Jostein Skjalg Hagemo

• Bekkevold, Marit; Solvik-Olsen, TONE; Lang, Astri Maria; Heyerdahl, Fridtjof; Hagemo, Jostein Skjalg & Rehn, Marius (2025). Data variables reported during neonatal transport: a systematic literature review. Journal of Perinatology. ISSN 0743-8346. 46(1), s. 6–11. doi: 10.1038/s41372-025-02483-y. Fulltekst i vitenarkiv Vis sammendrag

  Neonatal transports are essential for providing access to advanced intensive care treatment for sick and premature neonates. There is a lack of consensus of which core physiological variables, clinical parameters and quality metrics to report for clinical guidance during transport and clinical governance of transport systems. We performed a systematic literature review to identify which data variables are reported during neonatal transports and assess whether these variables are uniform and transferable across studies. In the final data extraction and quality appraisal, 108 studies were included. The studies were heterogenous, presented a large variation of registered variables and frequently lacked uniform definitions. Reaching consensus on a set of defined variables for registration and implementation internationally will enhance the opportunity to improve the safety, effectiveness and quality of care for these vulnerable neonates.

• Solvik-Olsen, TONE; Bekkevold, Marit; Heyerdahl, Fridtjof; Lang, Astri Maria; Hagemo, Jostein Skjalg & Rehn, Marius (2025). Environmental factors and clinical markers of stress during neonatal transport: A systematic literature review. BMJ Paediatrics Open. 9(1). doi: 10.1136/bmjpo-2025-003568. Fulltekst i vitenarkiv Vis sammendrag

  Background Neonatal transport is an essential component of modern neonatal intensive care globally, providing access to advanced treatment while exposing vulnerable neonates to environmental conditions that may increase the risk of physiological instability. Objective To systematically review studies measuring environmental exposures, specifically vibration, sound and temperature fluctuations during neonatal transport and to evaluate their impact on clinical parameters in neonates. Methods A systematic literature review identified studies reporting environmental factors or clinical data during transport via ground, rotor or fixed-wing air ambulances. The medical databases searched included MEDLINE/PubMed, Embase, the Cochrane database of systematic reviews, Nursing Reference Center Plus, UpToDate and SveMed covering the period from November 2020 to January 2025. Results 15 observational studies, 13 prospective and 2 retrospective covering publications from 1992 to 2025 were included. The studies included data on vibration, sound, ambient temperature and a wide range of clinical parameters such as heart rate and heart rate variability, change in clinical behaviour scales and cortisol in saliva reflecting the neonatal condition. Only four articles reported the effect of environmental factors on neonatal physiology. Conclusions This review highlights the presence of environmental factors, particularly noise and vibration, during transport and raises concerns about their impact on neonates. Although diverse clinical parameters were documented, the small sample sizes and variability in measurement methods across studies limit the ability to draw definitive conclusions. These observations emphasise the need

• Farbu, Bjørn Hoftun; Hagemo, Jostein Skjalg & Rehn, Marius (2025). Abdominal organ injury in cardiac arrest: Systematic literature review. PLOS ONE. 20(8). doi: 10.1371/journal.pone.0329164. Fulltekst i vitenarkiv Vis sammendrag

  Background Both cardiopulmonary resuscitation (CPR) and ischaemia could lead to abdominal organ injury. However, the importance of abdominal injury in cardiac arrest remains uncertain. We aimed to systematically review indexed literature to describe incidence of abdominal injury after non-traumatic cardiac arrest and associations with outcome. Methods We searched MEDLINE/PubMed, Embase, The Cochrane Database of Systematic Reviews and Scopus up to 12th September 2024 for studies reporting differences in outcomes between patients with and without abdominal injury, and all studies reporting abdominal adverse events after cardiac arrest. Two independent reviewers screened articles for eligibility. One reviewer extracted data and assessed risk of bias using the Critical Appraisal Skills Programme checklist. Injuries were defined as traumatic or ischaemic, either in the studies or otherwise by the reviewers. Results were summarized and presented in tables and Forest plots. We followed the PRISMA guidelines, and registered the study in PROSPERO. Results We included 68 studies and 140 case reports. Most studies were single-centre. Quantitative synthesis of evidence was not feasible given high heterogeneity and risk of bias. Traumatic injuries affected mostly liver and spleen, with incidences from 0% to 15%, reaching 29% in one study of mechanical chest compressions. Life-threatening injuries were uncommon. The incidence of ischaemic injury was dependent on assessment method; 7% to 28% had liver injury, 0.7% to 2.5% was diagnosed with non-occlusive mesenteric ischaemia, 82% to 100% had intestinal injury measured by biomarkers. Ischaemic injuries were associated with mortality. Conclusion In this comprehensive review of abdominal injuries following cardiac arrest, CPR-related traumatic injuries were uncommon, but should be considered in patients with unexplained clinical deterioration. Ischaemic injury incidence ranged from 0.7% to 100%, and was consistently associated with mortality. Whether abdominal ischaemia independently contributes to poor outcomes remains unresolved and warrants further investigation.

• Simensen, Randi; Fjose, Lars Olav; Thorsen, Kjetil; Olsen, Inge Christoffer; Rehn, Marius & Hagemo, Jostein Skjalg [Vis alle 8 forfattere av denne artikkelen] (2025). Comparison of inhalational methoxyflurane, intranasal fentanyl, and intravenous morphine for treatment of prehospital acute pain in Norway (PreMeFen): a randomised, non-inferiority, three-arm, phase 3 trial. The Lancet. ISSN 0140-6736. s. 1–10. doi: 10.1016/s0140-6736(25)01575-2. Fulltekst i vitenarkiv Vis sammendrag

  Background: Adequate pain control is essential; however, acute pain is often undertreated in prehospital care. This study aimed to evaluate three analgesic regimens for treating acute pain in an ambulance setting. Methods: PreMeFen is a randomised, open-label, non-inferiority, three-arm, phase 3 trial conducted in the working areas of the ground ambulance service of the Innlandet Hospital Trust, Norway. Patients aged 18-69 years and 70 years and older with traumatic or medical acute pain scoring 4 or higher on the Numeric Rating Scale (NRS) were randomly assigned (1:1:1) to receive in titration doses 3 mL inhalational methoxyflurane, 50 μg or 100 μg intranasal fentanyl, or 0·05 mg/kg or 0·1 mg/kg intravenous morphine, respectively, depending on the age group. The primary endpoint was change in pain NRS score from baseline to 10 min after treatment start and was analysed per protocol. The non-inferiority margin was 1·3. This trial is registered with ClinicalTrials.gov (NCT05137184) and is completed. Findings: Between Nov 12, 2021, and April 22, 2023, 632 patients were assessed for eligibility, and 338 were randomly assigned to methoxyflurane (n=112), fentanyl (n=115), or morphine (n=111). 281 patients were included in the per-protocol population. 145 (52%) of 281 patients were female and 136 (48%) were male. Median age was 61 years (IQR 47-75). The baseline NRS score was 7·6 (SD 1·8). Mean NRS score changes after 10 min were -3·31 (SD 2·67) for methoxyflurane, -1·98 (2·28) for fentanyl, and -2·74 (2·12) for morphine. Comparing changes in mean NRS score while adjusting for baseline showed that methoxyflurane was non-inferior to fentanyl (-1·33 [95% CI -2·01 to -0·64]) and morphine (-0·36 [-1·03 to 0·31]). Intranasal fentanyl was not non-inferior to morphine at 10 min (0·91 [0·27 to 1·55]). Adverse events occurred in 26 (24%) of 109 patients in the morphine group, 27 (24%) of 112 in the fentanyl group, and 24 (22%) of 111 in the methoxyflurane group. Two serious adverse events, respiratory depression (grade 2) and loss of consciousness (grade 3), occurred in the same patient in the methoxyflurane group. There were no treatment-related deaths. Interpretation: Inhalational methoxyflurane is non-inferior to intranasal fentanyl and intravenous morphine for acute pain management in the prehospital environment, assessed 10 min after administration. Inhalational methoxyflurane serves as a valuable non-intravenous alternative in the early phase of treatment and might bridge the gap to longer-acting analgesics.

• Christensen, Emma; Bugge, Helge Fagerheim; Hagemo, Jostein Skjalg; Larsen, Karianne; Harring, Astrid Karina V. & Gleditsch, Jostein [Vis alle 10 forfattere av denne artikkelen] (2024). Prehospital stroke diagnostics using three different simulation methods: A pragmatic pilot study. European Stroke Journal. ISSN 2396-9873. 9(4), s. 1016–1024. doi: 10.1177/23969873241252564. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: The optimal pathway for ultra-early diagnostics and treatment in patients with acute stroke remains uncertain. The aim of this study was to investigate how three different methods of simulated, rural prehospital computed tomography (CT) affected the time to prehospital treatment decision in acute stroke. Materials and Methods: In this pragmatic, simulation, pilot study of prehospital CT we investigated a conventional ambulance with transport to a standard care rural stationary CT machine managed by paramedics, a Mobile Stroke Unit (MSU), and a helicopter with a simulated CT machine. Each modality completed 20 real-life dispatches combined with simulation of predetermined animated patient cases with acute stroke symptoms and CT images. The primary endpoint of the study was the time from alarm to treatment decision. Results: Median time from alarm to the treatment decision differed significantly between the three groups (p = 0.0005), with 38 min for rural CT, 33 min for the MSU, and 30 min for the helicopter. There was no difference in time when comparing rural CT with MSU, nor when comparing the MSU with the helicopter. There was a difference in time to treatment decision between the rural CT and the helicopter (p < 0.0001). The helicopter had significantly lower estimated time from treatment decision to hospital (p = 0.001). Disscussion/Conclusion: Prehospital CT can be organized in several ways depending on geography, resources and need. Further research on paramedic run rural CT, MSU in rural areas, and helicopter CT is needed to find the optimal strategy.

• Solvik-Olsen, Tone; Kåsin, Jan Ivar; Hagemo, Jostein Skjalg & Heyerdahl, Fridtjof (2024). Manikin study showed that neonates are exposed to high sound and vibration levels during helicopter incubator transports. Acta Paediatrica. ISSN 0803-5253. 113(11), s. 2327–2492. doi: 10.1111/apa.17326. Fulltekst i vitenarkiv Vis sammendrag

  Aim This initial Norwegian study aimed to quantify the vibrations and sounds experienced by neonates when they were transported by helicopter in an incubator. Methods Two neonatal manikins weighing 500 and 2000 g were placed in a transport incubator and transported in an Airbus H145 D3 helicopter during standard flight profiles. The vibrations were measured on the mattress inside the incubator and the sound levels were measured inside and outside the incubator. Results The highest vibration levels were recorded during standard flight profiles when the lighter manikin was used. These ranged 0.27–0.94 m/s2, compared to 0.27–0.76 m/s2 for the heavier manikin. The measurements exceeded the action levels set by the European Union Vibration Directive for adult work environments. The sound levels inside the incubator ranged 84.6–86.3 A-weighted decibels, with a C-weighted peak level of 122 decibels. The sound levels inside the incubator were approximately 10 decibels lower than outside, but amplification was observed in the incubator at frequencies below 160 Hz. Conclusion Vibrations were highest for the lighter manikin. The sound levels during helicopter transport were higher than recommended for neonatal environments and sounds were amplified within the incubator at lower frequencies.

• Bekkevold, Marit; Solvik-Olsen, Tone; Heyerdahl, Fridtjof; Lang, Astri Maria; Hagemo, Jostein Skjalg & Rehn, Marius (2024). Reporting interhospital neonatal intensive care transport: international five-step Delphi-based template. BMJ Paediatrics Open. 8(1), s. 1–7. doi: 10.1136/bmjpo-2023-002374. Fulltekst i vitenarkiv Vis sammendrag

  Objective To develop a general and internationally applicable template of data variables for reporting interhospital neonatal intensive care transports. Design A five-step Delphi method. Setting A group of experts was guided through a formal consensus process using email. Subjects 12 experts in neonatal intensive care transports from Canada, Denmark, Norway, the UK and the USA. Four women and eight men. The experts were neonatologists, anaesthesiologists, intensive care nurse, anaesthetic nurse, medical leaders, researchers and a parent representative. Main outcome measures 37 data variables were included in the final template. Results Consensus was achieved on a template of 37 data variables with definitions. 30 variables to be registered for each transport and 7 for annual registration of the system of the transport service. 11 data variables under the category structure, 20 under process and 6 under outcome. Conclusions We developed a template with a set of data variables to be registered for neonatal intensive care transports. To register the same data will enable larger datasets and comparing services.

• Rehn, Marius; Heyerdahl, Fridtjof; Osbakk, Svein Are; Andresen, Åke Erling Lappen & Hagemo, Jostein Skjalg (2023). Challenges and Risks in Out-of-Hospital Transport of Patients During the Coronavirus Disease 2019 Pandemic. Air Medical Journal. ISSN 1067-991X. 42(3), s. 191–195. doi: 10.1016/j.amj.2023.02.002. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Norwegian critical care resources are regionalized making air ambulances transport of suspected or confirmed coronavirus disease 2019 (COVID-19)-positive patients a necessity. We prospectively observed pre- and interhospital transportation of patients with suspected or confirmed COVID-19 in our physician-manned emergency medical services. Methods: This was a prospective, observational quality assurance study of primary and secondary missions conducted by 2 Norwegian air ambulances during the COVID-19 pandemic. Results: Forty-one (24.1%) were primary missions, whereas 129 (75.9%) were interhospital transports. Most patients (158 [92.9%]) were transported with ground-based vehicles, and 12 (7.1%) were transported by rotor wing aircrafts. One hundred thirty-four of 170 patients (78.8%) were COVID-19 positive at the time of transportation. The median (interquartile range) fraction of inspired oxygen concentration was 0.60 (0.50-0.80), the positive end-expiratory pressure was 11 cm H2O (8-13.5 cm H2O), and the peak inspiratory pressure was 26 cm H2O (22-30 cm H2O). Some degree of elevated treatment challenge was reported in 157 (87.7%) transports, and in 139 (77.7%), the patient risk was considered elevated. The physician stated that some degree of elevated risk for the provider was elevated in 131 (73.2%) of the transports. Conclusion: The capacity of the physician-manned emergency medical services to safely transfer patients remains essential to maintain resilient critical care capacity, and the perceived elevated risks should be considered in capacity planning.

• Bredmose, Per P.; Hagemo, Jostein Skjalg; Østergaard, Doris & Sollid, Stephen (2021). Combining in-situ simulation and live HEMS mission facilitator observation: a flexible learning concept. BMC Medical Education. 21(1), s. 1–10. doi: 10.1186/s12909-021-03015-w. Fulltekst i vitenarkiv Vis sammendrag

  Background Continuous medical education is essential in Helicopter Emergency Medical Services (HEMS). In-situ simulation training makes it possible to train in a familiar environment. The use of a dedicated facilitator is essential; however, when an in-situ simulation training session is interrupted by a live mission, the efforts invested in the training are left unfulfilled. This study aims to evaluate if HEMS mission observation and debriefing by the simulation facilitator is a feasible alternative to mission-interrupted simulation training, and how this alternative to simulation training is perceived by both facilitators and HEMS crew members. Methods Facilitator observation during live missions and post-mission debriefing was offered as an alternative to mission-interrupted simulation training over a one-year period at three HEMS bases. Immediate feedback was requested from crews and facilitators after each observed live mission on a predefined questionnaire. At the end of the study period, semi-structured interviews were performed with a sample of HEMS crew members and facilitators to further explore the experience with the concept. Numerical data about the sessions were recorded continuously. Results A total of 78 training sessions were attempted, with 46 (59%) of the simulations conducted as planned. Of the remaining, 23 (29%) were not started because the crew had other duties (fatigued crew or crew called for a mission where observation was inappropriate/impossible), and 9 (12%) training sessions were converted to observed live missions. In total, 43 (55%), 16 (21%) and 19 (24%) attempts to facilitate simulation training were undertaken on the three bases, respectively. The facilitators considered mission observation more challenging than simulation. The interviews identified local know-how, clinical skills, and excellent communication skills as important prerequisites for the facilitators to conduct live mission observation successfully. Participating crews and facilitators found simulation both valuable and needed. Being observed was initially perceived as unpleasant but later regarded as a helpful way of learning. Conclusion Live mission observation and debriefing seems a feasible and well-received alternative to an in-situ simulation program in HEMS to maximise invested resources and maintain the learning outcome. Furthermore, additional training of simulation facilitators to handle the context of live mission observation may further improve the learning output.

• Mæhlen, Jens Otto; Mikalsen, Roger; Heimdal, Hans Julius; Rehn, Marius; Hagemo, Jostein Skjalg & Ottestad, William Arne (2021). Pre-hospital critical care management of severe hypoxemia in victims of Covid-19: a case series. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 29, s. 1–5. doi: 10.1186/s13049-021-00831-3. Fulltekst i vitenarkiv Vis sammendrag

  Objective Despite critical hypoxemia, Covid-19 patients may present without proportional signs of respiratory distress. We report three patients with critical respiratory failure due to Covid-19, in which all presented with severe hypoxemia refractory to supplemental oxygen therapy. We discuss possible strategies for ventilatory support in the emergency pre-hospital setting, and point out some pitfalls regarding the management of these patients. Guidelines for pre-hospital care of critically ill Covid-19 patients cannot be established based on the current evidence base, and we have to apply our understanding of respiratory physiology and mechanics in order to optimize respiratory support. Methods Three cases with similar clinical presentation were identified within the Norwegian national helicopter emergency medical service (HEMS) system. The HEMS units are manned by a consultant anaesthesiologist. Patient’s next of kin and the Regional committee for medical and health research ethics approved the publication of this report. Conclusion Patients with Covid-19 and severe hypoxemia may pose a considerable challenge for the pre-hospital emergency medical services. Intubation may be associated with a high risk of complications in these patients and should be carried out with diligence when considered necessary. The following interventions are worth considering in Covid-19 patients with refractory hypoxemia before proceeding to intubation. First, administering oxygen via a tight fitting BVM with an oxygen flow rate that exceeds the patient’s ventilatory minute volume. Second, applying continuous positive airway pressure, while simultaneously maintaining a high FiO2. Finally, assuming the patient is cooperative, repositioning to prone position.

• Bredmose, Per Poelhøi; Hagemo, Jostein Skjalg; Røislien, Jo; Østergaard, Doris & Sollid, Stephen J. M. (2020). In situ simulation training in helicopter emergency medical services: feasible for on-call crews? Advances in Simulation. 5. doi: 10.1186/s41077-020-00126-0. Fulltekst i vitenarkiv Vis sammendrag

  Simulation-based training of emergency teams offers a safe learning environment in which training in the management of the critically ill patient can be planned and practiced without harming the patient. We developed a concept for in situ simulation that can be carried out during on-call time. The aim of this study is to investigate the feasibility of introducing in situ, simulation-based training for the on-call team on a busy helicopter emergency medical service (HEMS) base. We carried out a one-year prospective study on simulation training during active duty at a busy Norwegian HEMS base, which has two helicopter crews on call 24/7. Training was conducted as low fidelity in situ simulation while the teams were on call. The training took place on or near the HEMS base. Eight scenarios were developed with learning objectives related to the mission profile of the base which includes primary missions for both medical and trauma patients of all ages, and interhospital transport of adults, children, and neonates. All scenarios included learning objectives for non-technical skills. A total of 44 simulations were carried out. Total median (quartiles) time consumption for on-call HEMS crew was 65 (59-73) min. Time for preparation of scenarios was 10 (5-11) min, time for simulations was 20 (19-26) min, cleaning up 7 (6-10) min, and debrief 35 (30-40) min. For all items on the questionnaire, the majority of respondents replied with the two most positive categories on the Likert scale. Our results demonstrate that in situ simulation training for on-call crews on a busy HEMS base is feasible with judicious investment of time and money. The participants were very positive about their experience and the impact of this type of training.

• Bredmose, Per Poelhøi; Stave, Halvard; Eriksen, Morten; Osbakk, Svein Are; Farstad, Gunnar & Hagemo, Jostein Skjalg (2020). Live Tissue Training on Anesthetized Pigs for Air Ambulance Crews. Air Medical Journal. ISSN 1067-991X. 40(1), s. 60–64. doi: 10.1016/j.amj.2020.10.003. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Patients with life- or limb-threatening severe injuries pose a challenge to prehospital services. Time-critical decision making and treatment are challenging because of occasional incomplete information, limited resources, adverse environments, and a range of basic and advanced technical skills available. To prepare for these infrequent critical situations, medical personnel from the helicopter emergency medical service at Oslo University Hospital developed a 1-day advanced trauma training course focusing on individual skills and teamwork during resuscitative procedures. Methods: Participants were trained under supervision in teams on an established live tissue model with anesthetized pigs. A questionnaire-based evaluation was conducted before and after training to measure the feasibility of covering the allocated learning objectives in the time allotted and participants’ perception of any change in their skills as a result of the course. Results: The self-reported skill level in all learning objectives improved significantly. Combining all learning objectives, the median self-reported skill level was significantly increased from 4 to 6 points (P < .001). Conclusion: Experienced prehospital physicians and other health staff reported an increased level of skill and competence in lifesaving and limb-saving procedures after completing a brief, intense 1-day course using living anesthetized pigs and cadaver models.

• Hagemo, Jostein Skjalg; Bredmose, Per Poelhøi; Stave, Halvard; Rehn, Marius & Buskop, Christian (2019). Response to: Best practice advice on pre-hospital emergency anaesthesia &amp; advanced airway management. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 27(1). doi: 10.1186/s13049-019-0613-7. Fulltekst i vitenarkiv
• Høiseth, Lars Øivind & Hagemo, Jostein Skjalg (2017). Predicting fluid responsiveness in whom? A simulated example of patient spectrum influencing the receiver operating characteristics curve. Journal of clinical monitoring and computing. ISSN 1387-1307. 32(2), s. 215–219. doi: 10.1007/s10877-017-0019-x. Fulltekst i vitenarkiv
• Hagemo, Jostein Skjalg; Christiaans, Sarah C.; Stanworth, Simon J.; Brohi, Karim H.; Johansson, Pär I. & Goslings, J. Carel [Vis alle 8 forfattere av denne artikkelen] (2015). Detection of acute traumatic coagulopathy and massive transfusion requirements by means of rotational thromboelastometry: An international prospective validation study. Critical Care. ISSN 1364-8535. 19(97). doi: 10.1186/s13054-015-0823-y. Fulltekst i vitenarkiv
• Hagemo, Jostein Skjalg; Stanworth, Simon; Juffermans, Nicole P.; Brohi, Karim; Cohen, Mitchell Jay & Johansson, Pär I. [Vis alle 10 forfattere av denne artikkelen] (2014). Prevalence, predictors and outcome of hypofibrinogenaemia in trauma: A multicentre observational study. Critical Care. ISSN 1364-8535. 18(2). doi: 10.1186/cc13798. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Exsanguination due to trauma-induced coagulopathy is a continuing challenge in emergency trauma care. Fibrinogen is a crucial factor for haemostatic competence, and may be the factor that reaches critically low levels first. Early fibrinogen substitution is advocated by a number of authors. Little evidence exists regarding the indications for fibrinogen supplementation in the acute phase. This study aims to estimate the prevalence of hypofibrinogenaemia in a multi-center trauma population, and to explore how initial fibrinogen concentration relates to outcome. Also, factors contributing to low fibrinogen levels are identified. Methods Patients arriving in hospital less than 180 minutes post-injury requiring full trauma team activation in four different centers were included in the study. Time from injury, patient demographics, injury severity scores (ISS) and 28 days outcome status were recorded. Initial blood samples for coagulation and blood gas were analyzed. Generalized additive regression, piecewise linear regression, and multiple linear regression models were used for data analyses. Results Out of 1,133 patients we identified a fibrinogen concentration ≤1.5g/L in 8.2%, and <2 g/L in 19.2%. A non-linear relationship between fibrinogen concentration and mortality was detected in the generalized additive and piecewise linear regression models. In the piecewise linear regression model we identified a breakpoint for optimal fibrinogen concentration at 2.29 g/L (95% confidence interval (CI): 1.93 to 2.64). Below this value the odds of death by 28 days was reduced by a factor of 0.08 (95% CI: 0.03 to 0.20) for every unit increase in fibrinogen concentration. Low age, male gender, lengthened time from injury, low base excess and high ISS were unique contributors to low fibrinogen concentrations on arrival. Conclusions Hypofibrinogenaemia is common in trauma and strongly associated with poor outcome. Below an estimated critical fibrinogen concentration value of 2.29 g/L a dramatic increase in mortality was detected. This finding indicates that the negative impact of low fibrinogen concentrations may have been previously underestimated. A number of clinically identifiable factors are associated with hypofibrinogenaemia. They should be considered in the management of massively bleeding patients. Interventional trials with fibrinogen substitution in high-risk patients need to be undertaken.

• Hagemo, Jostein Skjalg; Næss, Pål Aksel; Johansson, Pär I.; Windeløv, NA; Cohen, MJ & Røislien, Jo [Vis alle 10 forfattere av denne artikkelen] (2013). Evaluation of TEG (R) and RoTEM (R) inter-changeability in trauma patients. Injury. ISSN 0020-1383. 44(5), s. 600–605. doi: 10.1016/j.injury.2012.11.016. Fulltekst i vitenarkiv
• Hagemo, Jostein Skjalg (2013). Prehospital detection of traumatic coagulopathy. Transfusion. ISSN 0041-1132. 53, s. 48S–51S. doi: 10.1111/trf.12035. Fulltekst i vitenarkiv
• Hagemo, Jostein Skjalg; Jørgensen, Jørgen Joakim; Ostrowski, Sisse R.; Holtan, Anders; Gundersen, Yngvar & Johansson, Pär I. [Vis alle 8 forfattere av denne artikkelen] (2013). Changes in fibrinogen availability and utilization in an animal model of traumatic coagulopathy. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. doi: 10.1186/1757-7241-21-56. Fulltekst i vitenarkiv Vis sammendrag

  Background Impaired haemostasis following shock and tissue trauma is frequently detected in the trauma setting. These changes occur early, and are associated with increased mortality. The mechanism behind trauma-induced coagulopathy (TIC) is not clear. Several studies highlight the crucial role of fibrinogen in posttraumatic haemorrhage. This study explores the coagulation changes in a swine model of early TIC, with emphasis on fibrinogen levels and utilization of fibrinogen.Methods A total of 18 landrace pigs were anaesthetized and divided into four groups. The Trauma-Shock group (TS) were inflicted bilateral blast femoral fractures with concomitant soft tissue injury by a high-energy rifle shot to both hind legs, followed by controlled exsanguination. The Shock group (S) was exposed to shock by exsanguination, whereas a third group was exposed to trauma only (T). A fourth group (C) served as control. Physiological data, haematological measurements, blood gas analyses and conventional coagulation assays were recorded at baseline and repeatedly over 60 minutes. Thrombelastometry were performed by means of the tissue factor activated ExTEM assay and the platelet inhibiting FibTEM assay. Data were statistically analysed by repeated measurements analyses method.Results A significant reduction of fibrinogen concentration was observed in both the TS and S groups. INR increased significantly in the S group and differed significantly from the TS group. Maximum clot firmness (MCF) of the ExTEM assay was significantly reduced over time in both TS and S groups. In the FibTEM assay a significant shortening of the clotting time and an increase in MCF was observed in the TS group compared to the S group.Conclusion Despite a reduction in clotting capability measured by ExTEM MCF and a reduced fibrinogen concentration, extensive tissue trauma may induce an increased fibrin based clotting activity that attenuates the hypocoagulable tendency in exsanguinated animals.

• Thorsen, Kenneth; Ringdal, Kjetil G.; Strand, Kristian; Søreide, Eldar; Hagemo, Jostein Skjalg & Søreide, Kjetil (2011). Clinical and cellular effects of hypothermia, acidosis and coagulopathy in major injury. British Journal of Surgery. ISSN 0007-1323. 98(7), s. 894–907. doi: 10.1002/bjs.7497. Fulltekst i vitenarkiv
• Jensen, Anders Gadegaard; Callesen, Torben; Hagemo, Jostein Skjalg; Hreinsson, Kári; Lund, Vesa & Nordmark, Johanna (2010). Scandinavian clinical practice guidelines on general anaesthesia for emergency situations. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 54(8), s. 922–950. doi: 10.1111/j.1399-6576.2010.02277.x. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Simensen, Randi; Rehn, Marius; Hagemo, Jostein Skjalg; Fjose, Lars Olav & Heyerdahl, Fridtjof (2026). Methoxyflurane: analgesic benefit and environmental impact – Authors' reply. The Lancet. ISSN 0140-6736. 407, s. 1427–1428. doi: 10.1016/s0140-6736(26)00495-2. Fulltekst i vitenarkiv
• Solvik-Olsen, Tone; Kåsin, Jan Ivar; Hagemo, Jostein Skjalg & Heyerdahl, Fridtjof (2024). Response to the letter: ‘Vibrations during helicopter neonatal transport’. Acta Paediatrica. ISSN 0803-5253. doi: 10.1111/apa.17374. Fulltekst i vitenarkiv
• Simensen, Randi; Fjose, Lars Olav; Rehn, Marius; Hagemo, Jostein Skjalg; Thorsen, Kjetil & Heyerdahl, Fridtjof (2023). Comparison of three regimens with inhalational methoxyflurane versus intranasal fentanyl versus intravenous morphine in pre-hospital acute pain management: study protocol for a randomized controlled trial (PreMeFen). Trials. 24(1). doi: 10.1186/s13063-023-07590-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Pre-hospital pain management has traditionally been performed with intravenous (IV) morphine, but oligoanalgesia remain a recognized problem. Pain reduction is essential for patient satisfaction and is regarded as a measure of successful treatment. We aim to establish whether non-invasive methods such as inhalation of methoxyflurane is non-inferior to intranasal fentanyl or non-inferior to the well-known IV morphine in the pre-hospital treatment of acute pain. Method/design The PreMeFen study is a phase three, three-armed, randomized, controlled, non-inferiority trial to compare three regimens of analgesics: inhalation of methoxyflurane and intranasal (IN) fentanyl versus IV morphine. It is an open-label trial with a 1:1:1 randomization to the three treatment groups. The primary endpoint is the change in pain numeric rating scale (NRS) (0–10) from baseline to 10 min after start of investigational medicinal product administration (IMP). The non-inferiority margin was set to 1.3, and a sample size of 270 patients per protocol (90 in each treatment arm) will detect this difference with 90% power. Discussion We chose a study design with comparison of analgesic regimens rather than fixed doses because of the substantial differences in drug characteristics and for the results to be relevant to inform policymakers in the pre-hospital setting. We recognize that easier administration of analgesics will lead to better pain management for many patients if the regimens are as good as the existing, and hence, we chose a non-inferiority design. The primary endpoint, the change in pain (NRS) after 10 min, is set to address the immediate need of pain reduction for patients with acute prehospital pain. On a later stage, more analgesic methods are often available. Summary PreMeFen is a non-inferiority randomized controlled trial comparing three analgesic regimens aiming to establish whether inhalation of methoxyflurane or intranasal fentanyl is as good as IV morphine for fast reduction of acute pain in the prehospital setting.

• Hagemo, Jostein Skjalg; Skulberg, Arne Kristian; Rehn, Marius; Valberg, Morten; Pesonen, Maiju & Heimdal, Hans Julius [Vis alle 7 forfattere av denne artikkelen] (2022). Inhaled nitric oxide as temporary respiratory stabilization in patients with COVID-19 related respiratory failure (INOCOV): Study protocol for a randomized controlled trial. PLOS ONE. 17(5). doi: 10.1371/journal.pone.0268822. Fulltekst i vitenarkiv Vis sammendrag

  Background In March 2020, WHO announced the COVID-19 a pandemic and a major global public health emergency. Mortality from COVID-19 is rapidly increasing globally, with acute respiratory failure as the predominant cause of death. Many patients experience severe hypoxia and life-threatening respiratory failure often requiring mechanical ventilation. To increase safety margins during emergency anaesthesia and rapid sequence intubation (RSI), patients are preoxygenated with a closed facemask with high-flow oxygen and positive end-expiratory pressure (PEEP). Due to the high shunt fraction of deoxygenated blood through the lungs frequently described in COVID-19 however, these measures may be insufficient to avoid harmful hypoxemia. Preoxygenation with inhaled nitric oxide (iNO) potentially reduces the shunt fraction and may thus allow for the necessary margins of safety during RSI. Methods and design The INOCOV protocol describes a phase II pharmacological trial of inhaled nitric oxide (iNO) as an adjunct to standard of care with medical oxygen in initial airway and ventilation management of patients with known or suspected COVID-19 in acute respiratory failure. The trial is parallel two-arm, randomized, controlled, blinded trial. The primary outcome measure is the change in oxygen saturation (SpO2), and the null hypothesis is that there is no difference in the change in SpO2 following initiation of iNO. Trial registration EudraCT number 2020-001656-18; WHO UTN: U1111-1250-1698. Protocol version: 2.0 (June 25th, 2021).

• Høiseth, Lars Øivind & Hagemo, Jostein Skjalg (2016). Comparing measurement methods using linear least squares regression. Journal of clinical monitoring and computing. ISSN 1387-1307. 32(2), s. 373–374. doi: 10.1007/s10877-016-9955-0. Fulltekst i vitenarkiv
• Hagemo, Jostein Skjalg; Gaarder, Christine; Næss, Pål Aksel; Viksmoen, Yvonne & Heier, Hans Erik (2010). COMPARING TEG (R) AND ROTEM (R) AS POINT-OF-CARE DEVICES IN TRAUMA PATIENTS. Vox Sanguinis. ISSN 0042-9007. 99, s. 437–437. Fulltekst i vitenarkiv
• Bredmose, Per Poelhøi; Sollid, Stephen J. M.; Østergaard, Doris & Hagemo, Jostein Skjalg (2022). National implementation of whole crew on-call in situ simulation in Norwegian HEMS; feasibility, challenges, and possibilities : An implementation study. Universitetet i Stavanger. ISSN 9788284391243. Fulltekst i vitenarkiv Vis sammendrag

  This research project is a PhD-project on implementing medical orientated in situ simulation for on-call air ambulance crews in Norway, and the alternative use of “observed clinical practise” in real-life missions when simulations cannot be carried out. Since HEMS duty is typically a standby emergency service, there are periods between missions where training can be carried out. However, these free periods are unpredictable, and the planning of training can be challenging. Thus, we initially want to test in situ simulation training feasibility on HEMS bases in Norway. This thesis consists of four different studies using several research methods. The first study is a prospective quantitative interventional study, where one facilitator introduces in situ simulation training on one HEMS base in Norway to evaluate the feasibility of such training. In Study II, the same training concept was sought introduced on all HEMS bases in Norway and one SAR base. Both Studies I and II evaluate the participants' experience with a Likert-style questionnaire as well as using descriptive data. In relation to introducing in situ simulation nationally, the expected barriers to the introduction were studied with a qualitative method. Facilitators from the participating bases underwent structured group interviews in Study III. After the one-year study period, the facilitators were interviewed about the experienced barriers and the tools used to overcome these. Finally, in Study IV, a solution was sought to use facilitators more efficiently by combining in situ training with live mission observations. Study IV combines descriptive data, questionnaires, and phone-based individual interviews. We have found that in situ simulation training for on-call crews is feasible and can be implemented with a high level of satisfaction from participating crews. There were some challenges to the implementation that the facilitators have tried to overcome. A more rigid framework and follow up might have improved the implementation. It seemed difficult to conduct simulations successfully on the busier bases. Some of the key factors for the implementation was found to be the use of a facilitator with local knowledge, support from the departmental managers, dedicated time for the facilitators to prepare and lead the training, and the need for continuous development within the role as facilitator. We suggest live mission observation with post-mission debriefing as a feasible alternative to in situ simulation to maximise invested resources and maintain the learning output.

• Bredmose, Per Poelhøi; Sollid, Stephen J. M. & Hagemo, Jostein Skjalg (2022). National implementation of whole crew on-call in situ simulation in Norwegian HEMS; feasibility, challenges, and possibilities. Universitetet i Stavanger. ISSN 9788284391243. Fulltekst i vitenarkiv

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