研究者詳細 - 塚原　紘平

論文 - 塚原　紘平

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Association of emergency intensive care unit occupancy due to brain-dead organ donors with ambulance diversion. 国際誌

Tetsuya Yumoto, Takafumi Obara, Takashi Hongo, Tsuyoshi Nojima, Kohei Tsukahara, Masaki Hisamura, Atsunori Nakao, Takashi Yorifuji, Hiromichi Naito

Scientific reports 15 ( 1 ) 12633 - 12633 2025年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

Our study aims to explore how intensive care unit (ICU) occupancy by brain-dead organ donors affects emergency ambulance diversions. In this retrospective, single-center study at an emergency ICU (EICU), brain-dead organ donors were managed until organ procurement. We classified each day between August 1, 2021, and July 31, 2023, as either an exposure day (any day with a brain-dead organ donor in the EICU from admission to organ procurement) or a control day (all other days). The study compared these days and used multiple logistic regression analysis to assess the impact of EICU occupancy by brain-dead organ donors on ambulance diversions. Over two years, 6,058 emergency patients were transported by ambulance, with 1327 admitted to the EICU, including 13 brain-dead organ donors. Brain-dead donors had longer EICU stays (17 vs. 2 days, P < 0.001). With 168 exposure and 562 control days, EICU occupancy was higher on exposure days (75% vs. 67%, P = 0.003), leading to more ambulance diversions. Logistic regression showed exposure days significantly increased ambulance diversions, with an odds ratio of 1.79 (95% CIs 1.10-2.88). This study shows that managing brain-dead organ donors in the EICU leads to longer stays and higher occupancy, resulting in more frequent ambulance diversions. These findings highlight the critical need for policies that optimize ICU resource allocation while maintaining the infrastructure necessary to support organ donation programs and ensuring continued care for brain-dead donors, who play an essential role in addressing the organ shortage crisis.

DOI： 10.1038/s41598-025-97198-7

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Age-specific assessment of initial hemoglobin levels and shock index for predicting life-saving interventions in pediatric blunt liver and spleen injuries. 国際誌

Tetsuya Yumoto, Takafumi Obara, Takashi Hongo, Atsuyoshi Iida, Kohei Tsukahara, Morihiro Katsura, Yutaka Kondo, Hideto Yasuda, Shigeki Kushimoto, Takashi Yorifuji, Hiromichi Naito, Atsunori Nakao

Scientific reports 15 ( 1 ) 8502 - 8502 2025年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

This study aimed to evaluate the effectiveness of combining initial hemoglobin levels with the shock index for predicting the need for life-saving interventions (LSI) in pediatric patients with blunt liver and spleen injuries (BLSI), specifically tailored to different age groups. This was a multicenter retrospective cohort study of pediatric patients with BLSI in Japan. The area under the receiver operating characteristic curve (AUROC) were used to assess predictive accuracy. The study included 1,370 patients. LSI was required in 59 of 247 (23.9%) aged 1 to 6 years, 100 of 402 (24.9%) aged 7 to 12 years, and 125 of 297 (42.1%) patients aged 13 to 16 years. Within each specific age group, the predictability was categorized as fair and appeared higher than that of the entire cohort or when using either parameter alone. Notably, in the 1 to 6-year age group, the combined values showed the highest predictability, which was statistically superior to the shock index alone (AUROC of 0.770 vs. 0.671, P = 0.025). Tailoring initial hemoglobin levels and shock index to specific age groups enhances predictability of LSI in pediatric BLSI, showing a fair level of predictive accuracy.

DOI： 10.1038/s41598-025-92673-7

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Prevalence, characteristics, and outcomes of suicide-related out-of-hospital cardiac arrest among patients committing self-harm and suicide-attempts in Japan: A nationwide registry study. 国際誌

Takashi Hongo, Tetsuya Yumoto, Shunta Jinno, Yuka Yamamura, Takafumi Obara, Tsuyoshi Nojima, Kohei Tsukahara, Hiromichi Naito, Takashi Yorifuji, Atsunori Nakao

Resuscitation plus 22 100923 - 100923 2025年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Suicide-related out-of-hospital cardiac arrest (OHCA) is characterized by extremely low survival rates and represents a considerable global public health concern. This study aimed to investigate the prevalence, characteristics, and outcomes of suicide-related OHCA. METHODS: This multicenter, retrospective cohort study is an analysis of data collected from the JAPAN Registry of Self-harm and Suicide Attempts. Patients were divided into two groups, the OHCA group and the non-OHCA group. The primary outcome was death at 30 days. RESULTS: Among 1,960 self-harm and suicide attempts patients, 213 patients (10.9 %) were assigned to the OHCA group and 1,747 (89.1%) were in the non-OHCA group.Patients in the OHCA group were older (44 vs. 33 years old, p < 0.001), and the OHCA group had a higher proportion of males compared to the non-OHCA group (122 [57.3%] vs. 604 [34.6%], p < 0.001). Despite missing and unknown data, lower proportions of psychiatric consultation history (54 [30.8%] vs. 1177 [70.5%], p < 0.001), psychiatric hospitalization history (9 [5.1%] vs. 386 [23.1%], p < 0.001), and previous suicide attempts (16 [9.2%] vs. 807 [48.4%], p < 0.001) were observed in the OHCA group. Risk of death at 30 days was significantly higher in the OHCA group (200 [93.9%] vs. 31 [1.8%], p < 0.001). CONCLUSION: Suicide-related OHCA was rare and associated with poorer prognosis compared to patients without OHCA. It was more common in middle-aged men without a history of psychiatric care or prior suicide attempts, although the study was limited by missing data.

DOI： 10.1016/j.resplu.2025.100923

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救急搬送件数の急増と働き方改革への対応岡山大学の取り組み

湯本哲也, 内藤宏道, 本郷貴識, 小原隆史, 小崎吉訓, 上田浩平, 野島剛, 飯田淳義, 塚原紘平, 中尾篤典

日本臨床救急医学会雑誌 27 ( 6 ) 765 - 771 2024年12月

記述言語：日本語出版者・発行元：(一社)日本臨床救急医学会

2024年4月から医師にも働き方改革が適用された。当院では救急搬送件数が直近3年間で3倍に急増した。これに対応するため院内外の協力・連携や下り搬送の体制強化,病院救命士の活用・育成によるタスク・シェア/シフトの促進に努めてきた。その他,徹底したシフト制など働き方改革を進めてきた。また,大学病院としての使命でもある研究・教育にも注力してきた。2023年度の院内時間外勤務時間は2022年度のそれと比較して有意に減少したものの,働き方改革前後での全体的な満足度に変化はなかった。働き方改革は労働時間もさることながら,その中身が重要であり,救急科としての専門性や役割を発揮しながら,個々がやりがいを実感できる環境づくりが重要であるが,自己研鑽という名の時間外労働の実態は反映されにくく,地域救急医療体制維持と働き方改革とのバランスも今後の課題である。(著者抄録)

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COVID-19流行前後における小児院外心停止例に対するBystander CPRの変化とアウトカムの検証

小原隆史, 内藤宏道, 塚原紘平, 本郷貴識, 野島剛, 湯本哲也, 中尾篤典

蘇生 43 ( 3 ) 188 - 188 2024年11月

脳死下臓器提供のプロセスに関する包括的研究多機関共同後ろ向き研究J-RESPECT studyより

湯本哲也, 内藤宏道, 塚原紘平, 小原隆史, 本郷貴識, 早川峰司, 横堀將司, 西山慶, 渥美生弘, 田崎修, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 666 - 666 2024年11月

院外心停止患者における来院時体温による体温管理療法と30日後の神経学的予後

野島剛, 内藤宏道, 小原隆史, 田邉綾, 本郷貴識, 小崎吉訓, 上田浩平, 湯本哲也, 塚原紘平, 中尾篤典

蘇生 43 ( 3 ) 181 - 181 2024年11月

低体温症における来院時血中COHbの意義についての検証

三次悠哉, 湯本哲也, 本郷貴識, 小原隆史, 小崎吉訓, 野島剛, 上田浩平, 飯田淳義, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 812 - 812 2024年11月

ヘリウムガス吸入による心停止蘇生後に脳死下臓器提供に至った一例

神野駿太, 湯本哲也, 本郷貴識, 小原隆史, 野島剛, 上田浩平, 小崎吉訓, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 782 - 782 2024年11月

心停止のエピソードがあった症例の脳死下および心停止下臓器提供 ECPRの有無による比較

湯本哲也, 塚原紘平, 小原隆史, 本郷貴識, 野島剛, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 781 - 781 2024年11月

心肺蘇生を望まない意思表示のある院外心停止患者対応の実態と今後の展望

田邉綾, 本郷貴識, 小原隆史, 野島剛, 上田浩平, 稲葉基高, 小崎吉訓, 塚原紘平, 湯本哲也, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 752 - 752 2024年11月

オール岡山での搬送困難事例を減らすための取り組み高齢者施設における急変時等相談対応事業を開始して

湯本哲也, 田邉綾, 本郷貴識, 小原隆史, 小崎吉訓, 野島剛, 上田浩平, 飯田淳義, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 688 - 688 2024年11月

敗血症患者における来院時血中COHbの意義についての検証

福留将真, 湯本哲也, 薬師寺泰匡, 本郷貴識, 小原隆史, 小崎吉訓, 野島剛, 上田浩平, 塚原紘平, 内藤宏道, 中尾篤典

日本救急医学会雑誌 35 ( 11 ) 645 - 645 2024年11月

A nationwide longitudinal survey of infantile injury and its recurrence in Japan. 国際誌

Tomohiro Hiraoka, Takafumi Obara, Naomi Matsumoto, Kohei Tsukahara, Takashi Hongo, Tsuyoshi Nojima, Masaki Hisamura, Tetsuya Yumoto, Atsunori Nakao, Takashi Yorifuji, Hiromichi Naito

Scientific reports 14 ( 1 ) 24716 - 24716 2024年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

Injury recurrence in young children is a significant public health concern, as it may indicate an unfavorable home environment. This study evaluates whether infantile injuries increase recurrence during preschool years, contributing to more effective prevention strategies for vulnerable families. The study included 20,191 children from "The Longitudinal Survey of Babies in the 21st Century," a representative sample of infants born in Japan between May 10 and 24, 2010. We conducted a logistic regression analysis to compare injury recurrence risk between children aged 18 months to seven years with and without infantile injury histories. The study revealed that infants with a history of injuries had a higher risk of subsequent hospital visits for injuries during preschool years (crude Odds Ratio (cOR) 1.52, 95% CI, 1.41-1.64, adjusted OR (aOR) 1.48, 95% CI 1.37-1.60). Specific injuries, such as falls (aOR 1.34, 95% CI, 1.26-1.43), pinches (aOR 1.22, 95% CI, 1.15-1.29), drowning (aOR 1.29, 95% CI, 1.19-1.40), ingestion (aOR 1.35, 95% CI, 1.17-1.55), and burns (aOR 1.47, 95% CI, 1.31-1.65), independently increased the risk of future injuries. Our findings highlight the necessity of universal safety measures in the home environment and targeted interventions for families with a history of high-risk injuries.

DOI： 10.1038/s41598-024-76403-z

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Management of Obesity Hypoventilation Syndrome in Extreme Obesity: A Case Study. 国際誌

Yuya Miyoshi, Tetsuya Yumoto, Yoshinori Kosaki, Takashi Hongo, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

The American journal of case reports 25 e945112 2024年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND Obesity hypoventilation syndrome (OHS) is characterized by hypercapnia in obese patients, with acute hypercapnic respiratory failure often worsened by various conditions. Managing super-super obese patients presents complex challenges in critical care. Our case report details the successful treatment of acute respiratory failure in a patient with a body mass index (BMI) over 80 kg/m², highlighting the importance of comprehensive, multidisciplinary care in the Intensive Care Init (ICU). CASE REPORT A 39-year-old man with a BMI of 81.1 kg/m² presented to our emergency department with respiratory distress, altered consciousness, and an inability to move independently. Arterial blood gas analysis revealed severe hypercapnia and hypoxemia, indicating decompensated OHS. Laboratory tests and computed tomography scans suggested his condition was exacerbated by pneumonia and congestive heart failure. The patient was managed in the ICU with endotracheal intubation, mechanical ventilation, and esophageal pressure monitoring. In addition to antibiotics, diuretics were used to manage fluid balance. His care included multidisciplinary support with nutritional management and active physiotherapy. After 15 days, he was weaned from the ventilator and discharged from the ICU on day 20, continuing rehabilitation until he was discharged home on day 60. CONCLUSIONS This case report describes the successful treatment of acute hypercapnic respiratory failure from decompensated OHS in a super-super obese patient. Addressing the underlying conditions and tailoring clinical practices to the patient's specific needs, especially regarding ventilatory support, fluid balance, and nutrition, were crucial. A collaborative multidisciplinary approach was essential for improving outcomes.

DOI： 10.12659/AJCR.945112

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Association between signs of life and survival in traumatic cardiac arrest patients: A nationwide, retrospective cohort study. 国際誌

Takafumi Obara, Tetsuya Yumoto, Naofumi Bunya, Tsuyoshi Nojima, Tomohiro Hiraoka, Takashi Hongo, Yoshinori Kosaki, Kohei Tsukahara, Takenori Uehara, Atsunori Nakao, Hiromichi Naito

Resuscitation plus 19 100701 - 100701 2024年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The clinical impact of signs of life (SOLs) in traumatic cardiac arrest (TCA) remains to be elucidated. The aim of this study was to examine the association between SOLs and survival/neurological outcomes in TCA patients. METHODS: Retrospective data from the Japan Trauma Data Bank (2019-2021) was reviewed. TCA patients were assigned to one of two study groups based on the presence or absence of SOLs and compared. SOLs were defined as having at least one of following criteria: pulseless electrical activity >40 beats per minute, gasping, positive light reflex, or extremity/eye movement at hospital arrival. The primary outcome was survival at hospital discharge. The secondary outcome was favorable neurological status (Glasgow Outcome Scale score of 4 or 5) at hospital discharge. RESULTS: A total of 1,981 patients (114 with SOLs and 1,867 without SOLs) were included. Characteristics of patients were as follows: age (median age 60.0 years old [interquartile range: 41-80] years vs. 55.4 [38-75] years), gender (male: 76/114 (66.7%) vs. 1,207/1,867 (65.0%), blunt trauma (90/111 [81.1%] vs. 1,559/1,844 [84.5%]), Injury Severity Score (29.2 [22-41] vs. 27.9 [20-34]). Patients with SOLs showed higher survival (10/114 (8.8%) vs. 25/1,867 (1.3%), OR 1.96 [CI 1.20-2.72]) and higher favorable neurological outcomes (4/110 (3.5%) vs. 6/1,865 (0.3%), OR 2.42 [CI 1.14-3.70]) compared with patients without SOLs. CONCLUSIONS: TCA patients with SOLs at hospital arrival showed higher survival and favorable neurological outcomes at hospital discharge compared with TCA patients without SOLs.

DOI： 10.1016/j.resplu.2024.100701

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移植医療における診療連携(術前、術後管理/集中治療) 岡山大学病院での脳死下臓器提供のプロセスにおける連携と取り組み救急集中治療の立場から

湯本哲也, 小原隆史, 塚原紘平, 内藤宏道, 中尾篤典

移植 59 ( 総会臨時 ) 148 - 148 2024年9月