatory ability between TOKS, mTOKS and the National Early Warning Score (NEWS). ⋯ The discriminatory ability of TOKS improved statistically by including oxygen supplement. All models showed moderate to good discriminatory ability.
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Treatment of arrhythmias evoked by accidental or therapeutic hypothermia and rewarming remains challenging. We aim to find an ECG-biomarker that can predict ventricular arrhythmias at temperatures occurring in therapeutic and accidental hypothermia. ⋯ These calculations indicate that QRS/QTc has potential as novel biomarker for predicting risk of hypothermia-induced cardiac arrest. Our findings apply both to victims of accidental hypothermia and to patients undergoing therapeutic hypothermia during surgery or after e.g. cardiac arrest.