Jason T. Nomura, M.D

Director, Emergency Medicine Ultrasound Fellowship; Physician, Department of Emergency Medicine; Core Faculty, Christiana Care Stroke Program; CCQP Leader, Neuroscience

Publications

Even Faster Door-to-Alteplase Times and Associated Outcomes in Acute Ischemic Stroke
Even Faster Door-to-Alteplase Times and Associated Outcomes in Acute Ischemic Stroke
Jung S, Rosini JM, Nomura JT, Caplan RJ, Raser-Schramm J J Stroke Cerebrovasc Dis 2019 Dec;28(12):104329 PMID: 31607439
Abstract
BACKGROUND AND PURPOSE: The timely administration of thrombolytic therapy for acute ischemic stroke has been associated with good functional outcomes. Current guidelines recommend alteplase administration within 60 minutes in 75% of eligible patients and within 45 minutes in 50% of patients. There is limited evidence guiding these measures and their effect on outcomes. We report a single-center, retrospective assessment of the safety and efficacy of alteplase treatment within 45 minutes. METHODS: Five hundred and eighty-six patients were treated with alteplase in our emergency departments (EDs) between January 2014 and October 2016; 368 patients were included for analysis. Multivariate regression analysis was used to assess the association between door-to-alteplase (DTA) times and 90-day modified Rankin scale (mRS) scores. Incidence of intracerebral hemorrhage (ICH) was also documented. RESULTS: The median DTA time was 29 minutes versus 64 minutes in the DTA less than or equal to 45 minutes arm and more than 45 minutes arm, respectively. The primary outcome of 90-day mRS 0-1 was achieved in 56% of patients in the less than or equal to 45 minutes group versus 58% in more than 45 minutes group (P = .67). Odds of achieving mRS 0-1 were not significantly impacted by DTA times. In the multivariate regression analysis, patient characteristics associated with achieving mRS 0-1 were: younger age, male sex, not requiring intubation in the ED, and without prior history of hypertension, atrial fibrillation, or stroke. There was no significant difference in rates of ICH for patients less than or equal to 45 minutes versus more than 45 minutes. CONCLUSIONS: Rapid administration of alteplase was not associated with significantly better outcomes nor increased risk of ICH. Conclusions about efficacy are limited due to the retrospective nature of the study, small sample size, and incomplete data points.
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Impending paradoxical embolus
Impending paradoxical embolus
Provenzal A, Blanco P, Nomura JT J Emerg Med 2015 Apr;48(4):466-7 PMID: 25605318
Abstract
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Ultrasound-guidance can reduce adverse events during femoral central venous cannulation
Ultrasound-guidance can reduce adverse events during femoral central venous cannulation
Powell JT, Mink JT, Nomura JT, Levine BJ, Jasani N, Nichols WL, Reed J, Sierzenski PR

J Emerg Med 2014 Apr;46(4):519-24

PMID: 24462032

Abstract

BACKGROUND: Ultrasound-guidance for internal jugular central venous cannulation (CVC) has become the recommended best practice and has been shown to improve placement success and reduce complications. There is a dearth of studies that evaluate emergency point-of-care ultrasound guidance of femoral CVC.
OBJECTIVE: Our aim was to determine if point-of-care ultrasound guidance for femoral CVC decreases adverse events and increases the likelihood of successful placement when compared with the landmark technique.
METHODS: We conducted an Institutional Review Board-approved, prospective, observational study of consecutive patients who required CVC. Physicians who performed CVC completed a standardized, web-based data sheet for a national CVC registry. We evaluated single-institution data regarding CVC site, ultrasound usage, CVC indication, and mechanical complications (e.g., pneumothorax, arterial puncture, failed access, catheter misdirection, and hematoma). The study period was between January 2006 and June 2010. Analysis using Pearson's χ(2) and Agresti-Coull binomial confidence intervals was performed; significance was defined as p < 0.05.
RESULTS: We evaluated data for 143 patients who had femoral CVC in our institution. Sixty CVCs (42%) were performed under ultrasound guidance, 83 (58%) via landmark technique (p = 0.0159); 3.3% of femoral central venous lines placed by ultrasound guidance had recorded adverse events compared with 9.6% for the landmark technique (p = 0.145). There was no statistically significant difference in complications between ultrasound-guidance and landmark techniques. Our data showed a trend toward decreased rates of arterial puncture and reduced cannulation attempts resulting in improved placement success.
CONCLUSIONS: Our experience shows that ultrasound guidance for femoral CVC might decrease complications and improve placement success, although we cannot recommend this approach without additional data. We recommend a larger study to further evaluate this technique.
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An atypical misplacement of a temporary pacing catheter diagnosed and resolved by ultrasound
An atypical misplacement of a temporary pacing catheter diagnosed and resolved by ultrasound
Blanco P, Nomura JT

Am J Emerg Med 2014 Mar;

PMID: 24736126

Abstract

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