Thai Journal of Emergency Medicine

Complications after Mechanical Chest Compression versus Manual Cardiopulmonary Resuscitation in Patients with Non-Traumatic Cardiac Arrest: An Open-Label Randomized Controlled Study

Krissana Werawatakul — Fri, 21 Aug 2026 00:00:00 +0700

Introduction
Effective resuscitation is a key principle in the management of cardiac arrest. Automated mechanical chest compression devices have been widely adopted to reduce rescuer fatigue and improve the consistency of chest compression. However, chest injuries have been observed following chest compression performed both manually and with mechanical devices.
Objectives
To compare thoracic and intrathoracic injuries associated with automated mechanical chest compression versus manual chest compression in patients with non-traumatic cardiac arrest.
Methods
This was a prospective open-label controlled study with intended random allocation. Inclusion criteria were patients aged ≥15 years with cardiac arrest who underwent resuscitation in the Emergency Department of Roi Et Hospital between August 1, 2022 and January 1, 2023. Legal guardians or first-degree relatives were invited to provide written informed consent for study participation. Each patient was randomized to receive chest compression by either a rescuer (manual CPR) or an automated mechanical chest compression device. After completion of treatment, all patients underwent chest radiography in anteroposterior (AP) and lateral views.
Results
A total of 66 patients were enrolled: 34 in the mechanical compression group and 32 in the manual compression group. Male patients accounted for 18 (52.94%) and 21 (65.63%) in the mechanical and manual groups, respectively. Injuries were identified in 21 patients in the mechanical group and 7 patients in the manual group (p < 0.001). There were no statistically significant differences in specific injuries, including sternal fracture, rib fracture, pulmonary contusion, and pneumothorax. However, skin bruising was significantly more frequent in the mechanical compression group than in the manual compression group (p < 0.001).
Conclusion
Automated mechanical chest compression may be associated with a higher observed rate of thoracic injury, particularly external chest injury, compared with manual chest compression.

Factors Associated with 30-Day Mortality Among Acute Heart Failure Patient in the Emergency Department, Siriraj Hospital

Fri, 21 Aug 2026 00:00:00 +0700

Introduction
Acute heart failure is a significant global public health problem with an annual mortality rate of 10%. To investigate the predictive factors for mortality in acute heart failure patients can lead to improvement of patient care, including enhancing quality of life, reducing readmission rate, and reducing mortality.
Objective
To identify risk factors that impact the 30-day mortality rate among acute heart failure patients who visited the emergency department, Siriraj Hospital
Method
We conducted this retrospective case-control study on patients with acute heart failure who visited Siriraj Hospital. We collected data from June 1, 2018, to December 31, 2022, and used univariate analysis to identify factors influencing 30-day mortality. We further analyzed the significant factors through multiple logistic regression analysis.
Results
Among 450 acute heart failure patients, 300 patients survived (control group), and 150 patients died within 30 days (case group). Multiple logistic regression analysis identified significant risk factors for 30-day mortality, including valvular heart disease (adjusted OR 1.91, 95% CI 1.08–3.39) and cardiogenic shock (adjusted OR 3.30, 95% CI 1.56–7.12). On the contrary, systolic blood pressure (adjusted OR 0.99, 95% CI 0.98–0.99) and pre-existing statin use (adjusted OR 0.56, 95% CI 0.33–0.94) associated with decreased 30-day mortality.
Conclusion
The significant factors associated with 30-day mortality in acute heart failure patients included valvular heart disease, and cardiogenic shock. Meanwhile, systolic blood pressure and pre-existing use of statins were the protective factors that reduced the likelihood of 30-day mortality.

Factors Associated with 24-Hour Mortality Among Children and Adolescents Following Road Traffic Injuries at the Emergency Department of Khon Kaen Hospital

Nayawadee Kaweenuttayanon — Fri, 21 Aug 2026 00:00:00 +0700

Background
Road traffic injuries are a major cause of mortality and disability among children and adolescents, particularly among individuals aged 5–25 years. According to the 2021 Road Traffic Accident Statistics Report, adolescents aged 15–19 years accounted for the highest proportion of injuries and fatalities, representing 22.0% of all cases. Early identification of factors associated with mortality may facilitate risk assessment and improve the management of injured patients.
Objective
Objective to identify factors associated with 24-hour mortality among children and adolescents with road traffic injuries who presented to the Emergency Department of Khon Kaen Hospital.
Methods
A retrospective case-control study was conducted among patients aged 0–19 years who sustained road traffic injuries and were treated at the Emergency Department of Khon Kaen Hospital between January 2014 and December 2021. Patients triaged as Level 1 (resuscitation level) were included. The study population comprised two groups: patients who died within 24 hours of presentation (n = 144) and patients who survived beyond 24 hours (n = 144).
Results
A total of 288 critically injured patients were enrolled. Of these, 144 patients died within 24 hours and 144 survived. Most deceased patients were male (n = 115, 79.9%), and the age group with the highest number of deaths was 15–19 years (n = 104, 72.2%). After adjustment for potential confounders, factors significantly associated with 24-hour mortality were initial hypotension on arrival at the emergency department (AOR 182.11; 95% CI 20.00–1657.48; p < 0.001), thoracic injury (AOR 4.94; 95% CI 1.87–13.05; p = 0.001), an initial Glasgow Coma Scale (GCS) score of 3–8 (AOR 96.08; 95% CI 4.48– 2057.49; p = 0.003), and an Abbreviated Injury Scale (AIS) score greater than 3 (AOR 3.26; 95% CI 1.11–9.57; p = 0.031).
Conclusion
Initial hypotension, thoracic injury, an initial Glasgow Coma Scale score of 3–8, and an Abbreviated Injury Scale score greater than 3 were significantly associated with 24-hour mortality among children and adolescents with road traffic injuries. These factors may be useful for early risk assessment and monitoring of severely injured patients in the emergency department. Further studies are required to validate these findings and evaluate their applicability in clinical practice.

Parecoxib for Acute Pain Management in the Emergency Department: A Narrative Review

Thampron Thongphan — Fri, 21 Aug 2026 00:00:00 +0700

Parecoxib is an injectable COX-2 selective nonsteroidal anti-inflammatory drug with properties that make it suitable for use in the emergency department (ED). This narrative review aims to summarize the current evidence on the pharmacology, efficacy, and safety of parecoxib, as well as its role in multimodal analgesia for ED patients. Available data suggest that parecoxib provides analgesia comparable to nonselective NSAIDs without clear impairment of platelet function and may be associated with a lower risk of gastrointestinal adverse events. These characteristics indicate that parecoxib could be a useful non-opioid component of multimodal pain management in the ED. Nevertheless, its use should be individualized, avoiding administration in patients with hypersensitivity to parecoxib, celecoxib, or severe sulfonamide allergy, using caution in patients with pre-existing cardiovascular disease, and avoiding use in those with severe renal impairment. However, ED-specific studies remain limited, and further well-designed clinical trials are needed to better define the role of parecoxib in the management of acute pain in the ED.

Prevalence and Factors Associated with Helmet-Wearing Behavior During Motorcycle Riding Among High School Students, Chiang Rai Province

Praewanit Nedsuwan, Kriangsak Pintatham — Fri, 21 Aug 2026 00:00:00 +0700

Introduction
Chiang Rai Province faces increasing road traffic fatalities, especially among young adults and adolescents, largely due to failure to wear motorcycle helmets.
Objective
To determine the prevalence and factors influencing helmet-wearing behavior among high school students in Chiang Rai Province.
Methods
A cross-sectional online survey was conducted among grades 7–12 students across 18 district schools from July 8 to August 8, 2024.
Results
Among 1,706 participants, only 23.5% reported wearing a helmet every time. Logistic regression revealed that male gender, having a driving license, owning a helmet, having peers/parents who wear helmets, and receiving parental reminders were significantly associated with helmet use (p < 0.05).
Conclusion
Helmet use among these students remains low, influenced significantly by personal, social, and family-related factors.