Hybrid emergency room: Installation, establishment, and innovation in the emergency department

Treatment strategy for severe trauma patients requiring aortic occlusion for impending cardiopulmonary arrest in the hybrid emergency room

Aim

Computed tomography (CT) is useful in trauma care. Severely ill trauma patients may not tolerate whole-body CT even without patient transfer. This study examined clinical flow of severe trauma patients requiring aortic occlusion (AO) such as resuscitative thoracotomy or REBOA in the hybrid emergency room (ER) and investigated patient clinical courses prioritizing CT first versus resuscitation including AO first.

Methods

This retrospective, single-center observational study included consecutive trauma patients visiting our ER between May 2016 and February 2023. Patients were divided into the CT first group (whole-body CT preceded AO) and AO first group (AO preceded whole-body CT) and into two subgroups: AO after CT (AO/interventions for hemorrhage performed just after CT in the CT first group), and CT after AO (CT or damage control surgery performed after AO in the AO first group). We investigated 28-day survival rates.

Results

Survival probability by TRISS method was 49% (range: 3.3-94) in the CT first group (n = 6) and 20% (range: 0.7-45) in the AO first group (n = 7). Actual 28-day survival rates were 50% and 57%, respectively. Survival rates of the AO after CT subgroup (CT first group) were 75% (3/4) and 0% (0/2), respectively, and those of the CT after AO subgroup (AO first group) were 25% (1/4) and 100% (3/3), respectively.

Conclusion

In severe trauma patients with low predicted probability of survival treated in the hybrid ER, survival rates might be better if resuscitation including AO is performed before CT and if damage control surgery is performed first before CT.

Positive emotions for promoting quality improvement of extracorporeal membrane oxygenation therapy for COVID-19: In situ interprofessional simulation

Aim

The requirement during the COVID-19 pandemic to provide extracorporeal membrane oxygenation (ECMO) treatment regardless of experience caused high levels of anxiety among healthcare professionals. The aim of the present study was to evaluate the effectiveness of an in situ interprofessional simulation training conducted to improve readiness and preparedness for ECMO management of patients with COVID-19 at a non-high-volume ECMO centre.

Methods

Three emergency physicians, three clinical engineers and two nurses attended the 3-h simulation held at Hirosaki University Hospital in December 2021, during the COVID-19 pandemic. The training comprised a 30-min briefing, a 1-h ECMO circuit change session, a 1-h in-hospital transfer simulation for CT and a 30-min debriefing. Before and after the training, participants completed an online survey of their emotions, based on the Japanese version of the Medical Emotion Scale (J-MES). Related-samples Wilcoxon signed rank test was used to assess potential changes in emotional responses before and after the simulation, and p < 0.05 was considered to indicate significance.

Results

Participants' positive deactivating emotions increased from a median of 3.3 (range, 2.0-4.5) before the simulation to 4.0 (range, 2.5-5.0) after the simulation (p = 0.02), which indicates favourable performance according to the control value theory of educational psychology. There was no statistically significant change in other emotional categories.

Conclusion

Participants' positive deactivating emotions increased significantly following an in situ ECMO simulation training, which indicates the efficacy of the training for improving the quality of ECMO management in patients with COVID-19.

The Use of Prehospital Intensive Care Units in Emergencies-A Scoping Review

BACKGROUND

Amidst a rising tide of trauma-related emergencies, emergency departments worldwide grapple with the challenges of overcrowding and prolonged patient wait times. Addressing these challenges, the integration of prehospital intensive care units has appeared as a promising solution, streamlining trauma care and enhancing patient safety. Nevertheless, the feasibility of such an initiative becomes murky when considered globally. This review delves into the intricacies of prehospital intensive care units' deployment for trauma care, scrutinizing their configurations, operational practices, and the inherent challenges and research priorities.

METHODS

A scoping review was performed for eligible studies. The result was uploaded to the RAYYAN research platform, facilitating simultaneous evaluation of the studies by all researchers.

RESULTS

A total of 42 studies were initially selected. Four studies were duplicates, and 25 studies were unanimously removed as irrelevant. The remaining studies (n = 13) were included in the review, and the outcomes were categorized into diverse subgroups.

CONCLUSIONS

A country's emergency medical services must achieve specific milestones in education, competency, resource availability, and performance to effectively harness the potential of a prehospital intensive care unit. While certain nations are equipped, others lag, highlighting a global disparity in readiness for such advanced care modalities.