AbstractRecently, patients with out-of-hospital cardiac arrest (OHCA) refractory to conventional resuscitation have started undergoing extracorporeal cardiopulmonary resuscitation (ECPR). However, the mortality rate of these patients remains high. This study aimed to clarify whether a center ECPR volume was associated with the survival rates of adult patients with OHCA resuscitated using ECPR. This was a secondary analysis of a retrospective multicenter registry study, the SAVE-J II study, involving 36 participating institutions in Japan. Centers were divided into three groups according to the tertiles of the annual average number of patients undergoing ECPR: high-volume (≥ 21 sessions per year), medium-volume (11–20 sessions per year), or low-volume (< 11 sessions per year). The primary outcome was survival rate at the time of discharge. Patient characteristics and outcomes were compared among the three groups. Moreover, a multivariable-adjusted logistic regression model was applied to study the impact of center ECPR volume. A total of 1740 patients were included in this study. The center ECPR volume was strongly associated with survival rate at the time of discharge; furthermore, survival rate was best in high-volume compared with medium- and low-volume centers (33.4%, 24.1%, and 26.8%, respectively; P = 0.001). After adjusting for patient characteristics, undergoing ECPR at high-volume centers was associated with an increased likelihood of survival compared to middle- (adjusted odds ratio 0.657; P = 0.003) and low-volume centers (adjusted odds ratio 0.983; P = 0.006). The annual number of ECPR sessions was associated with favorable survival rates and lower complication rates of the ECPR procedure.Clinical trial registration: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041577 (unique identifier: UMIN000036490).

Background: The Traumatic Bleeding Severity Score (TBSS) was developed to predict the need for massive transfusion (MT). The aim of this study was to conduct the first external validation study about the TBSS in Japan, and to compare its prediction value to other pre-existing MT prediction scores. Methods: A multicenter retrospective observational study was conducted in Japan (Japanese observational study for coagulation and Thrombolysis in Early Trauma 2 : J-OCTET 2). Twenty-five tertiary critical care centers in Japan participated in this study, and severe trauma patients (Injury Severity Score : ISS ≥ 16) admitted from 2018 to 2019 were enrolled. At the analysis of the TBSS external validation, patients with isolated head injuries were excluded from the analysis. In this study, MT was defined as 10 units or more of red blood cells transfusion within 24 hours from injuries. The TBSS on admission was retrospectively calculated and its accuracy in predicting MT was analyzed by the area under the receiver operating characteristic curve (AUROC). To compare the predictive value between the TBSS and the pre-existing scores, the Trauma Associated Severe Hemorrhage score (TASH score) and the Assessment of Blood Consumption score (ABC score) on admission was similarly calculated, and the ROC comparison analysis was performed. Results: Totally, 1202 severely injured trauma patients were enrolled in the J-OCTET 2 study, and 889 patients were analyzed after the matching of the exclusion criteria. The median age was 66 years (IQR: 47-77), 71.4 % was male, 97.9% was blunt trauma, median ISS was 22 (IQR:16-29), and 13.8% received MT. The AUROC of the TBSS for was 0.848 (95% CI:0.81-0.88). According to the ROC comparison, the AUROC of the TASH score was 0.848 (95% CI: 0.81-0.88) and there was no significant difference between both prediction scores. (Bonferroni adjusted p=1.00). The AUROC of the ABC score was 0.751(95% CI: 0.70-0.80), which was significantly lower to TBSS’s (Bonferroni adjusted p<0.01). Conclusion: This TBSS external validation study showed that the accuracy of TBSS in the MT prediction was moderate accuracy. The predictive value of the TBSS was comparable to that of the TASH score and superior to the ABC score.

Background Risk stratification is important in patients with post–cardiac arrest syndrome. The Post‐Cardiac Arrest Syndrome for Therapeutic Hypothermia (CAST) and revised CAST (rCAST) scores have been well validated for predicting neurological outcomes, particularly for conventionally resuscitated patients with post–cardiac arrest syndrome. However, no studies have evaluated patients undergoing extracorporeal cardiopulmonary resuscitation. Methods and Results Adult patients with out‐of‐hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation were analyzed in this retrospective observational multicenter cohort study. We validated the accuracy of the CAST/rCAST scores for predicting neurological outcomes at 30 days. Moreover, we compared the predictive performance of these scores with the TiPS65 risk score derived from patients with out‐of‐hospital cardiac arrest who were resuscitated using extracorporeal cardiopulmonary resuscitation. A total of 1135 patients were analyzed. The proportion of patients with favorable neurological outcomes was 16.6%. In the external validation, the area under the receiver operating characteristic curve of the CAST score was significantly higher than that of the rCAST score (area under the receiver operating characteristic curve 0.677 versus 0.603; P<0.001), but there was no significant difference with that of the TiPS65 score (versus 0.633; P=0.154). Both CAST/rCAST risk scores showed good calibration (Hosmer–Lemeshow test: P=0.726 and 0.674), and the CAST score showed significantly better predictability in net reclassification compared with the rCAST (P<0.001) and TiPS65 scores (P=0.001). Conclusions The prognostic accuracy of the CAST score was significantly better than that of other risk scores in net reclassification. The CAST score may help to predict neurological outcomes in patients with out‐of‐hospital cardiac arrest who undergo extracorporeal cardiopulmonary resuscitation. However, the predictive value of the CAST score was not sufficiently high for clinical application. Registration URL: https://center6.umin.ac.jp/cgi‐open‐bin/ctr_e/ctr_view.cgi?recptno=R000041577; Unique identifier: UMIN000036490.

Lacosamide is an antiepileptic drug that acts on voltage-gated sodium channels and was approved as an antiepileptic by the Food and Drug Administration in 2008. Although the efficacy and safety of lacosamide have been established in many previous trials, some case reports have shown that it may lead to cardiovascular side effects, especially in patients with electrical conduction system disorders. We herein report a case of life-threatening cardiac arrhythmia caused by lacosamide intoxication that was successfully treated with veno-arterial extracorporeal membrane oxygenation.

A preliminary report from a global study showed that remdesivir, a nucleoside analog pro-drug that was originally developed as a therapeutic drug against Ebola virus, may exert clinical efficacy in cases of COVID-19, by shortening the time to recovery. We had the opportunity to use this new drug in the treatment of 7 COVID-19 patients with respiratory failure.

A 90-year-old woman prescribed with apixaban was admitted to a hospital after a ground-level fall. She was transferred to our hospital for advanced evaluation and treatment. Contrast-enhanced computed tomography showed a pseudoaneurysm inside the right gluteus maximus muscle. Angiography revealed an aneurysm of the peripheral branch of the inferior gluteal artery and multiple slight pseudoaneurysms of the peripheral branch of the internal iliac artery. We performed transcatheter arterial embolization using a gelatin sponge. After embolization, the hemoglobin stabilized. She was transferred to another hospital for rehabilitation. The use of direct oral anticoagulants in the elderly can lead to significant hemorrhage with minimal trauma. Transcatheter arterial embolization is a minimally invasive and safe procedure for such cases of trauma.