Aims: There are no specific criteria or protocols for extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA). Our hospital established criteria and protocols to introduce ECPR in August 2018, and in this study, we conducted an investigation on it.

Method: We retrospectively reviewed 57 cases of OHCA in which ECPR was performed at our hospital from August 2018 to March 2023.

Results: At the time of discharge, the survival group included 21 patients (37%) and the good neurological prognosis group included 10 patients (28%). The survival group had more cardiac arrests occurring in public places, more cases of ventricular fibrillation (VF)/pulseless ventricular tachycardia (pVT) at arrival, shorter arrival-to-ECPR and call-to-ECPR times, and better pH and pCO₂ values on arrival. Patients in the good neurological prognosis group were younger and had more VF/pVT on arrival, shorter call-to-ECPR times, and better pH and pCO₂ values on arrival. In addition, specific actions by emergency technicians (EMTs) lengthened the call-to-arrival time.

Conclusion: Shortening the call-to-ECPR time is important for improving ECPR prognosis. Specific actions by EMTs for VF/pVT on initial electrocardiography lengthen the call-to-arrival time, which is unfavorable. ECPR with a focus on early transport without specific actions by EMTs may lead to improved prognosis.

The proportion of elderly individuals in Japan is expected to continue rising, suggesting that opportunities for older adults to act as bystanders and perform cardiopulmonary resuscitation (CPR) at home will increase. However, few medical studies in Japan have focused specifically on the quality of chest compressions performed by elderly individuals. This cross-sectional study aimed to examine the relationship between physical characteristics and the depth of chest compressions delivered by older adults. A total of 156 citizens aged 65 and over who participated in a physical fitness assessment in Yasu City, Shiga Prefecture, were enrolled. Participants who achieved an average compression depth of ≥5 cm were classified into the “effective” group, and associations with body weight and grip strength were analyzed. The results indicated that grip strength was significantly associated with effective chest compression, with a cutoff value of 23.1 kg. Body weight was also significantly higher in the effective group, suggesting a contribution to adequate compression depth. These findings imply that grip strength and body weight may serve as key indicators of chest compression quality. Therefore, CPR training and support for elderly individuals should take such physical characteristics into consideration.

Objective: To analyze how participants of the Prehospital Emergency Medical Evaluation and Care (PEMEC) course perceive its content.

Methods: A survey was conducted among PEMEC participants from October 2023 to February 2024. Open-ended responses were collected regarding their reasons for overall evaluation and willingness to recommend the course. Text mining was performed using KH Coder software, employing co-occurrence network and correspondence analyses.

Results: A total of 435 out of 633 participants responded. The analysis revealed that many participants recognized the course as enabling practical use of the PEMEC algorithm in the field and expressed willingness to recommend it to colleagues. In the group that rated the course as “good,” active terms such as “learn,” “think,” and “connect” were frequently observed. Participants with less than 5 years of experience tended to emphasize learning opportunities, those with 5-15 years highlighted practical methods, and those with over 15 years referred to clinical decision-making.

Conclusion: PEMEC was perceived as a useful educational program for field practice. Future challenges include optimizing educational strategies based on participants’ years of clinical experience.

Objective: This study aimed to clarify the characteristics and prehospital management of isolated facial injury cases in Japan.

Methods: A retrospective cohort study was conducted using data from the Japan Trauma Data Bank between January 2019 and December 2022. Descriptive analyses were performed on patient demographics, injury sites, prehospital interventions, and length of hospital stay.

Results: Of 133,384 registered cases, 1,013 met the criteria for isolated facial injuries and were included in the analysis. The most common mechanism of injury was blunt trauma (n = 926, 91.4%). The eye was the most frequently injured site (n = 342, 23.0%). Prehospital interventions included cervical collar application in 276 cases (27.7%) and backboard use in 229 cases (23.0%). Hospital stays of 1-7 days were most common (n = 550, 54.3%).

Conclusion: We clarified the background and trends of isolated facial trauma cases in Japan. Further consideration is needed regarding measures tailored to the characteristics of patients and methods to prevent secondary damage, with a view to improving the prognosis and functional recovery of patients with facial trauma.

A questionnaire survey was conducted to understand the current situation of female employees in the firefighting industry, an organization where the majority of employees are male. The survey included 16 questions such as “What were the difficulties of working in the emergency team?”, “What are the differences between male employees and emergency personnel?”, and “Do you feel it is difficult that the emergency team works 24 hours a day?”. The survey was conducted among 31 female employees with experience in the emergency team, and 25 of them responded (response rate: 80.6%). The survey results showed that the most common difficulty in field activities was “physical strength”, followed by “dispatch during menstruation”. When asked about the difference between male employees and emergency personnel, almost all employees felt that “the difference in physical strength between male employees and emergency personnel” was the most common difficulty. Sixteen employees (64%) felt that it was difficult to work in the emergency team 24 hours a day, and of these, seven (44%) were concerned about childcare. The results suggest that four countermeasures are needed: the introduction of equipment to supplement physical strength, devising working hours for daytime emergency personnel, etc., training role models, and regular opinion exchange meetings. The results of this study will help people understand female firefighters and lead to further promotion of female staff participation in the workforce. We will report the voices of female firefighters as they address the challenges they face in achieving work-life balance.

Background: We developed a system to provide online end-of-life care for patients and their families who were unable to visit in person due to COVID-19-related visiting restrictions, even during the final stages of life. We analyzed implementation process, the reactions from families and medical professionals, and report on the challenges ahead.

Method: Online end-of-life care was provided to patients assessed to be in the terminal stage. Information on the procedures, family reactions, and responses from attending nurses was extracted from nursing records and analyzed.

Results: The implementation rate of online end-of-life care was 73%. Participating family members commented that they were able to see the patient’s peaceful expression. Up to 130 nurses were involved per day. While many reported that they felt able to support the families, some noted difficulties in communication via the device.

Conclusion: It was suggested that the implementation of this system would support families in understanding the patient’s condition and meeting their needs, while also alleviating feelings of helplessness among nurses. As information and communication technologies continue to advance, such systems are expected to further expand the range of options available in medical care.

Purpose: To determine the actual knowledge, practice, and attitudes of physicians and nurses in an intensive care units (ICUs) regarding nutrition support therapy for critically ill patients and the factors associated with knowledge and practice.

Methods: In October 2022, a cross-sectional questionnaire survey was conducted on physicians and nurses affiliated with the ICU of University of Tsukuba Hospital. Questionnaire items were divided into knowledge, practice, and attitude aspects associated with nutritional therapy for critically ill patients; only the nurses answered the practice items.

Results: The questionnaire was distributed to 79 respondents, 54 of whom responded. Those with sufficient knowledge accounted for 50％ and those with sufficient practice accounted for 64％. The compliance with each practice was 80％. In terms of attitudes, less than half of the respondents had learned about and referred to nutrition therapy guidelines. Knowledge was weakly positively correlated with age and years of experience.

Conclusions: Among ICU physicians and nurses, only half had sufficient knowledge of nutritional therapy for critically ill patients, but compliance with practice was high. Less than half of the participants had actively learned about nutritional therapy and applied relevant guidelines. In the future, it will be necessary to disseminate knowledge of guidelines through educational programs and to improve knowledge, practice, and attitudes regarding nutritional therapy for critically ill patients.

Segmental arterial mediolysis (SAM) often causes intra-abdominal or retroperitoneal hemorrhage, but rarely gastrointestinal (GI) bleeding. A man in his 60s had melena 10 days prior and was subsequently transferred to a local emergency hospital 4 days prior because of immobility. Severe anemia was diagnosed, and contrast-enhanced computed tomography revealed a suspected hematoma around the pancreas and duodenum. Although upper GI endoscopy was performed, no obvious bleeding was observed. Consequently, the patient was transferred to our emergency center for further investigation. Angiography performed on the same day revealed an anterior inferior pancreaticoduodenal artery with an aneurysm and narrow irregular vessels, which was considered as a hemorrhage caused by SAM. Arterial embolization was performed, and hemostasis was achieved. No progression of anemia or rebleeding was observed after embolization; therefore the patient was transferred to his attending physician on the second day of his illness. In this case, the intestinal wall distal to the duodenum was thinning at the site of an extensive aneurysm, which ruptured and caused duodenal bleeding. This case indicates that SAM may be a possible cause for upper GI bleeding in which the source of bleeding cannot be identified by GI endoscopy, especially bleeding beyond the duodenum.