Personal Statement
Emergency airway management was my initial research interest when I came to the field of emergency medicine. I was particularly interested in the fact that there was a wide variety of techniques and trainings in emergency airway management worldwide. Through the experience of teaching airway managements to residents and medical students, I quickly extended my research interest to procedural sedation and analgesia (PSA) because education and research topics in both Emergency airway management and PSA largely overlap each other.
Taking advantage of having completed clinical training in two different countries (US and Japan) and having appointments in academic institutions in both countries, I have had unique opportunities in airway and PSA researches and educational projects. For example, I incorporated some techniques used to teach emergency and surgical procedures in Japan into our emergency medicine residency curriculum. These techniques include mindfulness, positioning of providers who perform procedures, and emphasis on aesthetics.
The work was published as an essay in academic emergency medicine. I also published a PSA textbook in Japanese and wrote multiple chapters in emergency medicine and anesthesia textbooks about airway assessment, training of PSA, and recent updates on those topics in both Japanese and English. Teaching and writing about PSA gave me a chance to realize that there was limited evidence to support safety of PSA in Asian countries.
We conducted retrospective chart reviews of all PSAs performed in the emergency department at one academic institution in Japan. The study found that there was a lack of standard pre-PSA evaluation, documentations, and frequent minor complications such as transient hypoxia and hypoventilation. Due to the nature of retrospective study, we could not evaluate patient-centered outcomes including patient satisfaction and amnesia. This experience leads to a prospective observation study of PSA in the emergency department.
Fortunately, multiple emergency departments showed interests in this project and this prospective observation study a nationwide PSA registry in Japan in 2017 and I am a principal investigator of the project. Based on the success deployment of the registry and smooth ongoing data collection, we are planning to expand this registry to other countries in Asian-Pacific region. Currently, multiple hospitals in Nepal, Singapore, South Korea, and New Zealand are interested in participating in the registry.
In addition to the contributions described above, I have conducted a series of studies looking at efficacy of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for critically uncontrolled hemorrhagic shock. Our study became the first clinical study to evaluate the efficacy of REBOA on survival outcome in a large scale.
Before our study, the evidence was limited to case reports and small sample size case series. We found that REBOA is associated with higher mortality in blunt trauma patients. The paper has been cited by more than 80 papers since the paper was published in 2015. The study has been referenced as one of the key studies in this area and was also cited in UpToDate.
Our second and third studies were focused on use of REBOA in pediatric patients and patients with penetrating injury. These works have been presented at national and international meetings and published in a major trauma journal.
Our current focus is long term outcomes of patients who receive REBOA. These outcomes include survival, long-term functional and patient-reported outcomes of patients who survived to discharge after severe traumas.