World Journal of Emergency Medicine

Bronchial artery embolization for hemoptysis: a consensus statement by the Chinese College of Interventionalists

Jianfei Tu, Zhongzhi Jia, Binyan Zhong, Bin Shen, Guodong Zhang, Dengke Zhang, Haipeng Yu, Yiping Chen, Xi Liu, Liming Wang, Gaojun Teng, Sen Jiang, Jiansong Ji, Clinical Guidelines Committee of Chinese College of Interventionalists

2025, 16(3): 197-205. doi:10.5847/wjem.j.1920-8642.2025.041

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The “SOOTEST-ICU” bundle for optimizing cerebral hypoxia and reperfusion to minimize brain injury after resuscitation from cardiac arrest

Rui Shao, Chenchen Hang, Xingsheng Wang, Luying Zhang, Fei Shao, Ziren Tang

2025, 16(3): 206-211. doi:10.5847/wjem.j.1920-8642.2025.050

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BACKGROUND: Post-cardiac arrest brain injury remains the leading cause of mortality and long-term disability in patients following cardiac arrest (CA). However, optimizing clinical management strategies for bundled therapy after CA still faces challenges.

METHODS: For this literature review, we searched PubMed, Web of Science, and SpringerLink databases for high-quality studies published between December 1982 and July 1, 2024. The search included randomized clinical trials, meta-analyses, systematic reviews, and observational studies. References in included studies were also checked to identify additional sources.

RESULTS: Many studies have identified potential targets for interventions to mitigate brain injury and improve outcomes for post-resuscitated patients. To optimize clinical management strategies to minimize brain injury after CA, we developed the acronym “SOOTEST-ICU” bundle, which includes “SOOTEST” therapy to optimize peripheral oxygen delivery and “ICU” intervention to optimize the cerebral oxygen cascade. The order of the “SOOTEST” treatment was organized based on the severity and importance of brain oxygen affecting brain injury. It includes systolic blood pressure and mean arterial pressure management, oxygenation and ventilation management, original etiological treatment, temperature control, electrolytes and acid basic status, seizure control, and targeted substrate delivery. The acronym “ICU” intervention includes intracerebral oxygen delivery, cerebral oxygen diffusion, and oxygen utilization.

CONCLUSION: The “SOOTEST-ICU” therapy is developed to optimize oxygen and substrate cascades to minimize brain injury after CA.

Lifelong training, retraining, reskilling, upskilling and knowledge gaps in emergency medicine: a cross-sectional survey study

George Briassoulis, Mina Argyrakopoulou, Dafni Korela, Sotiria Labrinaki, Artemis Nikiforou, Antonios Papoutsakis, Panagiotis Briassoulis, Marianna Miliaraki, George Notas, Stavroula Ilia

2025, 16(3): 212-219. doi:10.5847/wjem.j.1920-8642.2025.061

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BACKGROUND: Identifying and managing medical emergencies presents challenges in healthcare, where familiarity with established algorithms is essential for high-quality care. This study assessed healthcare professionals’ understanding of the latest resuscitation guidelines and explored their views on lifelong training models.

METHODS: This cross-sectional study used two multiple-choice questionnaires with 50 questions developed by academic emergency and critical care consultants based on the 2021 Consensus on Science with Treatment Recommendations (CoSTRs) by the International Liaison Committee on Resuscitation (ILCOR). Healthcare staff involved in emergency coverage completed assessments on emergency management, self-evaluated their knowledge, and shared perspectives on continuous workplace education.

RESULTS: Of the 1,427 distributed questionnaires, 1,034 (72.5%) were completed. Knowledge gaps were more pronounced for pediatric algorithms from the European Resuscitation Council (ERC) and American Heart Association (AHA) compared to adult protocols (P<0.001). In multivariate logistic regression, being a physician, holding a Master of Science (MSc) degree, and younger age were independently associated with passing scores ≥70% (all P<0.001). Most participants (97.3%) favored brief, employer-funded teamwork refresher sessions every 4-6 months over the current four-year training model (0.6%) (P<0.001).

CONCLUSION: This study highlights healthcare life support providers’ insufficient expertise in current resuscitation guidelines. The importance of short-format retraining, upskilling, and reskilling programs with post-training assessments is evident, as most respondents expressed a strong learning motivation to participate if employer-funded.

Development of an emergency department length-of-stay prediction model based on machine learning

Weiming Wu, Min Li, Huilin Jiang, Min Sun, Yongcheng Zhu, Gongxu Zhu, Yanling Li, Yunmei Li, Junrong Mo, Xiaohui Chen, Haifeng Mao

2025, 16(3): 220-224. doi:10.5847/wjem.j.1920-8642.2025.048

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BACKGROUND: The problem of prolonged emergency department length of stay (EDLOS) is becoming increasingly crucial. This study aims to develop a machine learning (ML) model to predict EDLOS, with EDLOS as the outcome variable and demographic characteristics, triage level, and medical resource utilization as predictive factors.

METHODS: A retrospective analysis was performed on the patients who visited the emergency department of the Second Affiliated Hospital of Guangzhou Medical University from March 2019 to September 2021, and a total of 321,012 cases were identified. According to the inclusion and exclusion criteria, 187,028 cases were finally included in the analysis. ML analysis was performed using R-squared (R²), and the predictive factors and the EDLOS were used as independent variables and dependent variables, respectively, to establish models. The performance evaluation of the ML models was conducted through the utilization of the mean absolute error (MAE), root mean square error (RMSE), and R², enabling an objective comparative analysis.

RESULTS: In the comparative analysis of the six ML models, light gradient boosting machine (LightGBM) model demonstrated the lowest MAE (443.519) and RMSE (826.783), and the highest R² value (0.48), indicating better model fit and predictive performance. Among the top 10 predictive factors associated with EDLOS according to the LightGBM model, the emergency waiting time, age, and emergency arrival time had the most significant impact on the EDLOS.

CONCLUSION: The LightGBM model suggests that the emergency waiting time, age, and emergency arrival time may be used to predict the EDLOS.

Risk factors for death in patients with acute diquat poisoning

Qing Tang, Hongxin Wang, Hao Wang, Jiaqi Xu, Xin Luo, Shuxin Hua, Lijun Wang, Yanfen Chai

2025, 16(3): 225-230. doi:10.5847/wjem.j.1920-8642.2025.040

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BACKGROUND: In recent years, with the ban on paraquat, the use of diquat (DQ) as a substitute has significantly increased, leading to a corresponding increase in DQ poisoning cases. This study aimed to identify relevant risk factors affecting patient prognosis and provide a basis for the assessment of patient prognosis.

METHODS: Patients with DQ poisoning were included from September 2020 to December 2023, and data were extracted from their electronic medical records on the first day of hospitalization. Least Absolute Shrinkage and Selection Operator (LASSO) regression and binary multivariate logistic regression analyses were performed on the collected clinical data to identify risk factors.

RESULTS: A total of 117 patients with acute DQ poisoning were included, and were categorized into two groups based on their 28-day outcomes: survival group (n=67) and non-survival group (n=50). There were no statistically significant differences between the two groups in terms of sex, lymphocyte count, platelet-to-lymphocyte ratio, or blood purification rate (P>0.05). The analysis revealed that age (odds ratio [OR] 1.094, 95% confidence interval [95% CI] 1.022-1.171), blood drug concentration (OR 3.659, 95% CI 1.846-7.252), lactate (OR 1.686, 95% CI 1.062-2.678), neutrophil-to-lymphocyte ratio (NLR) (OR 1.101, 95% CI 1.017-1.192), albumin (OR 1.275, 95% CI 1.107-1.468), and aspartate aminotransferase (AST) (OR 1.027, 95% CI 1.005-1.051) were the risk factors for mortality.

CONCLUSION: This study identified key risk factors for 28-day mortality in patients with acute DQ poisoning, which may provide valuable guidance for clinical treatment, particularly for emergency physicians.

Potential common key genes associated with myocardial dysfunction and brain injury following cardiac arrest resuscitation in a rat model

Jie Chen, Zhonghao Li, Xiaoyu Liu, Tianpeng Hu, Nan Gao, Weijian Zhang, Guoqiang Zhang

2025, 16(3): 231-238. doi:10.5847/wjem.j.1920-8642.2025.055

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BACKGROUND: Post-cardiac arrest syndrome (PCAS) significantly contributes to mortality after initially successful cardiopulmonary resuscitation (CPR) in cardiac arrest (CA) patients. Effective cardiocerebral protection is essential for improving post-resuscitation survival. This study investigated the mechanisms and common targets of myocardial dysfunction and brain injury after resuscitation.

METHODS: The male Sprague-Dawley rats (10-12 weeks old, 400-500 g) were divided into two groups: the control group (n=6), which received sham surgery, and the CA/CPR group (n=10), which received ventricular fibrillation (VF) followed by CPR. After 24 h, brain and heart tissues were collected for analysis. The sequencing was used to identify differentially expressed genes (DEGs) between control and CA/CPR rats.

RESULTS: At 24 h after resuscitation, CA/CPR rats presented 217 DEGs in the hippocampus and 80 DEGs in the left ventricle (LV) compared to the control group. In the hippocampus, the most notable biological process was the positive regulation of tumor necrosis factor production, with key pathways related to inflammation and the immune response. In the LV, the Gene Ontology (GO) enrichment analysis revealed that gene alterations were primarily associated with amyloid-beta clearance, a pathway that was also relevant in the brain. Eleven common targets were identified in the DEGs of both heart and brain tissues. The reverse transcription-polymerase chain reaction (RT-PCR) validation revealed significant differences in the mRNA expression of Timp1, Apln, Ccl7, and Lgals3 in both LV and hippocampus.

CONCLUSION: This study identified possible key genes and underlying mechanisms involved in PCAS. The differential genes Timp1, Apln, Ccl7, and Lgals3 might serve as common biomarkers for myocardial and neurological injury following resuscitation.

Mannitol-facilitated entry of vancomycin into the central nervous system inhibits neuroinflammation in a rat model of MRSA intracranial infection by modulating brain endothelial cells

Yin Wen, Zhiwei Su, Huishan Zhu, Mengting Liu, Zhuo Li, Shiying Zhang, Shuangming Cai, Jiaqi Tang, Hongguang Ding, Hongke Zeng

2025, 16(3): 239-247. doi:10.5847/wjem.j.1920-8642.2025.057

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BACKGROUND: The present study aims to investigate whether mannitol facilitates central nervous system (CNS) entry of vancomycin and alleviates methicillin-resistant Staphylococcus aureus (MRSA) intracranial infection.

METHODS: Blood-brain barrier (BBB) permeability was assessed by measuring the concentration of sodium fluorescein (NaF) in the brain tissues of rats and fluorescein isothiocyanate-dextran (FITC-dextran) in a single-cell layer model. Neutrophil infiltration in the brain tissue, inflammatory cytokine levels in the serum, neurological function, and 7-day survival rates were used to evaluate therapeutic effects of mannitol and vancomycin in MRSA-infected rats. Syndecan-1 and filamentous actin (F-actin) levels were measured, and the relationship between F-actin and the endothelial glycocalyx layer (EGL) was explored via the depolymerization agent cytochalasin D and the polymerization agent jasplakinolide.

RESULTS: Following mannitol administration, the NaF and vancomycin concentrations in the brain tissue increased rapidly within 5 min and remained stable for 30 min, indicating that mannitol increased BBB permeability for 30 min. In vitro, mannitol treatment led to significantly greater FITC-dextran permeation through a single-cell layer compared to controls. In the MRSA intracranial infection model, rats treated with mannitol and vancomycin simultaneously presented less inflammation, improved neurological function, and increased 7-day survival rate compared to rats treated with vancomycin and mannitol at 10-hour intervals. Further experiments revealed that mannitol decreased the expression of syndecan-1 in brain tissues, which was confirmed by in vitro experiments showing that mannitol significantly decreased syndecan-1 via F-actin depolymerization.

CONCLUSION: Mannitol may enhance the therapeutic efficacy of vancomycin against intracranial MRSA infection by decreasing the endothelial glycocalyx of the BBB via F-actin depolymerization.

Uncovering host response in adults with severe community-acquired pneumonia: a proteomics and metabolomics perspective study

Zhongshu Kuang, Runrong Li, Su Lu, Yusong Wang, Yue Luo, Yongqi Shen, Li Yuan, Yilin Yang, Zhenju Song, Ning Jiang, Chaoyang Tong

2025, 16(3): 248-255. doi:10.5847/wjem.j.1920-8642.2025.063

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BACKGROUND: Community-acquired pneumonia (CAP) represents a significant public health concern due to its widespread prevalence and substantial healthcare costs. This study was to utilize an integrated proteomic and metabolomic approach to explore the mechanisms involved in severe CAP.

METHODS: We integrated proteomics and metabolomics data to identify potential biomarkers for early diagnosis of severe CAP. Plasma samples were collected from 46 CAP patients (including 27 with severe CAP and 19 with non-severe CAP) and 19 healthy controls upon admission. A comprehensive analysis of the combined proteomics and metabolomics data was then performed to elucidate the key pathological features associated with CAP severity.

RESULTS: The proteomic and metabolic signature was markedly different between CAPs and healthy controls. Pathway analysis of changes revealed complement and coagulation cascades, ribosome, tumor necrosis factor (TNF) signaling pathway and lipid metabolic process as contributors to CAP. Furthermore, alterations in lipid metabolism, including sphingolipids and phosphatidylcholines (PCs), and dysregulation of cadherin binding were observed, potentially contributing to the development of severe CAP. Specifically, within the severe CAP group, sphingosine-1-phosphate (S1P) and apolipoproteins (APOC1 and APOA2) levels were downregulated, while S100P level was significantly upregulated.

CONCLUSION: The combined proteomic and metabolomic analysis may elucidate the complexity of CAP severity and inform the development of improved diagnostic tools.

Exploring lipid-modifying therapies for sepsis through the modulation of circulating inflammatory cytokines: a Mendelian randomization study

Quan Li, Yun Qu, Jinfang Xue, Hai Kang, Chuanzhu Lyu

2025, 16(3): 256-261. doi:10.5847/wjem.j.1920-8642.2025.045

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BACKGROUND: Whether lipid-modifying drugs directly impact the outcome of sepsis remains uncertain. Therefore, systematic investigations are needed to explore the potential impact of lipid-related therapies on sepsis outcomes and to elucidate the underlying mechanisms involving circulating inflammatory cytokines, which may play critical roles in the pathogenesis of sepsis. This study aimed to utilize drug-target Mendelian randomization to assess the direct causal effects of genetically proxied lipid-modifying therapies on sepsis outcomes.

METHODS: First, a two-sample Mendelian randomization study was conducted to validate the causal associations among high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and sepsis. A subsequent drug-target Mendelian randomization study assessed the direct causal effects of genetically proxied lipid-modifying therapies on the risk of sepsis, sepsis-related critical care admission, and sepsis-related death. The identified lipid-modifying drug targets were subsequently explored for direct causal relationships with 36 circulating inflammatory cytokines. Finally, enrichment analyses of the identified cytokines were conducted to explore the potential relationships of lipid-modifying drugs with the inflammatory response.

RESULTS: Genetically proxied cholesteryl ester transfer protein (CETP) inhibitors were significantly associated with sepsis-related critical care admission (OR=0.84, 95% CI [0.74, 0.95], P=0.008,) and sepsis-related death (OR=0.68, 95% CI [0.52, 0.88], P=0.004). The genetically proxied CETP inhibitors were strongly associated with the levels of 15 circulating inflammatory cytokines. Enrichment analyses indicated that CETP inhibitors may modulate inflammatory cytokines and influence the inflammatory response pathway.

CONCLUSION: This study supports a causal effect of genetically proxied CETP inhibitors in reducing the risk of sepsis-related critical care admission and death. These findings suggest that the underlying mechanism may involve the modulation of some circulating inflammatory cytokines, influencing the inflammatory response pathway.

The Jamaica Handheld Ultrasound Project: a novel longitudinal point-of-care ultrasound curriculum in a resource-limited setting

Maxime Montour, Pranali Sheth, Steve Foo, Simone French, Tawanda Jones, Giselle Watt, Brian Kohen, Aamir Bandagi, Ariella Gartenberg, Michael Halperin, Trudy-Ann Johnson-Hylton, Jason Ifill, Alyssia McEwan, Jonathan Maik, Michelle Montenegro, Rie Seu, Nicole Leonard-shiu, Hugh Wong, Trevor Dixon

2025, 16(3): 262-265. doi:10.5847/wjem.j.1920-8642.2025.054

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Access to emergency medical services in Beijing: integrating web mapping application programming interfaces and empirical Bayesian Kriging interpolation analysis

Haolin Zhu, Mo Xu, Luying Zhu, Sijia Tian, Jinjun Zhang

2025, 16(3): 266-268. doi:10.5847/wjem.j.1920-8642.2025.044

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Association between serum creatinine levels at emergency admission and outcomes in patients with exertional heat stroke: a multicenter cohort study

Dingping Jin, Lan Chen, Sunying Wu, Jingnan Ren, Huan Zhang, Xiangliang Wu, Liyun Lu, Huimin Ma, Xiuqin Feng