Ryosuke Takegawa

Feinstein Institute for Medical Research · Laboratory of Emergency Medicine

Background Pyrethroid insecticides are widely used because of their low toxicity in humans. Spray-type pyrethroids are often formulated with kerosene as a carrier solvent, and inhalation of kerosene-containing products can lead to pneumonia and the formation of lung abscesses. We report a case of chemical pneumonia resulting in the development of a...

Introduction: Mitochondria-targeted S-nitrosothiol MitoSNO offers protection against ischemia-reperfusion injury by attenuating the reverse electron transport of mitochondrial complex I during reperfusion. This study aimed to assess whether administration of MitoSNO after ROSC improves neurological and survival outcomes following cardiac arrest (CA...

Purine nucleotide adenosine triphosphate (ATP) is a source of intracellular energy maintained by mitochondrial oxidative phosphorylation. However, when released from ischemic cells into the extracellular space, they act as death-signaling molecules (eATP). Despite there being potential benefit in using pyruvate to enhance mitochondria by inducing a...

This prospective observational single-center cohort study aimed to determine an association between cerebrovascular autoregulation (CVAR) and outcomes in hypoxic-ischemic brain injury post-cardiac arrest (CA), and assessed 100 consecutive post-CA patients in Japan between June 2017 and May 2020 who experienced a return of spontaneous circulation. C...

Background: Cardiac arrest (CA) can lead to neuronal degeneration and death through various pathways, including oxidative, inflammatory, and metabolic stress. However, current neuroprotective drug therapies will typically target only one of these pathways, and most single drug attempts to correct the multiple dysregulated metabolic pathways elicit...

Cardiac arrest (CA) and concomitant post‐CA syndrome lead to a lethal condition characterized by systemic ischemia–reperfusion injury. Oxygen (O2) supply during cardiopulmonary resuscitation (CPR) is the key to success in resuscitation, but sustained hyperoxia can produce toxic effects post CA. However, only few studies have investigated the optima...

Background Mitochondrial transplantation (MTx) is an emerging but poorly understood technology with the potential to mitigate severe ischemia–reperfusion injuries after cardiac arrest (CA). To address critical gaps in the current knowledge, we test the hypothesis that MTx can improve outcomes after CA resuscitation. Methods This study consists of...

Purine nucleotide adenosine triphosphate (ATP) is a source of intracellular energy maintained by mitochondrial oxidative phosphorylation. However, when released from ischemic cells into the extracellular space, they act as death-signaling molecules (eATP). Despite there being potential benefit in using pyruvate to enhance mitochondria by inducing a...

Abstract Cardiac arrest (CA) patients suffer from systemic ischemia–reperfusion (IR) injury leading to multiple organ failure; however, few studies have focused on tissue-specific pathophysiological responses to IR-induced oxidative stress. Herein, we investigated biological and physiological parameters of the brain and heart, and we particularly f...

We previously developed a risk assessment tool to predict outcomes after heat-related illness (J-ERATO score), which consists of six binary prehospital vital signs. We aimed to evaluate the ability of the score to predict clinical outcomes for hospitalized patients with heat-related illnesses. In a nationwide, prospective, observational study, adul...

Background: No direct approach assessing pulmonary vascular permeability exists in the current therapeutic strategy for patients with acute respiratory distress syndrome (ARDS). Transpulmonary thermodilution measures hemodynamic parameters such as pulmonary vascular permeability index and extravascular lung water, enabling clinicians to assess ARD...

Introduction: The effect of extracorporeal cardiopulmonary resuscitation (ECPR) on recovery of cerebral blood flow (CBF) after achieving a return of spontaneous circulation (ROSC) has been undetermined. The objective of this study was to determine the impact of ECPR on the changes of CBF post-ROSC in a rat model of prolonged cardiac arrest (CA) and...

Upper-extremity deep venous thrombosis (UEDVT) after whole blood donation is rarely reported. Blood donation has a low rate of complications and is typically safe. A small percentage of blood donors experience donation-related events such as UEDVT, which are extremely rare. We are reporting a rare case of a UEDVT following blood donation. This is a...

This case study describes a 45-year-old Caucasian male with a past medical history of obesity, hypertension, and non-insulin-dependent diabetes mellitus, who in the setting of coronavirus disease 2019 (COVID-19) pneumonia, developed portal vein thrombosis (PVT) presenting as an acute abdomen after hospital discharge from a cholecystitis episode. PV...

Aim: Hyperglycemia is a common response to acute illness, but it is not often seen in critical conditions. The frequency and cause of hypoglycemia in septic patients have not been well elucidated. In this study, we focused on sepsis-associated hypoglycemia in the early phase and evaluated the impact of hypoglycemia on mortality. Methods: We perf...

Objective Cardiac arrest (CA) is a major health burden with brain damage being a significant contributor to mortality. We found lysophosphatidylcholine (LPC), including a species containing docosahexaenoic acid (LPC-DHA), was significantly decreased in plasma post-CA, supplementation of which significantly improved neurological outcomes. The aim of...

Clinical studies have demonstrated that dynamic changes in regional cerebral oxygen saturation (rSO2) after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) have a role in predicting neurological outcomes after the return of spontaneous circulation (ROSC). Our study evaluated whether the timing of rSO2 decline shortly after CPR reflects...

Clinical studies have demonstrated that dynamic changes in regional cerebral oxygen saturation (rSO2) after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) have a role in predicting neurological outcomes after the return of spontaneous circulation (ROSC). Our study evaluated whether the timing of rSO2 decline shortly after CPR reflects...

Neurons (HT-22) and Astrocytes (C8-D1A) were subjected to 6h OGD followed by 20h of Reperfusion (OGD-R). OGD is based on the combination of chemical ischemia (standard culture media depleted of glucose and other energy sources) and severe hypoxia (~O 2 2.0%) for 6h, while 20h of reperfusion consists of re-addition of standard culture media and cond...

Background Despite the benefits of extracorporeal cardiopulmonary resuscitation (ECPR) in cohorts of selected patients with cardiac arrest (CA), extracorporeal membrane oxygenation (ECMO) includes an artificial oxygenation membrane and circuits that contact the circulating blood and induce excessive oxidative stress and inflammatory responses, resu...

Introduction: Clinical studies have demonstrated that the initial rapid decrement in regional cerebral oxygen saturation (rSO 2 ) level by near-infrared spectroscopy shortly after ROSC was associated with good neurological outcomes. Aim: To evaluate whether the timing of rSO 2 decline shortly after ROSC reflects the severity of brain injury in a we...

Objective: We recently reported that post-resuscitation normoxic therapy attenuates oxidative stress in multiple organs and improves post-cardiac arrest (CA) organ injury, oxygen metabolism, and survival. Yet, detailed mechanisms of gene expression patterns and signaling pathways mitigated by normoxic therapy have not been elucidated. Therefore, we...

Introduction: Transcutaneous CO 2 (tcPCO 2 ) and arterial CO 2 (artPCO 2 ) become decoupled during shock. Aim: To test the hypotheses the gradient between tcPCO 2 and artPCO 2 (tc-artPCO 2 ) can be an early, sensitive measure to detect inadequate tissue perfusion in a pig model of hemorrhage shock. Methods: Six female pigs were used. A transcutaneo...

Background Despite much evidence supporting the monitoring of the divergence of transcutaneous partial pressure of carbon dioxide (tcPCO 2 ) from arterial partial pressure carbon dioxide (artPCO 2 ) as an indicator of the shock status, data are limited on the relationships of the gradient between tcPCO 2 and artPCO 2 (tc-artPCO 2 ) with the systemi...

Background: The hemoglobin index (HbI) represents the amount of hemoglobin, which reflects the regional tissue blood volume. The HbI is calculated by a regional oxygen saturation monitor. In freshwater drowning, inhaled water is immediately absorbed into the blood causing hemodilution. We hypothesized that this blood dilution could be observed in...

We describe the clinical course of a 65-year-old male patient who suffered from hydrocarbon-induced myelodysplasia and was successfully treated with the thrombopoietin receptor agonist (TPO-RA), romiplostim. Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis, cytopenias, and increased risk of leukemic transformation. Her...

Background: The proportion of adult patients with return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) remains unchanged since 2012. A better resuscitation strategy is needed. This study evaluated the effectiveness of a regional cerebral oxygen saturation (rSO2)-guided resuscitation protocol without rhythm check...

The regional oxygen saturation (rSO₂) values of brain and muscle tissues can be measured simultaneously even if blood pressure cannot be measured due to circulatory failure associated with shock and may continuously reflect the oxygen supply‐demand balance. The regional oxygen saturation (rSO₂) values of brain and muscle tissues can be measured sim...

This case report describes a 52-year-old male patient, with the incidental finding of inferior vena cava filter (IVCF) fragments impacted into the right ventricle, secondary to IVCF fragmentation and subsequent embolization. While IVCFs are prescribed to prevent pulmonary embolizations when anticoagulation is either contraindicated, or has failed,...

Background: Transcutaneous CO2 (tcPCO2) and arterial CO2 (artPCO2) decoupling occurs during shock states. Our study aimed to test the hypothesis that the gradient between tcPCO2 and artPCO2 (tc-artPCO2) can detect inadequate tissue perfusion during hemorrhagic shock and resuscitation. Methods: This prospective animal study was performed by a qualif...

Background: Transcutaneous CO2 (tcPCO2) and arterial CO2 (artPCO2) decoupling occurs during shock states. Our study aimed to test the hypothesis that the gradient between tcPCO2 and artPCO2 (tc-artPCO2) can detect inadequate tissue perfusion during hemorrhagic shock and resuscitation. Methods: This prospective animal study was performed by a qualif...

Objectives: Cardiac arrest and subsequent resuscitation have been shown to deplete plasma phospholipids. This depletion of phospholipids in circulating plasma may contribute to organ damage postresuscitation. Our aim was to identify the diminishment of essential phospholipids in postresuscitation plasma and develop a novel therapeutic approach of...

This case series reviews four critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [coronavirus disease 2019 (COVID-19)] suffering from pneumatosis intestinalis (PI) during their hospital admission. All patients received the biological agent tocilizumab (TCZ), an interleukin (IL)-6 antagonist, as an exp...

Background Regional cerebral oxygen saturation (rSO2) is a non-invasive method of measuring cerebral perfusion; However, serial changes in cerebral rSO2 values among out-of-hospital cardiac arrest (OHCA) patients in pre-hospital settings have not been sufficiently investigated. We aimed to investigate the association between the serial change in rS...

Background In the field of emergency medical care, we often experience a situation in which we cannot measure pulse oximetric saturation (SpO₂) or blood pressure due to circulatory failure associated with shock. However, as we can measure rSO₂ values of the brain even in patients with shock, we hypothesized that we could evaluate the oxygen supply-...

Organ transplantation can be associated with vascular torsions and angulations of both recipient and donor vessels. Such kinks and/or torsions of vessels can compromise the vascular integrity, obstruct inflow and/or outflow, and result in loss of the organ and/or body parts. On many occasions, mild angulations and torsions can be successfully addre...

Background Mitochondria are essential organelles that provide energy for cellular functions, participate in cellular signaling and growth, and facilitate cell death. Based on their multifactorial roles, mitochondria are also critical in the progression of critical illnesses. Transplantation of mitochondria has been reported as a potential promising...

Background At lower ambient temperature, patients with out-of-hospital cardiac arrest (OHCA) easily experience hypothermia. Hypothermia has shown to improve the rate of successful return of spontaneous circulation (ROSC) in animal models. We hypothesized that lower temperature affects the impact of bystander cardiopulmonary resuscitation (CPR) on t...

Despite recent advances in the management of post-cardiac arrest syndrome (PCAS), the survival rate, without neurologic sequelae after resuscitation, remains very low. Whole-body ischemia, followed by reperfusion after cardiac arrest (CA), contributes to PCAS, for which established pharmaceutical interventions are still lacking. It has been shown t...

The pituitary gland plays an important endocrinal role, however its damage after cardiac arrest (CA) has not been well elucidated. The aim of this study was to determine a pituitary gland damage induced by CA. Rats were subjected to 10-min asphyxia and cardiopulmonary resuscitation (CPR). Immunohistochemistry and ELISA assays were used to evaluate...

Improving neurological outcomes after cardiac arrest (CA) is the most important patient-oriented outcome for CA research. Near-infrared spectroscopy (NIRS) enables a non-invasive, real-time measurement of regional cerebral oxygen saturation. Here, we demonstrate a novel, non-invasive measurement using NIRS, termed modified cerebral oximetry index (...

We compared the outcome of COVID-19 in immunosuppressed solid organ transplant (SOT) patients to a transplant naïve population. 10,356 adult hospital admissions for COVID-19 from March 1, 2020 to April 27, 2020 were analyzed. Data were collected on demographics, baseline clinical conditions, medications, immunosuppression, and COVID-19 course. Prim...

Introduction: Cardiac arrest (CA) is a significant public health burden with few effective therapies available. Plasma phospholipids are important for proper organ function. We hypothesized that alterations in plasma phospholipids may play an important role in the pathophysiology of CA and normalizing these alterations may be a novel therapeutic ap...

Despite three decades of advancements in cardiopulmonary resuscitation (CPR) methods and post-resuscitation care, neurological prognosis remains poor among survivors of out-of-hospital cardiac arrest, and there are no reliable methods for predicting neurological outcomes in patients with cardiac arrest (CA). Adopting more effective methods of neuro...

Stenosis proximal to transplant renal artery anastomoses are complications leading to allograft dysfunction. This study was aimed to evaluate a novel surgical approach to renal allograft revascularization, taking into consideration the length of time elapsed since transplantation. We describe an arterial bypass using a polytetrafluoroethylene (PTFE...

In this case report, we describe the clinical course of a complicated transplant renal artery (TRA) pseudoaneurysm, clinically featured by gross and massive hematuria one month after a kidney transplant was performed on a 50 year-old male patient. TRA pseudoaneurysm is a rare but potentially life-threatening complication that may result in bleeding...

Purpose: Current guidelines recommend rhythm checks every 2 minutes during CPR, but evidence for this recommendation is insufficient. Recent reports identified regional cerebral oxygen saturation (rSO 2 ) monitoring as useful in detecting ROSC and that coronary and cerebral perfusion decrease with the 2-minute rhythm check. On the basis of our prev...

Objective: To clarify the neurological prognosis of post-resuscitation hypoxic encephalopathy patients on the basis of cerebral autoregulation. Methods: We conducted a prospective, observational cohort study of patients admitted to our urban emergency and critical care center in Japan between 2017 and 2019. Cerebral regional oxygen saturation (rSO...

Introduction: There are some critical ill patients who cannot measure oxygen saturation (SpO 2 ) by pulse oximeter at the pre-hospital settings. For example, among emergency patients who were treated by emergency medical service (EMS) personnel of Osaka Municipal Fire Department in 2016, there were 3,571 patients who had urgent conditions judged by...

Introduction: The simplified monitoring of regional cerebral oxygen saturation (rSO 2 ) is a non-invasive method of measuring cerebral perfusion, but continuous changes in the cerebral rSO 2 values among OHCA patients in the pre-hospital settings have not been sufficiently investigated. Our objective is to investigate the association between the ch...

Aim: The hemoglobin index (HbI) represents the amount of hemoglobin, which reflects regional tissue blood volume. The HbI is calculated in real time by a regional oxygen saturation (rSO 2) monitor. For the hypothesis of our HbI project, we theorized that HbI could be a new method for the screening of subarachnoid hemorrhage (SAH) in overcrowded em...

Background: Cerebral oximetry (rSO2) may be useful in assessing the probability of return of spontaneous circulation (ROSC). However, the potential of assessing the trend in the rSO2 value has not been discussed when determining the probability of ROSC. Methods: This was a retrospective study of out-of-hospital cardiac arrest (OHCA) patients wit...

Purpose The aim of this study was to evaluate an association between nutritional biomarkers and prognosis in septic patients. Methods We retrospectively searched the association between nutritional biomarkers including serum albumin (Alb), total protein (TP), total cholesterol (T-chol), and cholinesterase (ChE), and prognosis for septic patients t...

Abstract 209: The Triple CPR 16 study: Does rhythm truly needed to be checked every 2 minutes in Cardiopulmonary Arrest Patients? Ryosuke Takegawa, Tadahiko Shiozaki, Mitsuo Ohnishi, Jotaro Tachino, Takashi Muroya, Tomohiko Sakai, Koichi Hayakawa, and Takeshi Shimazu Originally published5 Nov 2018Circulation. 2018;138:A209 Abstract Purpose: Curr...

Introduction: Simplified monitoring system of regional cerebral oxygen saturation (rSO 2 ) is a non-invasive technology for cerebral perfusion, but continuous changes of cerebral rSO 2 values among OHCA patients in pre-hospital settings have been insufficiently investigated. Methods: We recently developed a portable rSO 2 monitoring system that is...

Purpose: Current guidelines recommend rhythm checks every 2 minutes during cardiopulmonary resuscitation (CPR), but evidence for this recommendation is insufficient. Recent reports identified regional cerebral oxygen saturation (rSO 2 ) monitoring as useful in detecting return of spontaneous resuscitation (ROSC) and that coronary and cerebral perfu...

要旨 我々は来院時心肺停止患者に対し，2007年より脳内組織酸素飽和度（rSO 2 ）の連続測定を行い，脳内rSO 2 モニタリングの有用性を報告してきた。この度，我々の見解を支持する典型例を経験したため報告する。患者は70代の男性で，突然の胸部不快感を主訴に救急要請した。救急隊到着時は会話可能だったが，救急車内で心肺停止となり当院へ搬送された。心肺停止時および来院時の波形は無脈性電気活動であり，来院時動脈血液ガスでは，pH 6.851，BE –20.9mmol/L，乳酸66.0mg/dLと著明なアシドーシスを認めた。蘇生困難と思われる状態であったが，脳内rSO 2 値の推移は蘇生の可能性を予見させるものであり，心停止より23分後に自己心拍再開（以下，ROSC）が得られた。すなわち，用手的胸...

Background Deep vein thrombosis (DVT) is a major complication in critical care. There are various methods of prophylaxis, but none of them fully prevent DVT, and each method has adverse effects. Electrical muscle stimulation (EMS) could be a new effective approach to prevent DVT in intensive care unit (ICU) patients. We hypothesized that EMS increa...

Introduction: There is no consensus on how long we should continue cardiopulmonary resuscitation (CPR). When determining this, it is important to assess the probability of return of spontaneous circulation (ROSC). We have been evaluating the usefulness of regional cerebral oxygen saturation (rSO2) during resuscitation since 2007. At the 2014 AHA co...

Introduction: There is no consensus on how long we should continue cardiopulmonary resuscitation (CPR). When determining this, it is important to assess the probability of return of spontaneous circulation (ROSC). We have been evaluating the usefulness of regional cerebral oxygen saturation (rSO 2 ) during resuscitation since 2007. At the 2014 AHA...

Fifteen years have passed since lung protective strategy to the patients with acute respiratory distress syndrome (ARDS) established. Recently, the new Berlin Definition of ARDS has been developed and this classified ARDS into three stages (mild, moderate, and severe ARDS), depending on the PaO2/FiO2. After this new definition of ARDS, each treatme...

Background: Bicycle accidents are one of the major causes of unintentional traumatic injury in childhood. The purpose of this study was to examine characteristics and risks of handlebar injury in childhood. Methods: We conducted a more than 5-year retrospective survey of patients under 15 years of age with bicycle-related injuries admitted to ei...

Neutrophils work as the frontline of defense against infections and neutrophil extracellular traps (NETs) are one of the immune systems to suppress dissemination of infection by the netted chromatin decorated with antibacterial molecules. It was reported that NETs play an important role in various kinds of infections such as pneumonia. However, the...

Neutrophil extracellular traps (NETs) are fibrous structures that are produced extracellularly from activated neutrophil. They can trap and kill various pathogens, and their release is one of the first lines of immune system. Meanwhile, recently it was reported that NETs also exert adverse effects in inflammatory diseases. Acute respiratory distres...