Testuo Maeda’s research while affiliated with Kanazawa Medical University and other places

Aim: To assess the benefit of immediate call-first or CPR-first basic life support (BLS) in promoting a better outcome of out-of-hospital cardiac arrest (OHCA). Methods: From the nation-wide database of 2005 to 2012, we extracted bystander-witnessed OHCAs in which both emergency call and CPR were performed by bystanders on their own initiative (without instruction over telephone) within 6 min of witnessing patient collapse. These cases were categorized into the following four groups; immediate Call+CPR group (N=10,195 ,emergency call and/or CPR within 2 min of witness, call-CPR time interval = 0 or 1 min), immediate Call-First group (N=1,820 , emergency call within 2 min of witness, call-CPR interval = 2[[Unable to Display Character: ‒]]4 min), immediate CPR-First group (N=5,446 , bystander CPR within 2 min of witness, CPR-call interval =2[[Unable to Display Character: ‒]]4 min), the delayed Call/CPR group (N=4,671, the remaining cases). We compared the rates of neurologically favorable survival at 1-month among the four groups for all OHCAs and subgroups of OHCAs. Results: The overall survival rate was highest in Call-First group and lowest in delayed Call/CPR group (Figure). The rate of Call-First group was significantly higher than that of CPR-First group in OHCAs of presumed cardiac etiology (17.2% vs. 14.1%, unadjusted OR; 95% CI, 1.26; 1.05[[Unable to Display Character: ‒]]1.52). The rate of CPR-First group was significantly higher than that of Call-First group in OHCAs of presumed non-cardiac etiology (7.7% vs. 5.0%, 1.59; 1.11[[Unable to Display Character: ‒]]2.33) and young adults/children (age<35y, 32.8% vs. 17.8%, 2.25; 1.33[[Unable to Display Character: ‒]]3.95). Multiple logistic regression analysis confirmed the results of univariate analyses and disclosed that delayed Call/CPR is associated with poor outcomes. Conclusions: The immediate (within 2 min) CPR-first BLS action followed by emergency call without a large (>4 min) delay may be recommended when a single bystander having a fundamental skill to initiate CPR witnesses OHCAs of non-cardiac etiology and young adults/children.

To determine the effects of ageing and training experience on attitude towards performing basic life support (BLS). We gave a questionnaire to attendants of the courses for BLS or safe driving in authorised driving schools. The questionnaire included questions about participants' backgrounds. The questionnaire explored the participant's willingness to perform BLS in four hypothetical scenarios related to early emergency call, cardiopulmonary resuscitation (CPR) under their own initiative, telephone-assisted compression-only CPR and use of an automated external defibrillator (AED), respectively. There were significant differences in gender, occupation, residential area, experience of BLS training, and knowledge of AED use among the young (17-29 y, N = 6122), middle-aged (30-59 y, N = 827) and elderly (>59 y, N = 15,743) groups. In all four scenarios, the proportion of respondents willing to perform BLS was lowest in the elderly group. More respondents in the elderly group were willing to follow the telephone-assisted instruction rather than performing CPR under their own initiative. Multiple logistic regression analysis confirmed ageing as an independent factor related to negative attitude in all scenarios. Gender, occupation, resident area, experience with BLS training and knowledge about AED use were other independent factors. Prior BLS training did not increase willingness to make an emergency call. The aged population has a more negative attitude towards performing BLS. BLS training should be modified to help the elderly gain confidence with the essential elements of BLS, including making early emergency calls.