[Show abstract][Hide abstract] ABSTRACT: Japan is considering policies to set the target health expenditure level for each region, a policy approach that has been considered in many other countries. The objective of this study was to examine the relationship between regional health expenditure and health outcomes after out-of-hospital cardiac arrest (OHCA), which incorporates the qualities of prehospital, in-hospital and posthospital care systems.
We examined the association between prefecture-level per capita health expenditure and patients' health outcomes after OHCA.
We used a nationwide, population-based registry system of OHCAs that captured all cases with OHCA resuscitated by emergency responders in Japan from 2005 to 2011.
All patients with OHCA aged 1-100 years were analysed.
The patients' 1-month survival rate, and favourable neurological outcome (defined as cerebral performance category 1-2) at 1-month.
Among 618 154 cases with OHCA, the risk-adjusted 1-month survival rate varied from 3.3% (95% CI 2.9% to 3.7%) to 8.4% (95% CI 7.7% to 9.1%) across prefectures. The risk-adjusted probabilities of favourable neurological outcome ranged from 1.6% (95% CI 1.4% to 1.9%) to 3.7% (95% CI 3.4% to 3.9%). Compared with prefectures with lowest tertile health expenditure, 1-month survival rate was significantly higher in medium-spending (adjusted OR 1.31, 95% CI 1.03 to 1.66, p=0.03) and high-spending prefectures (adjusted OR 1.30, 95% CI 1.03 to 1.64, p=0.02), after adjusting for patient characteristics. There was no difference in the survival between medium-spending and high-spending regions. We observed similar patterns for favourable neurological outcome. Additional adjustment for regional per capita income did not affect our overall findings.
We observed a wide variation in the health outcomes after OHCA across regions. Low-spending regions had significantly worse health outcomes compared with medium-spending or high-spending regions, but no difference was observed between medium-spending and high-spending regions. Our findings suggest that focusing on the median spending may be the optimum that allows for saving money without compromising patient outcomes.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BMJ Open 08/2015; 5(8-8). DOI:10.1136/bmjopen-2015-008374 · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AimDrug overdose is an important issue in emergency medicine. However, studies covering overdose patients transported by ambulance have not been sufficiently carried out. We attempted to clarify problems of suspected drug overdose patients transported by ambulance.Methods
This is a prospective population-based cohort study. Data were collected by emergency medical service crews in Osaka City, Japan, between January 1998 and December 2010.ResultsDrug overdose cases increased annually from 1,136 in 1998 to 1,822 in 2010 (P < 0.0001 for trend). In these cases, the dominant age range was between 16 and 40 years and the age distribution did not change over time. The age of non-overdose cases increased (P < 0.0001 for trend), with patients aged ≥66 years becoming most common in recent years, reflecting the aging of society. Males comprised most non-overdose patients, but the percentage of females increased annually (P < 0.0001 in trend). Females comprised approximately 70% in overdose cases annually throughout the study period. The duration from the emergency call to the arrival at the hospital for overdose patients has increased markedly in recent years. It also takes more time to obtain acceptance from hospitals to care for patients of suspected overdose.Conclusion
The characteristics of drug overdose patients are clearly different from those of non-overdose patients. Recent trends of drug overdose patients indicate the accelerated burden on emergency medical services system.
[Show abstract][Hide abstract] ABSTRACT: Japan experienced measles outbreaks in both 2006 and 2007 mainly among university students. Improvement of vaccine coverage against vaccine-preventable viral infections is the prime task for preventing outbreaks of viral infections. To elucidate the promoting factors for complete vaccination against measles, rubella, mumps, and varicella-zoster viruses, we conducted a case-control study among single university students in Japan. Information on vaccinations and clinico-demographical factors were collected using a self-administered questionnaire and a photocopy of the Maternal and Child Health Handbook. Logistic regression analysis was performed to estimate odds ratios (ORs) and their 95% confidence intervals (CIs) for two-time vaccination against measles and rubella viruses as mandatory vaccinations and at least one-time vaccination against mumps and varicella-zoster viruses as optional vaccinations. A total of 1,370 (744 medical, 508 paramedical, and 118 pharmaceutical) students were invited to participate, 960 (70.1%) of whom were enrolled in the study. Students aged < 20 years had a greater propensity for measles and rubella vaccinations (OR 7.8 [95% CI, 5.1-11.8] and OR 6.1 [95% CI, 3.7-10.0], respectively) compared with those aged ≥ 20 years. Students with a history of living over-seas for 1 month or longer were more likely to complete vaccination for measles (OR 4.4 [95% CI, 1.4-13.5] compared with those without such history. This significantly high vaccination coverage was attributed to the measles-rubella catch-up campaign by the Japanese government and the immunization regulations by foreign countries. These findings suggest that social regulations would predispose people to complete vaccination.
The Tohoku Journal of Experimental Medicine 10/2014; 234(3):183-7. DOI:10.1620/tjem.234.183 · 1.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Although foreign body airway obstruction (FBAO) accounts for many preventable unintentional accidents, little is known about the epidemiology of FBAO patients and the effect of forceps use on those patients. This study aimed to assess characteristics of FBAO patients transported to hospitals by emergency medical service (EMS) personnel, and to verify the relationship between prehospital Magill forceps use and outcomes among out-of-hospital cardiac arrests (OHCA) patients with FBAO.Methods
We retrospectively reviewed ambulance records of all patients who suffered FBAO, and were treated by EMS in Osaka City from 2000 through 2007, and assessed the characteristics of those patients. We also performed a multivariate logistic-regression analysis to assess factors associated with neurologically favorable survival among bystander-witnessed OHCA patients with FBAO in larynx or pharynx.ResultsA total of 2,354 patients suffered from FBAO during the study period. There was a bimodal distribution by age among infants and old adults. Among them, 466 (19.8%) had an OHCA when EMS arrived at the scene, and 344 were witnessed by bystanders. In the multivariate analysis, Magill forceps use for OHCA with FBAO in larynx or pharynx was an independent predictor of neurologically favorable survival (16.4% [24/146] in the Magill forceps use group versus 4.3% [4/94] in the non-use group; adjusted odds ratio, 3.96 [95% confidence interval, 1.21¿13.00], p¿=¿0023).Conclusions
From this large registry in Osaka, we revealed that prehospital Magill forceps use was associated with the improved outcome of bystander-witnessed OHCA patients with FBAO.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 09/2014; 22(1):53. DOI:10.1186/s13049-014-0053-3 · 2.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AimThis study investigated the association between the number of phone calls made to hospitals from ambulances requesting if they can accept prehospital emergency patients with cardiovascular events, and the prehospital transportation time. Methods
Using ambulance records, we retrospectively enrolled adult patients suffering acute myocardial infarction from 1998 to 2007, and out-of-hospital cardiac arrest of cardiac origin from 2000 to 2007, transported to medical institutions by the emergency medical service in Osaka City. ResultsDuring the study period, 8,596 patients with acute myocardial infarction without arrest and 9,283 out-of-hospital cardiac arrests of cardiac origin were registered. The hospital arrival time (from patient's call until hospital arrival) increased along with the increasing number of phone calls to hospitals from ambulances for patients with acute myocardial infarction (from 23.2 min with one phone call to 39.7 min with ≥5 phone calls; P for trend <0.001), and for those with out-of-hospital cardiac arrest (from 24.4 min with one phone call to 36.6 min with ≥5 phone calls; P for trend <0.001). In a multivariable analysis, chronological factors such as weekend and night-time were significantly associated with an increment in the phone calls to hospitals from ambulances. Conclusions
From ambulance records in Osaka City, we showed that the increased number of phone calls to hospitals from ambulances led to prolongation of the hospital arrival time.
[Show abstract][Hide abstract] ABSTRACT: The present study aimed to clarify the incidence and outcomes of sudden cardiac arrests in schools and the clinically relevant characteristics of individuals who experienced sudden cardiac arrests.
We obtained data on sudden cardiac arrests that occurred in schools between January 1, 2005 and December 31, 2009 from the database of the Utstein Osaka Project, a population-based observational study on out-of-hospital cardiac arrests in Osaka, Japan. The data were analyzed to show the epidemiological features of sudden cardiac arrests in schools in conjunction with prehospital documentation. In total, 44 cases were registered as sudden cardiac arrests in schools during the study period. Of these, 34 cases had nontraumatic cardiac arrests. Twenty-one cases (62%) had pre-existing cardiac diseases and/or collapsed during physical exercise. Twenty-three cases (68%) presented with ventricular fibrillation or pulseless ventricular tachycardia, with cases of survival 1 month after cardiac arrest and those having favourable neurological outcome (Cerebral Performance Category 1or 2) being 12 (52%) and 10 (43%), respectively. The incidence of sudden cardiac arrests in students was 0.23 per 100,000 persons per year, ranging from 0.08 in junior high school to 0.64 in high school. The incidence of sudden cardiac arrests in school faculty and staff was 0.51 per 100,000 persons per year, a rate approximately 2 times of that observed in the students.
Although sudden cardiac arrests in schools is rare, they majorly occurred in individuals with cardiac diseases and/or during physical exercise and presented as ventricular fibrillation or pulseless ventricular tachycardia observed initially as cardiac arrhythmia.
[Show abstract][Hide abstract] ABSTRACT: In Japan, 5000-300,000 persons succumbed to measles every year until 2001. Measles/rubella-combined (MR) vaccination at age 17-18 years (phase 4 MR vaccination: MR-IV) was launched in 2008 in Japan as a measles-rubella catch-up campaign. A serological assessment of this campaign has not been thoroughly performed.
Titers of anti-measles and anti-rubella immunoglobulin G antibodies, and past medical history including measles and rubella vaccination and infection were obtained from first-year university students in 2008 and 2009, and the immune status against measles and rubella was compared between students at the target MR-IV age (the target age group) and those a year older than the target age (non-target age group).
186 students were in the target age group and 146 were in the non-target age group. The proportion of students with a history of measles and rubella infection was not significantly different between the 2 groups (8.8% vs. 6.3%, P = 0.41 and 11.0% vs. 9.9%, P=0.75, respectively). A history of two or more measles and rubella vaccinations was significantly more frequent in the target age group (85.2% and 54.9%, respectively) than in the non-target age group (20.8% and 13.2%, respectively) (both P < 0.001). Proportions of seropositives for measles and rubella were also greater in the target age group (98.9% and 97.8%, respectively) than in the non-target age group (91.0% and 87.5%, respectively) (both P < 0.001).
The MR-IV catch-up campaign helped achieve herd immunity and will contribute to the elimination of measles and rubella.
Pediatrics International 01/2014; 56(3). DOI:10.1111/ped.12285 · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Stroke is difficult to diagnose when consciousness is disturbed. However few reports have discussed the clinical predictors of stroke in out-of-hospital emergency settings. This study aims to evaluate the association between initial systolic blood pressure (SBP) value measured by emergency medical service (EMS) and diagnosis of stroke among impaired consciousness patients.
We included all patients aged 18 years or older who were treated and transported by EMS, and had impaired consciousness (Japan Coma Scale >= 1) in Osaka City (2.7 million), Japan from January 1, 1998 through December 31, 2007. Data were prospectively collected by EMS personnel using a study-specific case report form. Multiple logistic regressions assessed the relationship between initial SBP and stroke and its subtypes adjusted for possible confounding factors.
During these 10 years, a total of 1,840,784 emergency patients who were treated and transported by EMS were documented during the study period in Osaka City. Out of 128,678 with impaired consciousness, 106,706 who had prehospital SBP measurements in the field were eligible for our analyses. The proportion of patients with severe impaired consciousness significantly increased from 14.5% in the <100 mmHg SBP group to 27.6% in the > =200 mmHg SBP group (P for trend <0.001). The occurrence of stroke significantly increased with increasing SBP (adjusted odd ratio [AOR] 1.34, 95% confidence interval [CI] 1.33 to 1.35), and the AOR of the SBP > =200 mmHg group versus the SBP 101-120 mmHg group was 5.26 (95% CI 4.93 to 5.60). The AOR of the SBP > =200 mmHg group versus the SBP 101-120 mmHg group was 9.76 in subarachnoid hemorrhage (SAH), 16.16 in intracranial hemorrhage (ICH), and 1.52 in ischemic stroke (IS), and the AOR of SAH and ICH was greater than that of IS.
Elevated SBP among emergency patients with impaired consciousness in the field was associated with increased diagnosis of stroke.
BMC Emergency Medicine 12/2013; 13(1):24. DOI:10.1186/1471-227X-13-24
[Show abstract][Hide abstract] ABSTRACT: To evaluate the influence of vaccination dose and clinico-demographical factors on immune status against measles, rubella, mumps, and varicella viruses among university students, we conducted a case-control study by analyzing serum antibody titers according to past immunization and infection, and perinatal histories, using a multivariate regression model. A total of 1370 medical, paramedical, and pharmaceutical students were included in the analysis. Two or more doses of measles and rubella vaccination yielded notably greater odds ratios for immuno-positivity (9.1; 95% confidence interval (CI), 2.8-28.9 and 12.2; 95% CI, 0.71-210.3, respectively), compared with 1-dose vaccination, even though the superiority did not reach statistical significance for rubella. Students having younger/older siblings were more likely to be immuno-positive for mumps (2.5; 95% CI, 1.3-4.9 and 2.7; 95% CI, 1.4-5.5, respectively). On the other hand, post-term birth or macrosomia was associated with seronegative rubella virus antibodies. We concluded that a 2-dose vaccination strategy could successfully prevent measles and rubella outbreaks by increasing immunity.
[Show abstract][Hide abstract] ABSTRACT: In Japan, ambulance staffing for cardiac arrest responses consists of a 3-person unit with at least one emergency life-saving technician (ELST). Recently, the number of ELSTs on ambulances has increased since it is believed that this improves the quality of on-scene care leading to better outcomes from out-of-hospital cardiac arrest (OHCA). The objective of this study was to evaluate the association between the number of on-scene ELSTs and OHCA outcome.
This was a prospective cohort study of all bystander-witnessed OHCA patients aged ≥18 years in Osaka City from January 2005 through December 2007 using on an Utstein-style database. The primary outcome measure was one-month survival with favorable neurological outcome defined as a cerebral performance category ≤2. Multivariable logistic regression model were used to assess the contribution of the number of on-scene ELSTs to the outcome after adjusting for confounders.
Of the 2408 bystander-witnessed OHCA patients, one ELST group was present in 639 (26.5%), two ELST were present in 1357 (56.4%), and three ELST group in 412 (17.1%). The three ELST group had a significantly higher rate of one-month survival with favorable neurological outcome compared with the one ELST group (8.0% versus 4.5%, adjusted OR 2.26, 95% CI 1.27-4.04), while the two ELST group did not (5.4% versus 4.5%, adjusted OR 1.34, 95% CI 0.82-2.19).
Compared with the one on-scene ELST group, the three on-scene ELST group was associated with the improved one-month survival with favorable neurological outcome from OHCA in Osaka City.
[Show abstract][Hide abstract] ABSTRACT: Background:
Although regional variation in outcome after adult out-of-hospital cardiac arrest (OHCA) is known, no clinical studies have assessed this in pediatric OHCA.
Methods and results:
This nationwide, prospective, population-based observation of the whole of Japan included consecutive OHCA patients with resuscitation attempt from January 2005 through December 2009. Primary outcome was 1-month survival with neurologically favorable outcome. Japan was divided into the following 7 regions as the largest administrative units: Hokkaido-Tohoku, Kanto, Tokai-Hokuriku, Kinki, Chugoku, Shikoku, and Kyushu-Okinawa. The outcome of pediatric OHCA was then compared between the regions. Multiple logistic regression analysis was used to adjust for other factors that were considered to influence the relationship between region and outcome. A total of 8,240 pediatric OHCA patients were registered during the study period. One-month survival with neurologically favorable outcome significantly differed by region: 2.5% (24/967) in Hokkaido-Tohoku (adjusted odds ratio [AOR], 1.65; 95% confidence interval [CI]: 0.94-2.90), 2.9% (47/1614) in Tokai-Hokuriku (AOR, 2.06; 95% CI: 1.28-3.31), 2.1% (26/1239) in Kinki (AOR, 1.45; 95% CI: 0.84-2.51), 3.4% (16/465) in Chugoku (AOR, 3.11; 95% CI: 1.62-6.00), 1.5% (4/259) in Shikoku (AOR, 0.79; 95% CI: 0.26-2.43), and 2.8% (27/974) in Kyushu-Okinawa (AOR, 2.15; 95% CI: 1.24-3.74) referred to Kanto (1.4%, 37/2722).
According to Japanese nationwide OHCA registry data there are significant regional variations in the outcome of pediatric OHCA.
[Show abstract][Hide abstract] ABSTRACT: Objective:
There is a paucity of studies on the degree of regional variability in out-of-hospital cardiac arrest (OHCA) outcomes, particularly in neurological outcome. This study aimed to determine whether there is a significant regional variation in survival outcomes of OHCA across Japan.
We analyzed a prospective, nation-wide, population-based database (All-Japan Utstein Registry) involving all Japanese individuals who had non-traumatic OHCA resuscitated by emergency responders from January 2005 through December 2010. The primary study endpoint was favourable neurological survival at 1 month, defined as Cerebral Performance Category 1 or 2. We compared unadjusted and multivariable-adjusted rates of the outcome among seven geographic regions.
In the total catchment population of 128 million, there were 539,641 non-traumatic OHCA patients. Unadjusted neurologically favourable survival varied across regions from 1.9% to 3.1% (rate difference, 1.2%; 95%CI, 1.0-1.3%); the Northeast region had a significantly lower rate compared to the Midwest region (unadjusted rate ratio, 0.62; 95%CI, 0.60-0.64). This disparity became larger after adjusting for patient- and prehospital-level confounders (adjusted rate ratio, 0.52; 95%CI, 0.51-0.54). Among 35,153 OHCA patients with return of spontaneous circulation, unadjusted neurologically favourable survival varied from 26.4% to 34.7% (rate difference, 8.3%; 95%CI, 6.6-10.1%); the East region had a significantly lower rate compared to the Midwest region (adjusted rate ratio, 0.72; 95%CI, 0.68-0.76).
In this prospective, nation-wide, population-based study in Japan, we found a two-fold regional difference in neurologically favourable survival after OHCA, suggesting regional disparities in prehospital care and in-hospital post-resuscitation care.
[Show abstract][Hide abstract] ABSTRACT: It is unclear whether advanced airway management such as endotracheal intubation or use of supraglottic airway devices in the prehospital setting improves outcomes following out-of-hospital cardiac arrest (OHCA) compared with conventional bag-valve-mask ventilation.
To test the hypothesis that prehospital advanced airway management is associated with favorable outcome after adult OHCA.
Prospective, nationwide, population-based study (All-Japan Utstein Registry) involving 649,654 consecutive adult patients in Japan who had an OHCA and in whom resuscitation was attempted by emergency responders with subsequent transport to medical institutions from January 2005 through December 2010.
Favorable neurological outcome 1 month after an OHCA, defined as cerebral performance category 1 or 2.
Of the eligible 649,359 patients with OHCA, 367,837 (57%) underwent bag-valve-mask ventilation and 281,522 (43%) advanced airway management, including 41,972 (6%) with endotracheal intubation and 239,550 (37%) with use of supraglottic airways. In the full cohort, the advanced airway group incurred a lower rate of favorable neurological outcome compared with the bag-valve-mask group (1.1% vs 2.9%; odds ratio [OR], 0.38; 95% CI, 0.36-0.39). In multivariable logistic regression, advanced airway management had an OR for favorable neurological outcome of 0.38 (95% CI, 0.37-0.40) after adjusting for age, sex, etiology of arrest, first documented rhythm, witnessed status, type of bystander cardiopulmonary resuscitation, use of public access automated external defibrillator, epinephrine administration, and time intervals. Similarly, the odds of neurologically favorable survival were significantly lower both for endotracheal intubation (adjusted OR, 0.41; 95% CI, 0.37-0.45) and for supraglottic airways (adjusted OR, 0.38; 95% CI, 0.36-0.40). In a propensity score-matched cohort (357,228 patients), the adjusted odds of neurologically favorable survival were significantly lower both for endotracheal intubation (adjusted OR, 0.45; 95% CI, 0.37-0.55) and for use of supraglottic airways (adjusted OR, 0.36; 95% CI, 0.33-0.39). Both endotracheal intubation and use of supraglottic airways were similarly associated with decreased odds of neurologically favorable survival. CONCLUSION AND RELEVANCE: Among adult patients with OHCA, any type of advanced airway management was independently associated with decreased odds of neurologically favorable survival compared with conventional bag-valve-mask ventilation.
JAMA The Journal of the American Medical Association 01/2013; 309(3):257-66. DOI:10.1001/jama.2012.187612 · 35.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
Little is known about which symptoms are manifested before out-of-hospital cardiac arrest (OHCA). The objective of this study is to describe the prodromal symptoms of OHCA focusing on the onset of the symptom in relation of etiology of cardiac arrests, and to analyze the association between those symptoms and their outcomes after OHCA.
This prospective, population-based cohort study enrolled all persons aged 18 years or older who had experienced OHCA of presumed cardiac and non-cardiac origin that were witnessed by bystanders or emergency medical system (EMS) personnel in Osaka from 2003 through 2004.
There were 1042 were presumed to be of cardiac origin and 424 of non-cardiac. Patients with non-cardiac origin were more likely to have prodromal symptoms than those with cardiac etiology (70.0% vs. 61.8%, p=0.003). Over 40% of OHCA regardless of etiology had displayed symptoms at least several minutes before their arrest (40.2% [259/644] in those of cardiac origin and 45.5% [135/297] in those of non-cardiac origin). As to cardiac origin, the most frequent prodromal symptom was dyspnea (27.6%), followed by chest pain (20.7%) and syncope (12.7%). For non-cardiac origin, the most frequent symptom was also dyspnea (40.7%), but chest pain was rarely presented (3.4%). Although, prodromal symptoms themselves were not associated with better neurological outcomes (adjusted odds ratio [AOR], 2.03; 95% confidence interval [CI], 1.00-4.13), earlier contact to a patient yielded better neurological outcomes (AOR per every one-minute increase, 0.90; 95% CI, 0.82-0.99).
Many of OHCA regardless of etiology have prodromal symptoms before arrest. Prodromal symptoms induced early activation of the EMS system, and may thus improve outcomes after OHCA.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: It is unclear whether the basic life support (BLS) and advanced life support (ALS) pre-hospital termination of resuscitation (TOR) rules developed in North America can be applied successfully to patients with out-of-hospital cardiac arrest (OHCA) in other countries. OBJECTIVES: To assess the performance of the BLS and ALS TOR in Japan. METHODS: Retrospective nationwide, population-based, observational cohort study of consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2009 in Japan. The BLS TOR rule has 3 criteria whereas the ALS TOR rule includes 2 additional criteria. We extracted OHCA patients meeting all criteria for each TOR rule, and calculated the specificity and positive predictive value (PPV) of each TOR rule for identifying OHCA patients who did not have neurologically favorable one-month survival. RESULTS: During the study-period, 151,152 cases were available to evaluate the BLS TOR rule, and 137,986 cases to evaluate the ALS TOR rule. Of 113,140 patients that satisfied all three criteria for the BLS TOR rule, 193 (0.2%) had a neurologically favorable one-month survival. The specificity of BLS TOR rule was 0.968 (95% CI: 0.963-0.972), and the PPV was 0.998 (95% CI: 0.998-0.999) for predicting lack of neurologically favorable one-month survival. Of 41,030 patients that satisfied all five criteria for the ALS TOR rule, just 37 (0.1%) had a neurologically favorable one-month survival. The specificity of ALS TOR rule was 0.981 (95% CI: 0.973-0.986), and the PPV was 0.999 (95% CI: 0.998-0.999) for predicting lack of neurologically favorable one-month survival. CONCLUSIONS: The prehospital BLS and ALS TOR rules performed well in Japan with high specificity and PPV for predicting lack of neurologically favorable one-month survival in Japan. However, the specificity and PPV were not 1000 and we have to develop more specific TOR rules.
[Show abstract][Hide abstract] ABSTRACT: The effectiveness of epinephrine administration for cardiac arrests has been shown in animal models, but the clinical effect is still controversial.
A prospective, population-based, observational study in Osaka involved consecutive out-of-hospital cardiac arrest (OHCA) patients from January 2007 through December 2009. We evaluated the outcomes among adult non-traumatic bystander-witnessed OHCA patients for whom the local protocol directed the emergency medical service personnel to administer epinephrine. After stratifying by first documented cardiac rhythm, outcomes were compared among the following groups: non-administration, ≤10, 11-20 and ≥21 min as the time from emergency call to epinephrine administration. A total of 3,161 patients were eligible for our analyses, among whom 1,013 (32.0%) actually received epinephrine. The epinephrine group had a significantly lower rate of neurologically intact 1-month survival than the non-epinephrine group (4.1% vs. 6.1%, P=0.028). In cases of ventricular fibrillation (VF) arrest, patients in the early epinephrine group who received epinephrine administration within 10 min had a significantly higher rate of neurologically intact 1-month survival compared with the non-epinephrine group (66.7% vs. 24.9%), though other epinephrine groups did not. In cases of non-VF arrest, the rate of neurologically intact 1-month survival was low, irrespective of epinephrine administration.
The effectiveness of epinephrine after OHCA depends on the time of administration. When epinephrine is administered in the early phase, there is an improvement in neurological outcome from OHCA with VF.
[Show abstract][Hide abstract] ABSTRACT: Background: Detailed characteristics of those who experience an out-of-hospital cardiac arrest (OHCA) with public-access defibrillation (PAD) are unknown. Methods and Results: A prospective, population-based observational study involving consecutive OHCA patients with emergency responder resuscitation attempts was conducted from July 1, 2004 through December 31, 2008 in Osaka City. We extracted data for OHCA patients shocked by a public-access automated external defibrillator (AED) and evaluated the patients' and rescuers' characteristics. The main outcome measure was neurologically favorable 1-month survival. During the study period, 10,375 OHCA patients were registered and of 908 patients suffering ventricular fibrillation arrest, 53 (6%) received public-access AED shocks by lay-rescuers, with the proportion increasing from 0% in 2004 to 11% in 2008 (P for trend<0.001). Railway stations (34%) were the places where PAD shocks were most frequently delivered, followed by nursing homes (11%), medical facilities (9%), and fitness facilities (7%). In 57% of cases, the subject received public-access AED shocks delivered by non-medical persons, including employees of railway companies (13%), school teachers (6%), employees of fitness facilities (6%), and security guards (6%). The proportion of neurologically favorable 1-month survival tended to increase from 0% in 2005 to 58% in 2008 (P for trend = 0.081). Conclusions: Railway stations are the most common places where shocks by public-access AEDs were delivered in large urban communities of Japan, and among lay-rescuers railway station workers use AEDs more frequently. (Circ J 2011; 75: 2821-2826)
[Show abstract][Hide abstract] ABSTRACT: Both supraglottic airway devices (SGA) and endotracheal intubation (ETI) have been used by emergency life-saving technicians (ELST) in Japan to treat out-of-hospital cardiac arrests (OHCAs). Despite traditional emphasis on airway management during cardiac arrest, its impact on survival from OHCA and time dependent effectiveness remains unclear.
All adults with witnessed, non-traumatic OHCA, from 1 January 2005 to 31 December 2008, treated by the emergency medical services (EMS) with an advanced airway in Osaka, Japan were studied in a prospective Utstein-style population cohort database. The primary outcome measure was one-month survival with neurologically favorable outcome. The association between type of advanced airway (ETI/SGA), timing of device placement and neurological outcome was assessed by multiple logistic regression.
Of 7,517 witnessed non-traumatic OHCAs, 5,377 cases were treated with advanced airways. Of these, 1,679 were ETI while 3,698 were SGA. Favorable neurological outcome was similar between ETI and SGA (3.6% versus 3.6%, P = 0.95). The time interval from collapse to ETI placement was significantly longer than for SGA (17.2 minutes versus 15.8 minutes, P < 0.001). From multivariate analysis, early placement of an advanced airway was significantly associated with better neurological outcome (Adjusted Odds Ratio (AOR) for one minute delay, 0.91, 95% confidence interval (CI) 0.88 to 0.95). ETI was not a significant predictor (AOR 0.71, 95% CI 0.39 to 1.30) but the presence of an ETI certified ELST (AOR, 1.86, 95% CI 1.04 to 3.34) was a significant predictor for favorable neurological outcome.
There was no difference in neurologically favorable outcome from witnessed OHCA for ETI versus SGA. Early airway management with advanced airway regardless of type and rhythm was associated with improved outcomes.