論文 - 山元　良

Veno-arterial extracorporeal membrane oxygenation uses in trauma: a retrospective analysis of the Japanese nationwide trauma registry

Akutsu T., Endo A., Yamamoto R., Yamakawa K., Suzuki K., Hoshi H., Otomo Y., Morishita K.

BMC Emergency Medicine 24 （ 1 ） 179 2024年12月

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Background: Extracorporeal membrane oxygenation (ECMO) can provide temporary circulatory support and vital organ oxygenation and is potentially useful as a bridge therapy in some trauma cases. We aimed to demonstrate the characteristics and outcomes of patients with trauma treated with veno-arterial ECMO (V-A ECMO) using data from a Japanese nationwide trauma registry. Methods: This retrospective descriptive study analyzed data from the Japan Trauma Data Bank between January 2019 and December 2021. Patients with severe trauma (injury severity score [ISS] ≥ 9) and treated using V-A ECMO were assessed. Results: Among the 72,439 patients with severe trauma, 51 received V-A ECMO. Sixteen patients (31.3%) survived until hospital discharge. On hospital arrival, six (37.5%) survivors and 15 (42.9%) non-survivors experienced cardiac arrest. The median ISS for the survivor and non-survivor group was 25 (range, 25–39) and 25 (range, 17–33), respectively. Thoracic trauma was the most common type of trauma in both groups. In the non-survivor group, open-chest cardiopulmonary resuscitation, aortic cross-clamping, and resuscitative endovascular balloon occlusion of the aorta were performed in 10 (28.6%), 5 (14.3%), and 4 (11.4%) patients, respectively. However, these procedures were not performed in the survivor group. Peripheral oxygen saturation tended to be lower in the survivor group both before and upon arrival at the hospital. Conclusions: The results of this study suggest the potential benefit of V-A ECMO in some challenging trauma cases. Further studies are warranted to assess the indications for V-A ECMO in patients with trauma.

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Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for trauma and its performance in Japan over the past 18 years: a nationwide descriptive study

Hoshi H., Endo A., Yamamoto R., Yamakawa K., Suzuki K., Akutsu T., Morishita K.

World Journal of Emergency Surgery 19 （ 1 ） 19 2024年12月

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Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to control massive hemorrhages. Although there is no consensus on the efficacy of REBOA, it remains an option as a bridging therapy in non-trauma centers where trauma surgeons are not available. To better understand the current landscape of REBOA application, we examined changes in its usage, target population, and treatment outcomes in Japan, where immediate hemostasis procedures sometimes cannot be performed. Methods: This retrospective observational study used the Japan Trauma Data Bank data. All cases in which REBOA was performed between January 2004 and December 2021 were included. The primary outcome was the in-hospital mortality rate. We analyzed mortality trends over time according to the number of cases, number of centers, severity of injury, and overall and subgroup mortality associated with REBOA usage. We performed a logistic analysis of mortality trends over time, adjusting for probability of survival based on the trauma and injury severity score. Results: Overall, 2557 patients were treated with REBOA and were deemed eligible for inclusion. The median age of the participants was 55 years, and male patients constituted 65.3% of the study population. Blunt trauma accounted for approximately 93.0% of the cases. The number of cases and facilities that used REBOA increased until 2019. While the injury severity score and revised trauma score did not change throughout the observation period, the hospital mortality rate decreased from 91.3 to 50.9%. The REBOA group without severe head or spine injuries showed greater improvement in mortality than the all-patient group using REBOA and all-trauma patient group. The greatest improvement in mortality was observed in patients with systolic blood pressure ≥ 80 mmHg. The adjusted odds ratios for hospital mortality steadily declined, even after adjusting for the probability of survival. Conclusions: While there was no significant change in patient severity, mortality of patients treated with REBOA decreased over time. Further research is required to determine the reasons for these improvements in trauma care.

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Differences in outcomes of patients with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation between day-time and night-time

Koguchi H., Takayama W., Otomo Y., Morishita K., Inoue A., Hifumi T., Sakamoto T., Kuroda Y., Senda A., Suzuki H., Tanimoto A., Kitagawa K., Katayama Y., Igarashi N., Kawano M., Kuroki Y., Umehara T., Sasaki Y., Tominaga N., Hamaguchi T., Sakai T., Abe T., Hanafusa H., Yamaoka Y., Kakizaki Y., Sakato S., Kashiwabara S., Kadoya T., Misumi K., Kobayashi T., SouYamada , Kobayashi M., Akashi N., Kuno M., Maruyama J., Kobata H., Soh M., Shirasaki K., Shiba D., Isokawa S., Uchida M., Sakurai A., Tatsukawa H., Nishikawa M., Kojima M., Kosaki R., Shimazui T., Kinoshita H., Sawada Y., Yamamoto R., Masuzawa Y., Matsumura K., Shimazaki J.

Scientific Reports 14 （ 1 ）  2024年12月

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Although patients who underwent night-time resuscitation for out-of-hospital cardiac arrest (OHCA) had worse clinical outcomes than those who underwent day-time resuscitation, the differences between the outcomes of patients with OHCA who underwent extracorporeal cardiopulmonary resuscitation (ECPR) in the day-time and night-time remain unclear. We analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan. Patients were categorized according to whether they received treatment during the day-time or night-time. The primary outcomes were survival to hospital discharge and favorable neurological outcome at discharge, and the secondary outcomes were estimated low-flow time, implementation time of ECPR, and complications due to ECPR. A multivariate logistic regression model adjusted for confounders was used for comparison. Among the 1644 patients, the night-time patients had a significantly longer ECMO implementation time and estimated low-flow time than the day-time patients, along with a significantly higher number of complications than the day-time patients. However, the survival and neurologically favorable survival rates did not differ significantly between the groups. Thus, although patients who underwent ECPR at night had an increased risk of longer implementation time and complications, their clinical outcomes did not differ from those who underwent day-time ECPR.

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Association between preoperative lactate level and early complications after surgery for isolated extremity fracture

Nishida Y., Yamamoto R., Ono S., Sasaki J.

BMC Musculoskeletal Disorders 25 （ 1 ） 314 2024年12月

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Background: The role of lactate level in selecting the timing of definitive surgery for isolated extremity fracture remains unclear. Therefore, we aimed to elucidate the use of preoperative lactate level for predicting early postoperative complications. Methods: This was a single-center retrospective observational study of patients with isolated extremity fracture who underwent orthopedic surgery. Patients who underwent lactate level assessment within 24 h prior to surgery were included. The incidence of early postoperative complications was compared between patients with a preoperative lactate level of ≥ 2 and < 2 mmol/L. Moreover, subgroup analyses were performed based on the time from hospital arrival to surgery and fracture type. Results: In total, 187 patients were included in the study. The incidence of postoperative complications was significantly higher in patients with a preoperative lactate level of ≥ 2 mmol/L than those with a preoperative lactate level of < 2 mmol/L. This result did not change after adjusting for age and severity. Further, a high preoperative lactate level was associated with a greater incidence of postoperative complications in patients who underwent definitive surgery within 6 h after arrival. Conclusion: A preoperative lactate level of ≥ 2 mmol/L was associated with a greater incidence of early postoperative complications in isolated extremity fractures. Nevertheless, this correlation was only observed among patients who underwent definitive fixation within 6 h after hospital arrival.

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Prehospital endotracheal intubation for traumatic out-of-hospital cardiac arrest and improved neurological outcomes.

Yamamoto R, Suzuki M, Takemura R, Sasaki J

Emergency medicine journal : EMJ 2024年11月

ISSN  1472-0205

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Effect of intravenous thiamine administration on critically ill patients: A systematic review and meta-analysis of randomized controlled trials

Nakanishi N., Abe Y., Matsuo M., Tampo A., Yamada K., Hatakeyama J., Yoshida M., Yamamoto R., Higashibeppu N., Nakamura K., Kotani J.

Clinical Nutrition 43 （ 11 ） 1 - 9 2024年11月

ISSN  02615614

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Background &Aims: Thiamine is an essential micronutrient for energy metabolism. Thiamine deficiency is frequently observed in critically ill patients. However, the effect of thiamine administration is unclear in critically ill patients. Methods: We conducted a systematic review and meta-analysis. To identify randomized controlled trials on the effect of thiamine administration in critically ill patients, a literature search was conducted in MEDLINE, CENTRAL, and ICHUSHI databases from inception to April 2023. Pooled effect estimates were calculated about mortality as the primary outcome and shock duration, lactate level, Sequential Organ Failure Assessment (SOFA) score, delirium, length of mechanical ventilation, length of intensive care unit (ICU) stay, infection rate, all adverse events, and Short-Form Health Survey (SF-36) as the secondary outcomes. The certainty of evidence (CoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: Overall, 35 studies (3494 patients) were included. Evidence suggested that thiamine administration resulted in little to no difference in mortality (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.75 to 1.06; Low CoE); however, thiamine administration may reduce shock duration (mean difference [MD], −11.43 h; 95% CI, −20.16 to −2.69 h; Low CoE), lactate level (MD, −0.34 mmol/L; 95% CI, −0.63 to −0.05 mmol/L; Low CoE), and SOFA score (MD, −1.29; 95% CI, −1.91 to −0.66; Low CoE). Conversely, thiamine administration resulted in a slight increase in the length of ICU stay (MD, 0.40 days; 95% CI, 0.01–0.79 days; High CoE). Conclusions: Although thiamine administration may reduce shock state, it may not reduce mortality, and slightly increases the length of ICU stay.

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Effects of high-fat, low-carbohydrate enteral nutrition in critically ill patients: A systematic review with meta-analysis

Ohbe H., Yoshida M., Okada K., Inoue T., Yamada K., Nakamura K., Yamamoto R., Nozaki A., Higashibeppu N., Kotani J.

Clinical Nutrition 43 （ 10 ） 2399 - 2406 2024年10月

ISSN  02615614

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Background & aims: High-fat, low-carbohydrate enteral nutrition has gained attention, with expectations of an improved respiratory condition, fewer complications, and lower mortality. The present study performed a systematic review and meta-analysis of randomized controlled trials to examine the effects of high-fat, low-carbohydrate enteral nutrition in critically ill adult patients. Methods: We searched MEDLINE via Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), and ICHUSHI for randomized controlled trials comparing high-fat, low-carbohydrate enteral nutrition to standard enteral nutrition in critically ill adult patients who received enteral nutrition. The primary outcome was mortality. Secondary outcomes included intensive care unit (ICU) mortality, length of ICU stay, length of mechanical ventilation, and adverse events of diarrhea and gastric residual volume. We examined the risk of bias using the Cochrane risk-of-bias tool for randomized trials version 2. We assessed the overall certainty of evidence based on the Grading of Recommendations Assessment, Development, and Evaluation methodology. Synthesis results were calculated with risk ratios and 95% confidence intervals using a Mantel-Haenszel random-effects model. Results: Eight trials with 607 patients were included. The effects of high-fat, low-carbohydrate enteral nutrition on mortality did not significantly differ from those of standard enteral nutrition (62/280 [22.1%] vs. 39/207 [18.8%], risk ratios = 1.14, 95% confidence intervals 0.80 to 1.62, P = 0.47). No significant differences were observed in ICU mortality, ICU length of stay, diarrhea, or gastric residual volume between the two groups. However, high-fat, low-carbohydrate enteral nutrition was associated with a significantly shorter duration of mechanical ventilation (mean difference −1.72 days, 95% confidence intervals −2.93 to −0.50, P = 0.005). Conclusion: High-fat, low-carbohydrate enteral nutrition may not affect mortality, but may decrease the duration of mechanical ventilation in critically ill adult patients. Limitations include the small number of studies and potential for bias. Further research is needed to confirm these results and investigate effects on other outcomes and in a subgroup of patients requiring mechanical ventilation.

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特集 内科医が知っておくべきICU・ERでの薬の使い方 血液 止血製剤

山元 良

medicina （株式会社医学書院）  61 （ 10 ） 1692 - 1695 2024年09月

ISSN  00257699

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Simple severity scale for perforated peptic ulcer with generalized peritonitis: A derivation and internal validation study.

Yamamoto R, Hirakawa S, Tachimori H, Matsuoka T, Kikuchi H, Hasegawa H, Shirabe K, Kakeji Y, Kawakubo H, Kitagawa Y, Sasaki J

International journal of surgery (London, England) 110 （ 11 ） 7134 - 41 2024年08月

ISSN  1743-9191

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Quality indicators for integrating oncology and home palliative care in Japan: modified Delphi study.

Hasegawa T, Ochi T, Yamagishi A, Akechi T, Urakubo A, Sugishita A, Yamamoto R, Kubota Y, Shimoyama S

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 32 （ 7 ） 476 2024年07月

ISSN  0941-4355

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Door-to-Needle Time for Extracorporeal Cardiopulmonary Resuscitation and Neurological Outcomes in Out-of-Hospital Cardiac Arrest: A Nationwide Study

Yamamoto R., Kaito D., Homma K., Inoue A., Hifumi T., Sakamoto T., Kuroda Y., Sasaki J.

Journal of the American Heart Association 13 （ 12 ） e034971 2024年06月

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BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is an option for refractory cardiac arrest, and immediate initiation after indication is recommended. However, the practical goals of ECPR preparation (such as the door-to-needle time) remain unclear. This study aimed to elucidate the association between the door-to-needle time and neurological outcomes of out-of-hospital cardiac arrest. METHODS AND RESULTS: This is a post hoc analysis of a nationwide multicenter study on out-of-hospital cardiac arrest treated with ECPR at 36 institutions between 2013 and 2018 (SAVE-J [Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan] II study). Adult patients without hypothermia (≥32 °C) in whom circulation was not returned at ECPR initiation were included. The probability of favorable neurological function at 30 days (defined as Cerebral Performance Category ≤2) was estimated using a generalized estimating equations model, in which institutional, patient, and treatment char-acteristics were adjusted. Estimated probabilities were then calculated according to the door-to-needle time with 3-minute incre-ments, and a clinical threshold was assumed. Among 1298 patients eligible for this study, 136 (10.6%) had favorable neurological function. The estimated probability of favorable outcomes was highest in patients with 1 to 3 minutes of door-to-needle time (12.9% [11.4%–14.3%]) and remained at 9% to 10% until 27 to 30 minutes. Then, the probability dropped gradually with each 3-minute delay. A 30-minute threshold was assumed, and shorter door-to-extracorporeal membrane oxygenation/low-flow time and fewer adverse events related to cannulation were observed in patients with door-to-needle time <30 minutes. CONCLUSIONS: The probability of favorable functions after out-of-hospital cardiac arrest decreased as the door-to-needle time for ECPR was prolonged, with a rapid decline after 27 to 30 minutes. REGISTRATION: URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041577; Unique identifier: UMIN000036490.

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Simple parameters to identify patients treatable with early definitive fixation: A nationwide study

Udagawa K., Yamamoto R., Shimatani N., Nishida Y., Ono S., Niki Y., Sasaki J.

Injury 55 （ 6 ） 111117 2024年06月

ISSN  00201383

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Introduction: Early appropriate care (EAC) is widely accepted as a safe strategy to perform early definitive fracture fixation, and good clinical outcomes have been reported in selected, multiply injured patients, although the optimal candidate for early definitive fixation (EDF) has not been validated. The aim of this study was to identify simple clinical parameters to help select patients who could undergo EDF. Methods: Patients with extremity injuries who underwent open reduction and internal fixation were retrospectively identified, using data from the Japan Trauma Data Bank (JTDB). Age, vital signs on hospital presentation, and the injury severity score (ISS) were examined by transforming these variables to binary categories. Patients were divided into categories based on these variables, and in-hospital mortality was compared between patients treated with EDF (EDF group) and those treated without EDF (non-EDF group) in each category. Results: Of the 12,735 patients who were eligible for the analyses, 3706 (29.1 %) were managed with EDF. In-hospital mortality was significantly higher in the EDF group than in the non-EDF group among patients with a low Glasgow Coma Scale (GCS) score (<13), low systolic blood pressure (sBP) (<90 mmHg), and ISS≥15, whereas in-hospital mortality was comparable between the EDF and non-EDF groups among patients with GCS scores ≥13, sBP ≥90 mmHg, and ISS <15. Discussion: In this large nationwide database of trauma patients, EDF was performed without affecting mortality in patients with GCS scores ≥13 and sBP ≥90 mmHg on hospital presentation, as well as ISS <15. These parameters might be useful as screening tools to select the candidates who could be treated with EDF safely.

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Effects of Energy Delivery Guided by Indirect Calorimetry in Critically Ill Patients: A Systematic Review and Meta-Analysis

Watanabe S., Izumino H., Takatani Y., Tsutsumi R., Suzuki T., Tatsumi H., Yamamoto R., Sato T., Miyagi T., Miyajima I., Nakamura K., Higashibeppu N., Kotani J.

Nutrients 16 （ 10 ）  2024年05月

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BACKGROUND: The utility of using indirect calorimetry (IC) to estimate energy needs and methods for its application to this purpose remain unclear. This systematic review investigated whether using IC to estimate energy expenditure in critically ill patients is more meaningful for improving survival than other estimation methods. METHODS: Comprehensive searches were conducted in MEDLINE using PubMed, Cochrane Central Register of Controlled Trials, and Igaku-Chuo-Zasshi up to March 2023. RESULTS: Nine RCTs involving 1178 patients were included in the meta-analysis. The evidence obtained suggested that energy delivery by IC improved short-term mortality (risk ratio, 0.86; 95% confidence interval [CI], 0.70 to 1.06). However, the use of IC did not appear to affect the length of ICU stay (mean difference [MD], 0.86; 95% CI, -0.98 to 2.70) or the duration of mechanical ventilation (MD, 0.66; 95% CI, -0.39 to 1.72). Post hoc analyses using short-term mortality as the outcome found no significant difference by target calories in resting energy expenditure, whereas more frequent IC estimates were associated with lower short-term mortality and were more effective in mechanically ventilated patients. CONCLUSIONS: This updated meta-analysis revealed that the use of IC may improve short-term mortality in patients with critical illness and did not increase adverse events.

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Steroid therapy for patients with septic shock: A multicenter observational study conducted in Japan.

Murata M, Shimizu S, Yamamoto R, Kamitani T, Yamazaki H, Ogawa Y, Fukuhara S, Yasuda H, Yamamoto Y, AMOR-VENUS study group

Internal medicine (Tokyo, Japan) 2024年05月

ISSN  0918-2918

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Impact of antithymocyte globulin usage and risk stratification for posttransplant lymphoproliferative disorders in aplastic anemia patients after allogeneic hematopoietic cell transplantation.

Yamamoto R, Hiramoto N, Fujimoto A, Yamazaki H, Mori T, Uchida N, Doki N, Kato J, Nishikubo M, Kako S, Nishida T, Ota S, Onizuka M, Eto T, Onodera K, Ikegame K, Matsuoka KI, Kanda Y, Fukuda T, Atsuta Y, Onishi Y

Bone marrow transplantation 59 （ 5 ） 688 - 691 2024年05月

ISSN  0268-3369

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Special feature 医療従事者を守る職業感染制御の再点検 ■領域別スタッフの曝露対策のポイント　❶救急外来・手術室

山下 幾太郎, 山元 良, 佐々木 淳一

感染対策ICTジャーナル （(株)ヴァンメディカル）  19 （ 2 ） 125 - 130 2024年04月

ISSN  18814964

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Components and Delivery Formats of Cognitive Behavioral Therapy for Chronic Insomnia in Adults: A Systematic Review and Component Network Meta-Analysis.

Furukawa Y, Sakata M, Yamamoto R, Nakajima S, Kikuchi S, Inoue M, Ito M, Noma H, Takashina HN, Funada S, Ostinelli EG, Furukawa TA, Efthimiou O, Perlis M

JAMA psychiatry 81 （ 4 ） 357 - 365 2024年04月

ISSN  2168-622X

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Delta Shock Index and higher incidence of emergency surgery in older adults with blunt trauma

Funabiki S., Yamamoto R., Homma K., Yoshizawa J., Jia S., Takanashi Y., Kahara R., Sasaki J.

European Journal of Trauma and Emergency Surgery 50 （ 2 ） 561 - 566 2024年04月

ISSN  18639933

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Purpose: Vital signs are important for predicting clinical outcomes in patients with trauma. However, their accuracy can be affected in older adults because hemodynamic changes are less obvious. This study aimed to examine the usefulness of changes in vital signs during transportation in predicting the need for hemostatic treatments in older patients with trauma. Methods: This retrospective cohort study was conducted using data from the Japan Trauma Data Bank (2004–2019). Patients aged ≥ 65 years who were hemodynamically stable at the scene were included in this study. The incidence of emergency surgery within 12 h after hospital arrival was compared between patients with delta Shock Index (dSI) > 0.1 and those with dSI ≤ 0.1. Predicting ability was examined after adjusting for patient demographics, comorbidities, vital signs at the scene and on hospital arrival, Injury Severity Score, and abbreviated injury scale in each region. Results: Among the 139,242 patients eligible for the study, 3,701 underwent urgent hemostatic surgery within 12 h. Patients with dSI > 0.1 showed a significantly higher incidence of emergency surgery than those with dSI ≤ 0.1 (871/16,549 [5.3%] vs. 2,830/84,250 [3.4%]; odds ratio (OR), 1.60 [1.48–1.73]; adjusted OR, 1.22 [1.08–1.38]; p = 0.001). The relationship between high dSI and a higher incidence of intervention was observed in patients with hypertension and those with decreased consciousness on arrival. Conclusion: High dSI > 0.1 was significantly associated with a higher incidence of urgent hemostatic surgery in older patients.

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Immediate Angiography and Decreased In-Hospital Mortality of Adult Trauma Patients: A Nationwide Study

Yamamoto R., Maeshima K., Funabiki T., Eastridge B.J., Cestero R.F., Sasaki J.

CardioVascular and Interventional Radiology 47 （ 4 ） 472 - 480 2024年04月

ISSN  01741551

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Purpose: This study aimed to elucidate whether immediate angiography within 30 min is associated with lower in-hospital mortality compared with non-immediate angiography. Materials and Methods: We conducted a retrospective cohort study using a nationwide trauma databank (2019–2020). Adult trauma patients who underwent emergency angiography within 12 h after hospital arrival were included. Patients who underwent surgery before angiography were excluded. Immediate angiography was defined as one performed within 30 min after arrival (door-to-angio time ≤ 30 min). In-hospital mortality and non-operative management (NOM) failure were compared between patients with immediate and non-immediate angiography. Inverse probability weighting with propensity scores was conducted to adjust patient demographics, injury mechanism and severity, vital signs on hospital arrival, and resuscitative procedures. A restricted cubic spline curve was drawn to reveal survival benefits by door-to-angio time. Results: Among 1,455 patients eligible for this study, 92 underwent immediate angiography. Angiography ≤ 30 min was associated with decreased in-hospital mortality (5.0% vs 11.1%; adjusted odds ratio [OR], 0.42 [95% CI, 0.31–0.56]; p < 0.001), as well as lower frequency of NOM failure: thoracotomy and laparotomy after angiography (0.8% vs. 1.8%; OR, 0.44 [0.22–0.89] and 2.6% vs. 6.5%; OR, 0.38 [0.26–0.56], respectively). The spline curve showed a linear association between increasing mortality and prolonged door-to-angio time in the initial 100 min after arrival. Conclusion: In trauma patients, immediate angiography ≤ 30 min was associated with lower in-hospital mortality and fewer NOM failures. Level of Evidence: Level 3b, non randomized controlled cohort/follow up study. Graphical Abstract: (Figure presented.).

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尿酸クリアランスと院外心停止後の予後の関連 SOS-KANTO 2017 Study

多村 知剛, 山元 良, 本間 康一郎, 北村 伸哉, 野村 智久, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 佐々木 淳一

日本救急医学会関東地方会雑誌 （日本救急医学会-関東地方会）  45 （ 1 ） 80 - 80 2024年02月

ISSN  0287-301X