The great East Japan earthquake and out-of-hospital cardiac arrest

From N Engl J Med, Kitamura, T., Kiyohara, K., Sakai, and Iwami, T., The Great East Japan Earthquake and Out-of-Hospital Cardiac Arrest., 369, 22 Copyright ? 2013 Massachusetts Medical Society. Reprinted with permission.Correspondenc

The association between low pH value and unfavorable neurological outcome among the out-of-hospital cardiac arrest patient treated by extra-corporeal CPR: Sensitivity analysis

This is the response to the comment from Dr. Romain Jouffroy and his colleague, on the manuscript "Association between low pH and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal CPR: a prospective observational cohort study in Japan". We performed sensitivity analysis based on the comment from them. It indicated that the results of primary analysis were robust even in considering their criticism.Okada, Y., Kiguchi, T., Kitamura, T. et al. The association between low pH value and unfavorable neurological outcome among the out-of-hospital cardiac arrest patient treated by extra-corporeal CPR: sensitivity analysis. j intensive care 8, 53 (2020). https://doi.org/10.1186/s40560-020-00470-

Nationwide public-access defibrillation in Japan

BACKGROUND: It is unclear whether dissemination of automated external defibrillators (AEDs) in public places can improve the rate of survival among patients who have had an out-of-hospital cardiac arrest. METHODS: From January 1, 2005, through December 31, 2007, we conducted a prospective, population-based, observational study involving consecutive patients across Japan who had an out-of-hospital cardiac arrest and in whom resuscitation was attempted by emergency responders. We evaluated the effect of nationwide dissemination of public-access AEDs on the rate of survival after an out-of-hospital cardiac arrest. The primary outcome measure was the 1-month rate of survival with minimal neurologic impairment. A multivariate logistic-regression analysis was performed to assess factors associated with a good neurologic outcome. RESULTS: A total of 312,319 adults who had an out-of-hospital cardiac arrest were included in the study; 12,631 of these patients had ventricular fibrillation and had an arrest that was of cardiac origin and that was witnessed by bystanders. In 462 of these patients (3.7%), shocks were administered by laypersons with the use of public-access AEDs, and the proportion increased, from 1.2% to 6.2%, as the number of public-access AEDs increased (P<0.001 for trend). Among all patients who had a bystander-witnessed arrest of cardiac origin and who had ventricular fibrillation, 14.4% were alive at 1 month with minimal neurologic impairment; among patients who received shocks from public-access AEDs, 31.6% were alive at 1 month with minimal neurologic impairment. Early defibrillation, regardless of the type of provider (bystander or emergency-medical-services personnel), was associated with a good neurologic outcome after a cardiac arrest with ventricular fibrillation (adjusted odds ratio per 1-minute increase in the time to administration of shock, 0.91; 95% confidence interval, 0.89 to 0.92; P<0.001). The mean time to shock was reduced from 3.7 to 2.2 minutes, and the annual number of patients per 10 million population who survived with minimal neurologic impairment increased from 2.4 to 8.9 as the number of public-access AEDs increased from fewer than 1 per square kilometer of inhabited area to 4 or more. CONCLUSIONS: Nationwide dissemination of public-access AEDs in Japan resulted in earlier administration of shocks by laypersons and in an increase in the 1-month rate of survival with minimal neurologic impairment after an out-of-hospital cardiac arrest.From N Engl J Med,Kitamura, T., Iwami, T., Kawamura, T., Nagao, K., Tanaka, H., & Hiraide, A., Nationwide public-access defibrillation in japan., 362, 11 Copyright © 2010 Massachusetts Medical Society. Reprinted with permission.Original Articl

Characteristics and outcomes of emergency patients with self-inflicted injuries: A report from ambulance records in Osaka City, Japan

Background: Few studies have evaluated the actual situations of emergency patients with self-inflicted injuries treated by emergency-medical-service (EMS) personnel. Methods: This study retrospectively reviewed population-based ambulance records in Osaka City, Japan, between January 2010 and December 2012, and enrolled emergency patients who suffered from self-inflicted injuries such as poisoning by drugs or gas, cutting/piercing skin, jumping from heights, hanging, and drowning. The endpoint was the annual incidence per 100,000 populations in Osaka City of emergency patients who presented with self-inflicted injuries by age and sex. Their outcomes including deaths at the scene and hospital arrival were also evaluated. Results: During the study period, a total of 8,671 patients with 9,424 incidents of self-inflicted injuries were documented. The annual incidence of self-inflicted injuries was higher among women than men in the whole population and in the age group =50 years (49.0 versus 68.9, P < 0.001). The total number of self-inflicted deaths was 1,564 (16.6 %), and the overall proportion of self-inflicted deaths was greater among men than women (32.2 % [1075/3340] vs. 7.5 % [451/6027], P < 0.001). The proportion of self-inflicted hanging was 76.7 % [1142/1489], followed by poisoning by carbon monoxide at 57.1 % [56/98] and jumping to death at 47.6 % [254/534]. Discussion: Using large-scale EMS records, we investigated characteristics and outcomes of emergency patients with self-inflicted injuries treated by EMS personnel. Our findings suggested the gender paradox that the proportion of self-inflicted deaths was higher among men than women, while the proportion of non-fatal self-inflicted injuries was higher among women than among men, particularly in the group aged <=49 years. Our findings showing the importance of the prevention for self-inflicted injuries as well as the gender paradox of self-inflicted injuries will provide important epidemiological information to improve psychiatric cares in prehospital emergency settings. Conclusions: In the total population, the annual incidence of self-inflicted injuries responded to by EMS personnel was higher among women than among men. However, the proportion of self-inflicted deaths was greater among men than women, and the most frequent manner among deceased patients was by hanging.Matsuyama, T., Kitamura, T., Kiyohara, K. et al. Characteristics and outcomes of emergency patients with self-inflicted injuries: a report from ambulance records in Osaka City, Japan. Scand J Trauma Resusc Emerg Med 24, 68 (2016). https://doi.org/10.1186/s13049-016-0261-

Influence of COVID-19 pandemic on bystander interventions, emergency medical service activities, and patient outcomes in out-of-hospital cardiac arrest in Osaka City, Japan

Background: The coronavirus disease (COVID-19) pandemic may have negatively affected bystander interventions, emergency medical service (EMS) personnel activities, and patient outcomes after out-of-hospital cardiac arrest (OHCA). This study assessed bystander interventions, EMS activities, and patient outcomes during the COVID-19 pandemic era and compared them with those during the non-COVID-19 pandemic era in Osaka City, Japan, where public-access automated external defibrillators (AEDs) are well established. Methods: We conducted this population-based cohort study that included all cases with non-traumatic OHCA treated by EMS personnel and excluded cases with no resuscitation attempt, traumatic cases, cases occurring in healthcare facilities, or cases witnessed by EMS personnel. Data were compared between the COVID-19 pandemic period (February 1, 2020 to July 31, 2020) and the non-COVID-19 pandemic period (February 1, 2019 to July 31, 2019). Results: During the study periods, 1687 patients were eligible for analyses (COVID-19: n = 825; non-COVID-19: n = 862). Patients with OHCA during the COVID-19 pandemic period were significantly less likely to receive bystander cardiopulmonary resuscitation (CPR) (COVID-19: 33.0%; non-COVID-19: 41.3%; p < 0.001) and public-access AED pad application (COVID-19: 2.9%; non-COVID-19: 6.1%; p = 0.002) compared with patients during the non-COVID-19 pandemic period. There were no significant differences in 1-month survival with favorable neurological outcomes between the two periods (COVID-19: 4.6%; non-COVID-19: 6.1%; p = 0.196). Conclusion: The COVID-19 pandemic period did not affect patient outcomes after OHCA but changed bystander behaviors in Osaka City, Japan

Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest

10.1186/cc10483Critical Care155R23

Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest

Introduction: 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.Methods: 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.Results: 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.Conclusions: 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.Kajino, K., Iwami, T., Kitamura, T. et al. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care 15, R236 (2011). https://doi.org/10.1186/cc1048

Latent trajectory modelling of pulmonary artery pressure in systemic sclerosis: a retrospective cohort study

OBJECTIVES: To visualise the trajectories of pulmonary arterial pressure (PAP) in systemic sclerosis (SSc) and identify the clinical phenotypes for each trajectory, by applying latent trajectory modelling for PAP repeatedly estimated by echocardiography. METHODS: This was a multicentre, retrospective cohort study conducted at four referral hospitals in Kyoto, Japan. Patients with SSc who were treated at study sites between 2008 and 2021 and who had at least three echocardiographic measurements of systolic PAP (sPAP) were included. A group-based trajectory model was applied to the change in sPAP over time, and patients were classified into distinct subgroups that followed similar trajectories. Pulmonary hypertension (PH)-free survival was compared for each trajectory. Multinomial logistic regression analysis was performed for baseline clinical characteristics associated with trajectory assignment. RESULTS: A total of 236 patients with 1097 sPAP measurements were included. We identified five trajectories: rapid progression (n=9, 3.8%), early elevation (n=30, 12.7%), middle elevation (n=54, 22.9%), late elevation (n=24, 10.2%) and low stable (n=119, 50.4%). The trajectories, in the listed order, showed progressively earlier elevation of sPAP and shorter PH-free survival. In the multinomial logistic regression analysis with the low stable as a reference, cardiac involvement was associated with rapid progression, diffuse cutaneous SSc was associated with early elevation and anti-centromere antibody was associated with middle elevation; older age of onset was associated with all three of these trajectories. CONCLUSION: The pattern of changes in PAP over time in SSc can be classified into five trajectories with distinctly different clinical characteristics and outcomes

Pre-hospital advanced airway management for adults with out-of-hospital cardiac arrest: Nationwide cohort study

Objective To determine survival associated with advanced airway management (AAM) compared with no AAM for adults with out-of-hospital cardiac arrest. Design Cohort study between January 2014 and December 2016. Setting Nationwide, population based registry in Japan (All-Japan Utstein Registry). Participants Consecutive adult patients with out-of-hospital cardiac arrest, separated into two sub-cohorts by their first documented electrocardiographic rhythm: shockable (ventricular fibrillation or pulseless ventricular tachycardia) and non-shockable (pulseless electrical activity or asystole). Patients who received AAM during cardiopulmonary resuscitation were sequentially matched with patients at risk of AAM within the same minute on the basis of time dependent propensity scores. Main outcome measures Survival at one month or at hospital discharge within one month. Results Of the 310 620 patients eligible, 8459 (41.2%) of 20 516 in the shockable cohort and 121 890 (42.0%) of 290 104 in the non-shockable cohort received AAM during cardiopulmonary resuscitation. After time dependent propensity score sequential matching, 16 114 patients in the shockable cohort and 236 042 in the non-shockable cohort were matched at the same minute. In the shockable cohort, survival did not differ between patients with AAM and those with no AAM: 1546/8057 (19.2%) versus 1500/8057 (18.6%) (adjusted risk ratio 1.00, 95% confidence interval 0.93 to 1.07). In the non-shockable cohort, patients with AAM had better survival than those with no AAM: 2696/118 021 (2.3%) versus 2127/118 021 (1.8%) (adjusted risk ratio 1.27, 1.20 to 1.35). Conclusions In the time dependent propensity score sequential matching for out-of-hospital cardiac arrest in adults, AAM was not associated with survival among patients with shockable rhythm, whereas AAM was associated with better survival among patients with non-shockable rhythm.Izawa Junichi, Komukai Sho, Gibo Koichiro, Okubo Masashi, Kiyohara Kosuke, Nishiyama Chika et al. Pre-hospital advanced airway management for adults with out-of-hospital cardiac arrest: nationwide cohort study. BMJ 2019; 364 :l43