Papers by Tetsunori KAWASE
Research Square (Research Square), Feb 27, 2024
The current study aimed to investigate assault cases involving prehospital emergency care, focusi... more The current study aimed to investigate assault cases involving prehospital emergency care, focusing on safety aspects. Methods This single-center, retrospective case-control study reviewed our facility's physician-staffed medical care, including consecutive assault cases to patients injured by a perpetrator's intentional attack from January 2005 to October 2020. The study relied on our institution's medical and prehospital emergency care and communication records with the re department. The patients were divided into two groups, "problem group" and "control group", based on the viewpoint of operational safety. Results Of the 4,957 prehospital emergency care cases during the study period, 65 (1.3%) were identi ed as assault cases, with 10 in the problem group and 55 in the control group. A multivariate analysis using logistic regression analysis revealed nonpenetrating injury (odds ratio [OR]: 6.97, 95% con dence interval [CI]: 1.37-35.4, P = 0.019) and shorter interval from the request for physician dispatch to contact with the injured person (request-to-contact interval) (OR: 0.762, 95% CI: 0.580-0.996, P = 0.047) as the independent risk factors to predict the problem group. Conclusion The attack method was a penetrating mechanism in most of the assault cases. Conversely, cases with non-penetrating injuries or shorter request-to-contact interval may cause problems in prehospital emergency care and therefore require particular attention.
Journal of Emergency Management
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has caused great disruptions in ed... more Introduction: The coronavirus disease 2019 (COVID-19) pandemic has caused great disruptions in education and healthcare systems. However, before the COVID-19 pandemic, Hyogo Prefecture did not have a centralized system for sharing information among hospitals, public healthcare centers, the government, fire departments, and medical associations. In March 2021, we used Slack® an enterprise social network, to invite people from hospitals, healthcare centers, the government, fire departments, and medical associations to join our workspace. This study was undertaken to verify whether the use of Slack can improve information sharing during a disaster.Methods: A questionnaire on whether information-sharing tools such as Slack are useful for disaster response in Hyogo Prefecture, including for COVID-19, was administered using a Google Form.Results: Of the 19 people who responded to the questionnaire, 15 (78.9 percent) were first-time users of Slack and 18 (94.7 percent) found it easy to use...
Clinical Case Reports, 2020
We report a case of vascular injury caused by a multi‐lumen catheter for CRRT inserted through le... more We report a case of vascular injury caused by a multi‐lumen catheter for CRRT inserted through left jugular vein. Diagnosis was delayed because CRRT could be continued. Clinicians should be aware of potential vascular complications associated with the wrong placement of multi‐lumen catheters even if blood flow continues without difficulty.
Circulation, 2019
Introduction: It have reported previously that extracorporeal cardiopulmonary resuscitation (ECPR... more Introduction: It have reported previously that extracorporeal cardiopulmonary resuscitation (ECPR) for out of hospital cardiac arrest should induct within 45 minutes from collapse. However, We often encounter patients with favorable neurological outcome who had longer time interval from collapse to induction of V-A ECMO (Downtime: DT). We analyzed that relation about neurological outcome and DT for patients undergone ECPR. Methods: In this single center retrospective study, from January 2010 to April 2019, we identified 147 patients who underwent ECPR. Of these, 87 patients (59%) had shorter DT (≦45min:Group S), and 60 patients (41%) had longer DT (≧46min:Group L). We compared neurological outcome between two groups. Glasgow-Pittsburgh Cerebral Performance Category (CPC) 1-2 was defined as favorable neurological outcome, CPC3-5 was defined as unfavorable outcome at 3 months. Results were expressed as Median (IQR). Results: Patient characteristics were not different between the two g...
Circulation, 2018
Introduction: We have reported previously a favorable neurological outcome by extracorporeal card... more Introduction: We have reported previously a favorable neurological outcome by extracorporeal cardiopulmonary resuscitation (ECPR) for out of hospital cardiac arrest. However, effects of ECPR on patients with prolonged pulseless electrical activity (PEA) are unclear. We analyzed etiology of patients with favorable neurological outcomes after ECPR for PEA with witness. Methods: In this single center retrospective study, from January 2007 to May 2018, we identified 68 patients who underwent ECPR for PEA with witness. Of these, 13 patients (19%) had good neurological outcome at 1 month (Glasgow-Pittsburgh Cerebral Performance Category (CPC):1-2, Group G), and 55 patients (81%) had unfavorable neurological outcome (CPC:3-5, Group B). We compared courses of treatment and causes/places of arrests between two groups. Results are expressed as mean ± SD. Results: Patient characteristics were not different between the two groups. Time intervals from collapse to induction of V-A ECMO were also ...
Critical Care Medicine, 2019
Japanese Circulation Journal-english Edition, 2003
The purpase of the study was to aim at no-blood transfusion in the operation of descending thorac... more The purpase of the study was to aim at no-blood transfusion in the operation of descending thoracic aortic aneurysm. This policy was suported by means of the assist devices and techniques as follows ; 1. Heparin-coated left heart bypass or inter-arterlal shunt sets with pomp (5 cases) and without pump (5 cases). 2. Autotransfusion of the blood (Average 867 ml). 3. Geratin pre-cortet artificial prosthesis. 4. One-lung ventilation cannula. 5. Hypothermmic anesthesia (Average of the body temperature 33.3℃) and 6. Use of Erythropoietin after operation. Ten patients with true descending thoracic aortic aneurysms were electively operated. The average age was 61 years, and seven of them were male. The aorta was closs-clamped (mean 101 min.) and graft replacement was performed. The average blood loss during operation was 948ml. No blood transfusion was done in 3 cases. All the patients were discharged after uneventful courses This desease would be operated without blood transfusion in future.
Japanese Circulation Journal-english Edition, 2004
Shock, 2021
Supplemental Digital Content is available in the text ABSTRACT Background: Initial electrocardiog... more Supplemental Digital Content is available in the text ABSTRACT Background: Initial electrocardiogram (ECG) rhythm is a predictor of outcomes in out-of-hospital cardiac arrest (OHCA) in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR). However, ECG rhythm often changes before ECPR, and the consequence of this change remains unclear. This study aimed to assess the relationship between the conversion of ECG rhythm from initial shockable rhythm before ECPR and mortality. Patients and Methods: This was a retrospective cohort study of OHCA patients with initial shockable rhythm who underwent ECPR between January 2010 and September 2020. Patients were classified into two groups: asystole (patients whose ECG rhythm converted to asystole at any time before initiating ECPR) and non-asystole (patients whose ECG rhythm did not convert to asystole at any time before initiating ECPR) groups. The primary outcome was in-hospital mortality. Results: A total of 102 patients were included in the study; in-hospital mortality rate was 46.1% (n = 47) and 76 (74.5%) patients had unfavorable neurological outcomes (Cerebral Performance Category: 3–5). There were 33 and 69 patients in the asystole and non-asystole groups, respectively. The mortality rates in the asystole and non-asystole groups were 69.7% and 34.8%, respectively (P = 0.001). On multivariable analysis, the asystole group showed a significant association with mortality (odds ratio, 5.42; 95% confidence interval, 2.11–15.36; P < 0.001). Conclusion: Conversion to asystole before ECPR at any time in patients with OHCA is associated with mortality in patients with an initial shockable ECG rhythm.
Acute Medicine & Surgery, 2020
To investigate the clinical features of traumatic asphyxia, specifically the presence of cardiac ... more To investigate the clinical features of traumatic asphyxia, specifically the presence of cardiac arrest and therapeutic efficacy. This review will be useful for future emergencies. Methods: Sixteen traumatic asphyxia cases from our hospital between April 2007 and March 2019 were reviewed and divided into three groups: those experiencing cardiac arrest at the time of rescue (group A, six cases), those experiencing cardiac arrest after rescue (group B, five cases), and those who did not experience cardiac arrest (group C, five cases). Results: All cases had abnormal findings in the skin or conjunctiva. The total mortality rate reached 56%. Among the 11 cases in groups A and B that resulted in cardiac arrest, 10 had an Injury Severity Score of 16 or higher and an Abbreviated Injury Scale score in the chest of 3 or higher. The patients' injuries included pneumothorax, flail chest, and pericardial hematoma. The heartbeat was restarted in seven cases, and two cases completely recovered. Conclusion: In some traumatic asphyxia cases, the treatment course was relatively effective even with cardiac arrest; thus, life support efforts should not be spared in such cases.
Prehospital and Disaster Medicine, 2019
Introduction:For recent years, we often hear the words, “never experienced before” on a weather f... more Introduction:For recent years, we often hear the words, “never experienced before” on a weather forecast in Japan.Aim:To evaluate our response to “Heisei 30-year July heavy rain” in the Hyogo Emergency Medical Operations Center.Methods:Review our actions taken and exchanges of views with local government representatives in a time-related manner compared with public announcements of evacuation/sheltering warning.Results:A specialized warning of heavy rain was announced at 10:50 PM on Friday by the local meteorological observatory. At 11:50 PM, the emergency management headquarters of prefectural medical response was established in the hospital, but a connection could not be established to 10 regional health centers for the weekend. Water levels of some rivers were increasing nearly to flood levels, and an evacuation order was announced to hundreds of thousands of people. This situation continued for a few days throughout many regions. The information of flood or landslide probability...
We report a case of perforation of the superior vena cava caused by a multi-lumen central venous ... more We report a case of perforation of the superior vena cava caused by a multi-lumen central venous catheter. Diagnosis was delayed because extra-corporeal blood flow was not interrupted. Clinicians should be aware of potential vascular complications associated with multi-lumen catheters even in cases in which hemodialysis continues with no complications.
Trauma Case Reports, 2020
Background: The focused assessment with sonography for trauma (FAST) examination is helpful for t... more Background: The focused assessment with sonography for trauma (FAST) examination is helpful for the identification of pericardial effusion in trauma. However, in a cardiac rupture with a pericardial perforation, pericardial effusion is not always detected by FAST. We experienced the case that FAST and enhanced CT failed to detect pericardial effusion. Case presentation: A 51-year old woman injured after falling from a height of 3 m was brought to our institute. Focused assessment with sonography for trauma and enhanced computed tomography did not reveal any pericardial effusion; however, a massive hemothorax was revealed. Because the patient's hemodynamic state had become unstable, we performed an urgent left anterolateral thoracotomy. A left pericardial perforation was detected. By performing a clamshell thoracotomy, we found a rupture of 1 cm in diameter at the left atrial appendage. The hemodynamic state was stabilized by suturing the injury site. The postoperative course was uneventful, and the patient was transferred to another hospital after 31 days of admission. Conclusions: Cardiac injury in the left atrial appendage is rare and sometimes difficult to diagnose and to repair. In the case of a blunt chest trauma with a massive hemothorax, although focused assessment with sonography for trauma gives negative results for pericardial effusion, a cardiac rupture with pericardial perforation should be considered.
Critical Care Medicine, 2018
Critical Care Medicine, 2018
Prehospital and Disaster Medicine, 2017
focused on teaching acute lifesaving interventions. The Respi-Heart device was applied to the ani... more focused on teaching acute lifesaving interventions. The Respi-Heart device was applied to the animal and used to monitor vital parameters throughout the training session. A total of 22 animals were included in the study. The data gathered from Respiheart were compared to results from a pulse oximeter and ventilator connected to the animal. Statistical comparison were performed using linear regression and Bland-Altman plots to analyze agreement of methods. Results: The heart rate as measured by the pulse oximeter was correlated to the rate reported by RespiHeart. The R 2 was 0.9946 with a p-value of less than 0.0001. Bland-Altman analysis of heart rate revealed a bias of-0.06127 (95% CI-2.219-2.097). The respiratory rate as set on the ventilator was correlated to the rate reported by RespiHeart. The R 2 was 0.9978 with a p-value of less than 0.0001. Bland-Altman analysis of respiratory rate revealed a bias of-0.008584 (95% CI-0.42-0.4028). Conclusion: The results obtained in this study demonstrate a high degree of correlation between the data obtained from RespiHeart and the pulse oximeter and ventilator. This renders RespiHeart as a promising device for prehospital use.
The Japanese Journal of Thoracic and Cardiovascular Surgery, 2001
Sinus rhythm gained after the Cox/maze procedure concomitant with mitral valve operation has demo... more Sinus rhythm gained after the Cox/maze procedure concomitant with mitral valve operation has demonstrated long-term attrition during the follow-up, no information exists on whether the type of mitral valve operation-(repair vs. replacement)-affects this sinus rhythm maintenance rate. We retrospectively studied patients undergoing concomitant mitral valve operation and Cox/maze procedure to answer this question. Methods: Between April 1993 and August 1995, 87 consecutive patients-35 men and 52 women (mean age: 59.3 years)-with chronic atrial fibrillation and mitral valve disease underwent the modified Cox/maze procedure and concomitant mitral valve operation, with 56 having mitral valve repair (repair group) and 31 mitral valve replacement (replacement group). Patients were followed up and changes in rhythm studied retrospectively. Results: Follow-up for a mean 51.3 ± 11.6 months was completed in 82 of 83 long-term survivors (99%). Repair group surgery survival was 98.1 ± 1.9% at 1 year and 94.2 ± 3.2% at 5 based on the Kaplan-Meier method. Replacement group surgery survival was 85.7 ± 5.9% at 1 year and 82.9 ± 6.4% at 5. Probability in sinus rhythm maintenance for the repair group at 1 year was 88.6 ± 5.4% and at 5 years was 67.6 ± 9.1%. Probability in sinus rhythm maintenance for the replacement group at 1 year was 95.7 ± 4.3% and at 5 years was 65.0 ± 11.1%. Conclusions: Medium-term results after the Cox/maze III procedure concomitant with mitral valve operation are good. The attrition of sinus rhythm maintenance appears similar by the completion of 5-year follw-up.
The Journal of Japanese College of Angiology, 2013
A 74-year-old man presented with intermittent claudication in his right leg. Endovascular treatme... more A 74-year-old man presented with intermittent claudication in his right leg. Endovascular treatment using metallic stents was performed for occlusion of his right common iliac arterial aneurysm and right external iliac artery. Soon after endovascular treatment, the aneurysm rapidly increased in size and a diagnosis of impending rupture was made. He was treated surgically using a bifurcated graft. Metallic stenting is a risky treatment in cases with ischemia caused by thrombosed aneurysm.
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Papers by Tetsunori KAWASE