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Table of Content

    01 July 2025, Volume 16 Issue 4
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    Review Article
    Prognostic scores of extracorporeal membrane oxygenation: a scoping review Open Access
    Jie Zhu, Sijie Lu, Yawen Wu, Qiming Zhao, Weina Pei, Yanlin Hu, Mingming Li, Yongnan Li, Xiangyang Wu
    2025, 16(4):  303-312.  doi:10.5847/wjem.j.1920-8642.2025.078
    Abstract    HTML    PDF (472KB)   

    BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is an effective measure for saving the lives of critically ill patients. Prompt identification of the risk factors for mortality among patients receiving ECMO and comprehensive analysis of the long-term prognosis of survivors are vital. This scoping review summarized the representative prognostic scoring systems, aiming to help clinicians in selecting an appropriate scoring system to avoid unnecessary medical resource consumption and reduce ECMO-associated mortality.

    METHODS: A comprehensive search of multiple databases, including PubMed, Embase, and the Cochrane Library, was conducted. After removing duplicate studies, a full-text review was performed, and all studies that reported score systems before and/or after ECMO support were included. This protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and has been registered with the Open Science Framework (osf.io/zp4ge).

    RESULTS: Among the 114 studies included, we identified three scores for patients receiving veno-venous ECMO (VV-ECMO), five scores for patients receiving veno-arterial ECMO (VA-ECMO), and three critical illness scores, which apply to both VV- and VA-ECMO conditions. All characteristics of these scoring systems, their advantages, and their limitations were summarized.

    CONCLUSION: The implementation of an ECMO scoring system helps to assess the condition of critically ill patients, predict outcome, and provide objective indicators to determine the optimal timing for ECMO intervention. Due to the limitations of the currently available scores, further efforts in improving and validating the ECMO scoring system are needed to achieve the goals of minimizing unnecessary consumption of medical resources and reducing mortality rates.

    Original Articles
    Effect of bag valve ventilation versus mechanical ventilation after endotracheal intubation during cardiopulmonary resuscitation on outcomes following out-of-hospital cardiac arrest: a propensity score analysis Open Access
    Young Min Kim, Hyun Seok Chai, Gwan Jin Park, Sang Chul Kim, Hoon Kim, Seok Woo Lee, Hyeon Jeong Park, Han Bit Kim, Hyo Been Lee, Ji Han Lee
    2025, 16(4):  313-320.  doi:10.5847/wjem.j.1920-8642.2025.062
    Abstract    HTML    PDF (518KB)   

    BACKGROUND: In this study, we aimed to evaluate the impact of mechanical ventilator (MV) utilizaton during cardiopulmonary resuscitation (CPR) on out-of-hospital cardiac arrest (OHCA) patient clinical outcomes in the emergency department.

    METHODS: This single-centered, retrospective, case-control study analyzed electronic medical records. Patients aged >18 years with non-traumatic OHCA who were treated at an emergency medical center between January 2019 and December 2023 were included. These patients were accessed according to the ventilatory method used: MV ventilation (volume control, tidal volume 6-8 mL/kg, frequency 10 beat per minute, inspiratory time 1 s) and manual resuscitator bag valve (BV) ventilation. The primary outcome was the return of spontaneous circulation (ROSC). After 1:1 propensity score matching, the clinical outcomes were analyzed.

    RESULTS: A total of 649 patients were enrolled in this study. Before matching, the clinical outcomes and pneumothorax incidence did not differ between the MV and BV groups. After 1:1 matching between the two groups using propensity scores, 522 patients (261 MV and 261 BV) were analyzed. Propensity score matching yielded an adequate balance (standardized mean difference <0.10) for all covariates. The estimated odds ratio (OR) for ROSC was 1.23 (95% confidence interval [CI]: 0.85-1.77; P=0.267), for survival at hospital admission was 1.02 (95%CI: 0.68-1.53; P=0.918), for survival at hospital discharge was 2.31 (95%CI: 1.10-5.20; P=0.033), and for good neurologic outcome was 2.56 (95%CI: 0.84-9.43; P= 0.116).

    CONCLUSION: In patients with OHCA admitted to the emergency department, MV ventilation during CPR showed clinical outcomes similar to those of BV ventilation in most measures. However, survival at hospital discharge was significantly higher in the MV group, suggesting potential benefits of MV use in selected patients.

    Murine model for investigating severe trauma Open Access
    Rui Li, Jing Zhou, Wei Huang, Jingjing Ye, Wei Chong, Panpan Chang, Tianbing Wang
    2025, 16(4):  321-330.  doi:10.5847/wjem.j.1920-8642.2025.082
    Abstract    HTML    PDF (4497KB)   

    BACKGROUND: The lack of a stable, easy-to-operate animal model for severe trauma has hindered the research progress. The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of severe trauma, providing a reliable research tool.

    METHODS: Male C57BL/6J mice (aged 8-10 weeks and weighting approximately 20 g) were used to establish the severe trauma model. Under anesthesia, a midshaft femoral fracture was created and packed with sterile cotton. A midline incision was made from the inguinal region to the sternum, exposing the abdominal organs for 30 min. The right femoral artery was cannulated to induce controlled blood loss at 30%, 35%, 40%, and 50% of the total blood volume. Survival rates were monitored for 24 h post-induction. In the mice that experienced 30% blood loss, the mean arterial pressure, body temperature, blood gas parameters, peripheral blood inflammatory markers, and major organ pathological changes were assessed.

    RESULTS: Mice with femoral fractures, soft tissue injuries, abdominal organ exposure, and 30% blood loss exhibited stable survival rates. Increased blood loss significantly reduced survival rates. Mean arterial pressure decreased initially, recovering within 0-15 min and returning to baseline by 50 min. Similarly, the body temperature decreased initially and gradually recovered to baseline within 50 min. Levels of peripheral blood inflammatory markers remained elevated for 12 h post-injury. Distant organs, including intestines, lungs, liver, spleen and kidneys, displayed varying degrees of injury.

    CONCLUSION: The established mouse model replicates the pathophysiological responses to severe trauma, indicating stability and reproducibility, which could be an useful tool for further trauma research.

    Initial serum electrolyte imbalances and mortality in patients with traumatic brain injury: a retrospective study Open Access
    Ahammed Mekkodathil, Ayman El-Menyar, Talat Chughtai, Ahmed Abdel-Aziz Bahey, Ahmed Labib Shehatta, Ali Ayyad, Abdulnasser Alyafai, Hassan Al-Thani
    2025, 16(4):  331-339.  doi:10.5847/wjem.j.1920-8642.2025.064
    Abstract    HTML    PDF (505KB)   

    BACKGROUND: Electrolyte imbalance is common following traumatic brain injury (TBI) and can significantly impact patient outcomes. We aimed to explore the occurrence, patterns, and consequences of electrolyte imbalance in adult patients with TBI.

    METHODS: A retrospective study was conducted from 2016 to 2021 at a level 1 trauma center among hospitalized TBI patients. On admission, the levels of serum electrolytes, including sodium, potassium, calcium, magnesium, and phosphate, were analyzed. Demographics, injury characteristics, and interventions were assessed. The primary outcome was the in-hospital mortality. Multivariate logistic regression analysis was performed to identify independent predictors of mortality in TBI patients.

    RESULTS: A total of 922 TBI patients were included in the analysis, of whom 902 (98%) had electrolyte imbalance. The mean age of patients with electrolyte imbalance was 32.0±15.0 years. Most patients were males (94%). The most common electrolyte abnormalities were hypocalcemia, hypophosphatemia, and hypokalemia. The overall in-hospital mortality rate was 22% in the entire cohort. In multivariate logistic analysis, the predictors of mortality included age (odds ratio [OR]=1.029, 95% confidence intervals [CI]: 1.013-1.046, P<0.001), low GCS (OR=0.883, 95%CI: 0.816-0.956, P=0.002), high Injury Severity Score (ISS) scale (OR=1.051, 95%CI: 1.026-1.078, P<0.001), hypernatremia (OR=2.175, 95%CI: 1.196-3.955, P=0.011), hyperkalemia (OR=4.862, 95%CI: 1.222-19.347; P=0.025), low serum bicarbonate levels (OR=0.926, 95%CI: 0.868-0.988, P=0.020), high serum lactate levels (OR=1.128, 95%CI: 1.022-1.244, P=0.017), high glucose levels (OR=1.072, 95%CI: 1.014-1.133, P=0.015), a longer activated partial thromboplastin time (OR=1.054, 95%CI: 1.024-1.084, P<0.001) and higer international normalized ratio (INR) (OR=3.825, 95%CI: 1.592-9.188, P=0.003).

    CONCLUSION: Electrolyte imbalance is common in TBI patients, with the significant prevalence of hypocalcemia, hypophosphatemia, and hypokalemia. However, hypernatremia and hyperkalemia were associated with the risk of mortality, emphasizing the need for further research to comprehend electrolyte dynamics in TBI patients.

    Bromodomain protein 4 inhibitor JQ-1 alleviates hepatic ischemia-reperfusion injury by blocking the NLRP3/caspase-1 pathway Open Access
    Li Wang, Weihua Gong
    2025, 16(4):  340-347.  doi:10.5847/wjem.j.1920-8642.2025.081
    Abstract    HTML    PDF (2321KB)   

    BACKGROUND: Hepatic ischemia-reperfusion (I/R) injury is a major challenge in liver surgery and transplantation. Bromodomain protein 4 (BRD4) has emerged as a promising target due to its role in oxidative stress and inflammation. JQ-1, a specific BRD4 inhibitor, has shown protective effects on organs suffering I/R injury. This study aims to investigate the expression of BRD4 in liver tissues after I/R injury and to explore its role in this process using JQ-1 both in vivo and in vitro.

    METHODS: Our study established a mouse model of hepatic I/R injury and investigated the protective effect of JQ-1. We compared the histological features, BRD4 expression, and liver enzyme levels between JQ-1-treated and untreated groups. Additionally, the antioxidant properties of JQ-1 were analyzed in RAW 264.7 cells by evaluating cytokine expression, NLRP3 inflammasome activity, and reactive oxygen species production.

    RESULTS: BRD4 was abundantly expressed in liver tissues after hepatic I/R injury, while JQ-1 treatment had antioxidant and hepatoprotective effects. JQ-1 also suppressed pro-inflammatory cytokine release in vitro. Furthermore, we clarified the mechanism by which JQ-1 enhances liver injury recovery through Kupffer cells by blocking the NOD-like receptor thermal protein domain-associated protein 3 (NLRP3)/caspase-1 pathway.

    CONCLUSION: JQ-1 has potential as a pre-clinical emergency therapy for hepatic I/R injury. Its ability to inhibit BRD4 and modulate the inflammatory response in Kupffer cells offers a promising avenue for future clinical intervention.

    A risk prediction model for acute kidney injury following acute heart failure in an emergency department cohort in China Open Access
    Lingjie Cao, Yuanyuan Pei, Xiaolu Ma, Liping Guo, Fengtao Yang, Fange Shi, Pengfei Wang, Dilu Li, Kunyu Yang, Jihong Zhu
    2025, 16(4):  348-356.  doi:10.5847/wjem.j.1920-8642.2025.068
    Abstract    HTML    PDF (534KB)   

    BACKGROUND: Acute kidney injury (AKI) is a severe and fatal complication of acute heart failure (AHF). Existing studies on AKI following AHF in the Chinese population have scarce insights available from the emergency department (ED). This study aimed to investigate the predictive factors of patients with AHF complicated with AKI in a Chinese ED cohort, and to establish a risk prediction model.

    METHODS: Hospitalized patients diagnosed with AHF in the ED from December 2016 to September 2023 were included. The overall dataset were divided into the training set and the testing set at a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for AKI in patients with AHF in the training set, leading to the development of a risk prediction model. The performance of the model was further assessed.

    RESULTS: A total of 789 patients with AHF were enrolled, with an AKI incidence of 29.7%. The mortality rates of the AKI and non-AKI groups were 23.1% and 7.6%, respectively. Logistic regression analysis showed that the levels of white blood cell (OR=2.368; 95%CI: 1.502-3.733, P<0.001), albumin (OR=2.669; 95%CI: 1.601-4.451, P<0.001), serum creatinine (OR=3.221; 95%CI: 1.935-5.363, P<0.001), and hemoglobin (OR=2.009; 95%CI: 1.259-3.205, P=0.003), maximum 24-h furosemide dosage (OR=2.196; 95%CI: 1.346-3.582, P=0.002), the use of non-invasive ventilation (OR=2.419; 95%CI: 1.454-4.024, P=0.001), and diabetes mellitus (OR=3.192; 95%CI: 2.014-5.059, P<0.001) were independent risk factors for AKI after AHF. These factors were subsequently incorporated into a risk prediction model. The area under the receiver operating characteristic (AUROC) curve for the predictive model was 0.815 (95%CI: 0.776-0.854) and 0.802 (95%CI: 0.776-0.854) in the training set and the testing set, respectively.

    CONCLUSION: This risk prediction model might assist physician to predict AKI following AHF effectively in the emergency setting.

    Prehospital oxygen-therapy and mortality in patients treated by emergency medical services: a prospective, observational multicenter study Open Access
    Carlos del Pozo Vegas, Ancor Sanz-García, Antonio Dueñas-Ruiz, Pedro de Santos Castro, Ana Gil Contreras, María Blanco González, Alberto Correas Galán, Joan B. Soriano, Raúl López-Izquierdo, Francisco Martín-Rodríguez
    2025, 16(4):  357-366.  doi:10.5847/wjem.j.1920-8642.2025.084
    Abstract    HTML    PDF (618KB)   

    BACKGROUND: Oxygen supply is a common procedure performed by emergency medical services (EMS); however, whether prehospital oxygen or fraction of inspired oxygen (FiO2) therapy predict mortality has not been studied to date. This study aims to determine mortality associated with oxygen therapy in unselected patients with acute disease who underwent prehospital care.

    METHODS: This was a prospective, observational, cohort, multicenter, EMS-delivery, ambulance-based study. Adults with unselected acute disease who were managed by EMS and evacuated with high priority to the emergency department of four hospitals in three Spanish provinces. Epidemiological variables, on-scene vital signs, and prehospital blood analysis data were collected. The primary outcome was short- (2-, 7-, and 30-day), medium- (90- and 180-day), and long-term (365-day) all-cause cumulative mortality. The samples were a priori split according to thresholds of their received FiO2(FiO2=0.21, that is without oxygen therapy; FiO2 between 0.22 and 0.49; and FiO2≥0.5). The categorical variables FiO2, epidemiological variables, vital signs, prehospital point-of-care testing (POCT) and patient outcomes were fitted with a logistic regression model. Additionally, a propensity score matching and a survival analysis were used.

    RESULTS: The final sample included 7,494 patients, 70.3% of whom did not receive oxygen therapy, 15% with a FiO2 between 0.22 and 0.49, and 14.7% with a FiO2≥0.5. The 2-day mortality was 0.4%, 5.3%, and 22.9% respectively (P<0.001). The 365-day mortality was 9.9%, 33.1%, and 50.5% respectively (P<0.001). Finally, the FiO2 predictive capacities 2-,30-, and 365-day mortality were AUC=0.870 (95%CI: 0.840-0.899), 0.810 (95%CI: 0.784-0.837), 0.704 (95%CI: 0.679-0.728), respectively.

    CONCLUSION: Prehospital oxygen therapy by thresholds of FiO2 was linked to death and allowed mortality prediction. This finding could provide an aid for EMS providers, allowing to assess more individualized patient risk.

    Research Letters
    Clinical outcomes of patients with acute myocardial infarction undergoing coronary revascularization via simplified treatment: a single-center retrospective study Open Access
    Yugen Shi, Nannan Li, Xue Feng, Qingshan Zhang, Shuai Bao, Zheng Zhao, Li Sun, Suhua Yan, Ye Wang, Xiaolu Li
    2025, 16(4):  367-373.  doi:10.5847/wjem.j.1920-8642.2025.070
    Abstract    HTML    PDF (410KB)   
    Changes of public behavior alter weather-dependent strain on emergency medical services Open Access
    Calvin Lukas Kienbacher, Norah Al Rasheed, Ibrahem Aldeghaither, Esam E. Barnawi, Jason M. Rhodes, Harald Herkner, Feven Alemu, Dominik Roth, Kenneth A. Williams
    2025, 16(4):  378-382.  doi:10.5847/wjem.j.1920-8642.2025.056
    Abstract    HTML    PDF (364KB)   
    Mean 24-hour end-tidal carbon dioxide following diagnosis predicts mortality in patients with sepsis Open Access
    Jingyi Wang, Li Weng, Jun Xu, Bin Du
    2025, 16(4):  383-386.  doi:10.5847/wjem.j.1920-8642.2025.067
    Abstract    HTML    PDF (321KB)   
    Development and validation of a predictive model for testicular atrophy after orchiopexy in children with testicular torsion Open Access
    Jia Wei, Zixia Li, Yuexin Wei, Daxing Tang, Guannan Bai, Lidong Men, Shengde Wu, Xiang Yan
    2025, 16(4):  387-391.  doi:10.5847/wjem.j.1920-8642.2025.079
    Abstract    HTML    PDF (368KB)   
    Case Letters
    Septic shock caused by non-O1/non-O139 Vibrio cholerae: a case report Open Access
    Wenli Fang, Yuqiong Geng, Yani Gao, Yan Xiao
    2025, 16(4):  395-397.  doi:10.5847/wjem.j.1920-8642.2025.069
    Abstract    HTML    PDF (475KB)   
    Refractory fever, pulmonary infiltrates, and auricular chondritis: a rare case of VEXAS syndrome following COVID-19 infection in the emergency department Open Access
    Shuo Zhang, Bingjie Wang, Yanan Tian, Zhiyu Lao, Jia Liu, Hang Yin, Hui Xiong
    2025, 16(4):  398-400.  doi:10.5847/wjem.j.1920-8642.2025.066
    Abstract    HTML    PDF (404KB)   
    Melioidosis pneumonia resulting from near drowning after an electric shock: a case report Open Access
    Wen Wang, Huanhuan Ren, Xianxian Fu, Jianqiang Chen, Yuefu Zhan
    2025, 16(4):  401-403.  doi:10.5847/wjem.j.1920-8642.2025.071
    Abstract    HTML    PDF (1022KB)   
    Purulent effusive-constrictive pericarditis and infective native aortic aneurysm: a case report Open Access
    Mariana Passos, Filipa Gerardo, Inês Fialho, David Roque
    2025, 16(4):  404-406.  doi:10.5847/wjem.j.1920-8642.2025.073
    Abstract    HTML    PDF (545KB)   
    Life-threatening gastrointestinal bleeding in a rare case of blue rubber bleb nevus syndrome Open Access
    Chen Li, Yanfen Chai, Songtao Shou
    2025, 16(4):  407-409.  doi:10.5847/wjem.j.1920-8642.2025.072
    Abstract    HTML    PDF (547KB)   
    A rare etiology of sudden onset severe back pain: spinal subarachnoid hemorrhage Open Access
    Shanshan Jin, Qiuping Huang, Ruilan Wang
    2025, 16(4):  410-412.  doi:10.5847/wjem.j.1920-8642.2025.080
    Abstract    HTML    PDF (563KB)