ORCID Profile
0000-0001-7142-4386
Current Organisations
Beth Israel Deaconess Medical Center
,
Massachusetts General Hospital
,
Boston Medical Center
,
Brigham and Women's Hospital
,
Centre Hospitalier de l'Université de Montréal
,
Royal North Shore Hospital
,
University of Sydney
,
NSW Ambulance (Aeromedical Operations)
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Publications
Endovascular treatment for acute ischemic stroke beyond the 24-hour time window: selection by target mismatch profile
Publisher: SAGE Publications
Date: 08-10-2023
Serratus Anterior Plane Block for Clinically Suspected Rib Fractures in Prehospital and Retrieval Medicine
Publisher: Informa UK Limited
Date: 08-12-2022
DOI: 10.1080/10903127.2022.2150344
Abstract: To describe the use of the serratus anterior plane block (SAPB) in the prehospital and retrieval environment including the ability to accurately identify those patients with thoracic trauma and clinically suspected rib fractures who would benefit from this procedure. This is a retrospective case series of all patients with thoracic trauma and clinically suspected rib fractures who received SAPB by a prehospital and retrieval medical team in New South Wales, Australia, between 2018 and 2021. The primary outcome was to identify the proportion of patients who received appropriate blocks based on the criteria of reporting moderate pain after receiving adequate pre-block analgesia. Secondary outcomes included the proportions of patients with rib fractures identified on thoracic imaging, concomitant time-critical pathology, radiologist identification of fluid adjacent to the serratus anterior muscle, and local anesthetic systemic toxicity. Of the 2004 patients who sustained thoracic trauma, only 13 received a SAPB. Nine (69.2%) met the predetermined definition of appropriate selection. Of the four patients who did not meet this criteria, three reported less than moderate pain and one did not receive adequate pre-block analgesia. There was no significant effect on median scene interval when compared to other thoracic trauma patients who did not receive a SAPB. Ten patients had rib fractures identified on in-patient imaging (chest x-ray or computed tomography (CT)) with a median (IQR) number of ribs fractured of 5 (interquartile range 2-10). Three of these patients had radiological flail segments. Prespecified time-critical pathology was identified in three patients (23.1%) on initial hospital imaging. Five out of eight patients with post-SAPB CT imaging (62.5%) available for radiologist review had fluid identified adjacent to the serratus anterior muscle. None of the 13 patients had local anesthetic systemic toxicity. The SAPB can be safely and successfully performed in the prehospital and retrieval environment, where clinicians can appropriately identify patients with thoracic trauma and clinically suspected rib fractures who would benefit from this technique. Further research is required to identify the ideal patient population to perform the SAPB upon and compare its performance to current analgesic options.
The effect of ketamine and fentanyl on haemodynamics during intubation in pre‐hospital and retrieval medicine
Publisher: Wiley
Date: 13-12-2022
DOI: 10.1111/AAS.14177
Abstract: Ketamine use for rapid sequence intubation (RSI) is frequent in pre‐hospital and retrieval medicine (PHARM) and is associated with potentially deleterious haemodynamic changes, which may be ameliorated by concurrent use of fentanyl. To describe the frequency with which fentanyl is used in conjunction with ketamine in a system where its use is discretionary, and to explore any observed changes in haemodynamics with its use. A retrospective observational study of over 800 patients undergoing RSI with ketamine ± fentanyl in the PHARM setting between 2015 and 2019. The primary outcome was the proportion of patients in each group who had a systolic blood pressure (SBP) outside a pre‐specified target range, with adjustment for baseline abnormality, within 10 min of anaesthetic induction. Eight hundred and seventy‐six patients were anaesthetised with ketamine, of whom 804 were included in the analysis. 669 (83%, 95% CI 80%–86%) received ketamine alone, and 135 (17%, 95% CI 14%–20%) received both fentanyl and ketamine. Median fentanyl dose was 1.1 mcg/kg (IQR 0.75–1.5 mcg/kg). Systolic blood pressure (SBP) at induction was consistently associated with SBP after intubation in multivariable logistic regression, but fentanyl use was not associated with a change in odds of meeting the primary outcome (OR 1.08 95% CI 0.72–1.60), becoming hypertensive (OR 1.35 95% CI 0.88–2.07) or hypotensive (OR 0.76 95% CI 0.47–1.21). The addition of fentanyl to ketamine for RSI was not associated with an alteration of the odds of post‐induction haemodynamic stability, although the doses used were low. These findings justify further study into the optimal dosing of fentanyl during RSI in pre‐hospital and retrieval medicine.
Acute and Interventional Treatments
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2023
Prehospital activation of a coordinated multidisciplinary hospital response in preparation for patients with severe hemorrhage. A state-wide data linkage study of the New South Wales “Code Crimson” pathway
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-03-2022
Young Woman with Left Chest Pain
Publisher: Elsevier BV
Date: 04-2022
Basilar artery occlusion management: Specialist perspectives from an international survey
Publisher: Wiley
Date: 13-02-2023
DOI: 10.1111/JON.13084
Abstract: Two early basilar artery occlusion (BAO) randomized controlled trials did not establish the superiority of endovascular thrombectomy (EVT) over medical management. While many providers continue to recommend EVT for acute BAO, perceptions of equipoise in randomizing patients with BAO to EVT versus medical management may differ between clinician specialties. We conducted an international survey (January 18, 2022 to March 31, 2022) regarding management strategies in acute BAO prior to the announcement of two trials indicating the superiority of EVT, and compared responses between interventionalists (INTs) and non‐interventionalists (nINTs). Selection practices for routine EVT and perceptions of equipoise regarding randomizing to medical management based on neuroimaging and clinical features were compared between the two groups using descriptive statistics. Among the 1245 respondents (nINTs = 702), INTs more commonly believed that EVT was superior to medical management in acute BAO (98.5% vs. 95.1%, p .01). A similar proportion of INTs and nINTs responded that they would not randomize a patient with BAO to EVT (29.4% vs. 26.7%), or that they would only under specific clinical circumstances ( p = .45). Among respondents who would recommend EVT for BAO, there was no difference in the maximum prestroke disability, minimum stroke severity, or infarct burden on computed tomography between the two groups ( p .05), although nINTs more commonly preferred perfusion imaging (24.2% vs. 19.7%, p = .04). Among respondents who indicated they would randomize to medical management, INTs were more likely to randomize when the National Institutes of Health Stroke Scale was ≥10 (15.9% vs. 6.9%, p .01). Following the publication of two neutral clinical trials in BAO EVT, most stroke providers believed EVT to be superior to medical management in carefully selected patients, with most indicating they would not randomize a BAO patient to medical treatment. There were small differences in preference for advanced neuroimaging for patient selection, although these preferences were unsupported by clinical trial data at the time of the survey.
Review article: ventricular assist devices in the emergency department.
Publisher: Wiley
Date: 04-2014
Abstract: Ventricular assist devices (VADs) have become an indispensable tool in the management of end-stage cardiac failure, both as a means of bridging to cardiac transplantation and as destination therapy for long-term quality of life improvement. Although the technology continues to advance and these devices continue to be refined, they are still associated with significant complications. This article reviews the basics of VAD function and physiology, as well as the myriad to complications that follow their implantation. This review aims to provide a systematic approach to the troubleshooting, diagnosis and management of both VAD-associated complications and the resuscitation of the decompensated VAD patient presenting to the ED.
No-reflow phenomenon in stroke patients: A systematic literature review and meta-analysis of clinical data
Publisher: SAGE Publications
Date: 08-06-2023
DOI: 10.1177/17474930231180434
Abstract: The no-reflow phenomenon refers to the absence of microvascular reperfusion despite macrovascular reperfusion. The aim of this analysis was to summarize the available clinical evidence on no-reflow in patients with acute ischemic stroke. A systematic literature review and a meta-analysis of clinical data on definition, rates, and impact of the no-reflow phenomenon after reperfusion therapy was carried out. A predefined research strategy was formulated according to the Population, Intervention, Comparison, and Outcome (PICO) model and was used to screen for articles in PubMed, MEDLINE, and Embase up to 8 September 2022. Whenever possible, quantitative data were summarized using a random-effects model. Thirteen studies with a total of 719 patients were included in the final analysis. Most studies (n = 10/13) used variations of the Thrombolysis in Cerebral Infarction scale to evaluate macrovascular reperfusion, whereas microvascular reperfusion and no-reflow were mostly assessed on perfusion maps (n = 9/13). In one-third of stroke patients with successful macrovascular reperfusion (29%, 95% confidence interval (CI), 21–37%), the no-reflow phenomenon was observed. Pooled analysis showed that no-reflow was consistently associated with reduced rates of functional independence (odds ratio (OR), 0.21, 95% CI, 0.15–0.31). The definition of no-reflow varied substantially across studies, but it appears to be a common phenomenon. Some of the no-reflow cases may simply represent remaining vessel occlusions, and it remains unclear whether no-reflow is an epiphenomenon of the infarcted parenchyma or causes infarction. Future studies should focus on standardizing the definition of no-reflow with more consistent definitions of successful macrovascular reperfusion and experimental set-ups that could detect the causality of the observed findings.
Prospective, multicentre observational study of point‐of‐care ultrasound practice in emergency departments across Australia and New Zealand: The POCUS‐ED Registry
Publisher: Wiley
Date: 30-05-2022
Abstract: The present study aimed to describe the characteristics, performance, accuracy and significance of point‐of‐care ultrasound (POCUS) use in the ED, by utilising an expanded version of the ACEM‐mandated special skills placement (SSP) logbook, to develop a novel clinical quality registry. A prospective, observational study was performed across EDs in Australia and New Zealand over a 12‐month period. Trainees undertaking ACEM‐approved ultrasound (US) SSPs recorded all US scan interpretations and follow‐up imaging reports in an online database. In total, 2647 USs were recorded by 26 special skills trainees across 10 EDs in Australia or New Zealand of these 2356 scans (89%) were clinically indicated. Overall, 2493 scans (94%) were used for diagnostic assessment, of which 1147 (43%) had abnormal findings. Basic echocardiography, extended Focused Assessment with Sonography in Trauma and right upper quadrant scans were the most commonly used modalities. There were 134 US‐guided procedures logged in the registry. Approximately 36% of scans were reported to alter the original provisional diagnosis, whereas in another 37% of cases, POCUS was thought to confirm the original clinical suspicion. The majority of scans (76.5%) entered into the registry were physically reviewed by the SSP supervisor. This multicentred registry provides a detailed description of the current utilisation of POCUS within special skills US placements across EDs in Australia and New Zealand. This data should inform clinical leaders in emergency US to improve both POCUS education and governance around this important tool.
Clinical outcomes of traumatic pneumothoraces undergoing conservative management following detection by prehospital physicians
Publisher: Elsevier BV
Date: 09-2023
Stroke and Thromboprophylaxis in the Era of COVID-19
Publisher: Elsevier BV
Date: 2021
Characteristics, clinical findings and outcomes of acute aortic dissection: A comparison between an Australian emergency department and the International Registry of Acute Aortic Dissection
Publisher: Wiley
Date: 30-05-2022
Abstract: Acute aortic dissection (AAD) is a rare, life‐threatening condition for which the International Registry of Acute Aortic Dissection (IRAD) remains the most detailed clinical resource. The present study compared the characteristics, clinical findings and outcomes of patients presenting to Liverpool Hospital, NSW, Australia (LPOOL) with AAD to those in IRAD. Secondary aims were to identify LPOOL patient variables associated with 30‐day mortality and to assess the impact of transfer times in the ED on 30‐day mortality. Retrospective observational study of patients presenting to LPOOL with AAD between 2011 and 2019. Clinical records were examined and compared with IRAD data. Variables in LPOOL associated ( P 0.10) with 30‐day mortality by univariable analysis were subsequently entered in a multivariable logistic regression to identify independent predictors. Mediation analysis was performed to assess the impact of ED transfer times on 30‐day mortality. The characteristics, clinical findings and outcomes of 156 LPOOL patients were overall similar to those in IRAD. Syncope, weakness or paralysis, raised lactate and chest X‐ray abnormalities were identified as independent predictors of 30‐day mortality. Time from ED to ICU explained 28% of the variance in survival at 30 days. The characteristics, clinical features and outcomes of patients with AAD presenting to LPOOL appeared similar to those reported by IRAD. The identification of independent mortality predictors serves to improve the understanding of local AAD presentations. Reducing ED to ICU transfer times may increase 30‐day survival and further interdisciplinary research should be considered.
Leech on the eye: a novel use for hypertonic saline.
Publisher: Wiley
Date: 02-2009
DOI: 10.1111/J.1742-6723.2009.01156.X
Abstract: Although human interaction with leeches is common in Australia, there is little documented literature on ocular injuries as a result of contact with a leech. We report a case of ocular leech attachment and a previously undocumented method of removal with hypertonic saline solution.
Mechanical Thrombectomy for Large Ischemic Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-06-2023
DOI: 10.1212/WNL.0000000000207536
Abstract: There is growing evidence for endovascular thrombectomy (EVT) in patients with large ischemic core infarct and large vessel occlusion (LVO). The objective of this study was to compare the efficacy and safety of EVT vs medical management (MM) using a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs). We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to mechanical thrombectomy for large ischemic core from inception until February 10, 2023. The primary outcome was independent ambulation (modified Rankin Scale [mRS] 0–3). Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models. The quality of articles was evaluated through the Cochrane risk assessment tool and the Newcastle-Ottawa Scale. This study was registered in PROSPERO (CRD42023396232). A total of 5,395 articles were obtained through the search and articles that did not meet the inclusion criteria were excluded by review of the title, abstract, and full text. Finally, 3 RCTs and 10 cohort studies met the inclusion criteria. The RCT analysis showed that EVT improved the 90-day functional outcomes of patients with large ischemic core with high-quality evidence, including independent ambulation (mRS 0–3: RR 1.78, 95% CI 1.28–2.48, p 0.001) and functional independence (mRS 0–2: RR 2.59, 95% CI 1.89–3.57, p 0.001), but without significantly increasing the risk of symptomatic intracranial hemorrhage (sICH: RR 1.83, 95% CI 0.95–3.55, p = 0.07) or early mortality (RR 0.95, 95% CI 0.78–1.16, p = 0.61). Analysis of the cohort studies showed that EVT improved functional outcomes of patients without an increase in the incidence in sICH. This systematic review and meta-analysis indicates that in patients with LVO stroke with a large ischemic core, EVT was associated with improved functional outcomes over MM without increasing sICH risk. The results of ongoing RCTs may provide further insight in this patient population.
Reply to: ‘Letter to Editor: Clinical outcomes of traumatic pneumothoraces undergoing conservative management following detection by prehospital physicians’
Publisher: Elsevier BV
Date: 10-2023
An evaluation of the accuracy of prehospital eFAST in the assessment of polytrauma by a physician-staffed helicopter emergency medical service
Publisher: Cold Spring Harbor Laboratory
Date: 04-12-2020
DOI: 10.1101/2020.12.02.20242453
Abstract: While the accuracy of point of care ultrasound in trauma is well understood, there is limited reporting on the efficacy of prehospital ultrasound by helicopter emergency medical service (HEMS). In severe trauma, early diagnosis and communication of life-threatening injuries has the potential to facilitate timely care. This HEMS ultrasound registry evaluation set out to report the accuracy of the extended focused assessment with sonography in trauma (eFAST) exam. Retrospective review of trauma patients who received a prehospital eFAST by GSA-HEMS clinicians between 1 January 2013 and 31 December 2017. Clinician interpretations of these scans were compared to immediate in-hospital CT imaging or operating room reports as the gold-standard reference. The primary outcome measure was the accuracy of eFAST for intraperitoneal free fluid compared to hospital CT scan. Secondary outcomes included accuracy of eFAST for pneumothorax, haemothorax and pericardial fluid, comparison of clinician seniority and whether prehospital interventions were supported by eFAST results. We included 896 patients who underwent eFAST by prehospital clinicians. 411 patients had adequate in-hospital data available for comparison. For the primary outcome of IPFF, eFAST had a sensitivity of 25% [95% CI 16-36%] and specificity of 96% [95% CI 93-98%]. Sensitivities and specificities were calculated for pneumothorax (38% and 96% respectively), haemothorax (17% and 97% respectively) and pericardial effusion (17% and 100% respectively). Fifty percent of patients had thoracostomies supported by lung US whilst 24% of patients who received a prehospital blood transfusion had an eFAST negative for haemorrhage. This study shows that prehospital eFAST is a reliable tool for ruling in the diagnoses of intraperitoneal free fluid, pneumothorax, haemothorax and pericardial effusion and as expected less reliable than CT imaging for these injuries. Extended Focused Abdominal Sonography in Trauma (eFAST) is widely used in an in hospital setting for the assessment of blunt and penetrating injury. Point of care sonography in the prehospital setting has become feasible due to advances in technology, widespread physician training and availability of scanning devices. Our study demonstrates that prehospital eFAST is highly specific for the diagnosis of significant abdominal haemorrhage. Prehospital eFAST is less accurate for other injuries including haemothorax and pneumothorax. The explanation for this finding is unclear, but may be associated with scanning earlier in the clinical course, diminishing sensitivity, environmental factors or human factors. Further studies are required to understand the optimal role of point of care ultrasound in the prehospital setting.
Advances in Stroke: Treatments-Interventional
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2022
Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: One-Year Follow-up.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-10-2022
DOI: 10.1212/WNL.0000000000201426
Abstract: Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1–6.9] p 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1–4.6] p 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4–5.8] p 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6–0.9] p = 0.49). Stroke was diagnosed in 1.3% [1.31–1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82–2.97], 5,656/195,539) of all stroke hospitalizations. There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year. This study is registered under NCT04934020 .
A multicenter evaluation of the accuracy of prehospital eFAST by a physician-staffed helicopter emergency medical service
Publisher: Springer Science and Business Media LLC
Date: 24-11-2022
Mixed‐methods pilot study exploring the influence of the novel Paediatric Anaesthetic Drug Solution tool on clinician cognitive load during simulated paediatric rapid sequence intubation in the emerge
Publisher: Wiley
Date: 17-04-2023
DOI: 10.1111/JPC.16396
Abstract: Rapid sequence intubation (RSI) in children is a low‐incidence, high‐risk event associated with cognitive overload and potential errors producing unfavourable outcomes. Cognitive aids, such as charts, algorithms and flow diagrams, are prompts that externalise and structure mental processes to reduce cognitive load, thereby reducing errors. The Paediatric Anaesthetic Emergency Drug Solution (PAEDS) approach combines a colour‐coded chart and medication box with a simplified mathematical system of volume‐based dosing the effect of which on cognitive load during a simulated RSI has not previously been described. A randomised, cross‐over trial was conducted with 26 multi‐disciplinary emergency medicine clinicians (doctors and nurses) allocated to four groups, performing four high‐fidelity RSI simulations, two mandating the use of the PAEDS approach. This mixed methods study followed the pragmatic ontology using grounded theory methodology. Qualitative data were collected from nine in idual interviews by a process of thematic analysis via an inductive approach, to allow for appropriate open and axial coding to occur. Quantitative data collected included cognitive loading using the raw NASA‐Task Load Index as well as time to intubation and drug dosage details to assess for safety. Qualitative results showed that the PAEDS approach reduced cognitive loading through the use of both the labelled medication box and colour‐coded medication charts. The PAEDS approach also showed improved perceived time pressure without feeling rushed, and with no recorded drug errors. Differences in the quantitative data for total cognitive load, error and time were not statistically significant, likely due to s le size. The PAEDS approach is a multifaceted system which is not inferior to current practice, with some components described as an improvement. Further research on a larger s le size needs to be conducted to assess the aspects of the PAEDS approach both collectively and independently.
Trial of Endovascular Thrombectomy for Large Ischemic Strokes
Publisher: Massachusetts Medical Society
Date: 06-04-2023
Severe Multifactorial Metabolic Alkalosis in the Emergency Department: A Case Report
Publisher: Elsevier BV
Date: 08-2023
Related Organisations
Beth Israel Deaconess Medical Center
Location: United States of America
Related Funding Activities
No related grants have been discovered for Christopher Partyka.