Effects of physician‐present prehospital care in patients with out‐of‐hospital cardiac arrest on return of spontaneous circulation: A retrospective, observational study in Saga, Japan

Abstract Background and Aims Emergency medical services for out‐of‐hospital cardiac arrest (OHCA) vary according to region and country, and patient prognosis differs accordingly. In Japan, physicians may provide prehospital care. However, the effect of physician‐present prehospital care on achieving return of spontaneous circulation (ROSC) in patients with cardiac arrest is not clear. Here, we aimed to examine the effect of physician‐present prehospital care on the prognosis of patients with OHCA at our hospital compared with physician‐absent care. Methods In this retrospective, observational study, patients aged ≥18 years with non‐traumatic OHCA from a single center in Saga City, Japan, between April 2011 and December 2019, were included. Patients were divided into two groups, based on prehospital physician presence or absence. Logistic regression analysis was used to determine the association between physician‐present prehospital care and ROSC. Results Of 820 patients with OHCA, 151 had a physician present and 669 did not. Logistic regression analysis with no adjustment showed that the odds ratio (OR) of physician‐present prehospital care for an increased ROSC rate was 1.74 (95% confidence interval [CI]: 1.22−2.48, p = 0.002). Logistic‐regression analysis adjusted for ROSC‐related factors indicated an OR of 1.05 (95% CI: 0.47−2.34, p = 0.914) for physician‐present prehospital care to ROSC. Conclusion Physician‐present prehospital care may not necessarily lead to increased ROSC rates. However, insufficient data limited our study findings. Further studies involving larger sample sizes are warranted

Real-World Effectiveness of the mRNA COVID-19 Vaccines in Japan: A Case–Control Study

The real-world effectiveness of the coronavirus disease 2019 (COVID-19) vaccines in Japan remains unclear. This case–control study evaluated the vaccine effectiveness (VE) of two doses of mRNA vaccine, BNT162b2 or mRNA-1273, against the delta (B.1.617.2) variant in the Japanese general population in the period June–September 2021. Individuals in close contact with COVID-19 patients were tested using polymerase chain reaction (PCR). A self-administered questionnaire evaluated vaccination status, demographic data, underlying medical conditions, lifestyle, personal protective health behaviors, and living environment. Two vaccine doses were reported by 11.6% of cases (n = 389) and 35.2% of controls (n = 179). Compared with controls, cases were younger and had a lower proportion who always performed handwashing for ≥20 s, a higher proportion of alcohol consumers, and a lower proportion of individuals living in single-family homes or with commuting family members. After adjusting for these confounding factors and day of PCR testing by multivariate logistic regression analysis, the VE in the period June–July (delta variant proportion 45%) was 92% and 79% in the period August–September (delta variant proportion 89%). The adjusted VE for homestay, hotel-based isolation and quarantine, and hospitalization was 78%, 77%, and 97%, respectively. Despite declining slightly, VE against hospitalization remained robust for ~3 months after the second dose. Vaccination policymaking will require longer-term monitoring of VE against new variants

Comparison of self-reported symptoms in COVID-19 patients who had or had not previously received COVID-19 mRNA vaccination

Although mRNA coronavirus disease 2019 (COVID-19) vaccines have been reported for high effectiveness against symptoms, it remains unclear whether post-vaccination infections are less symptomatic than infections in vaccine-naive individuals. We included patients with COVID-19 diagnosed by polymerase chain reaction tests during Japan’s alpha and delta variant epidemics. COVID-19 symptoms at approximately 4 weeks were compared based on COVID-19 vaccination status. In total, 398 cases (372 symptomatic and 26 asymptomatic; 286 unvaccinated, 66 vaccinated with one dose, and 46 with two doses) were analyzed. The most common symptoms were fever (78.4%), fatigue (78.4%), cough (74.4%), loss of taste or smell (62.8%), and headache (59.8%). Post-vaccination infections were significantly less likely to be symptomatic. Possible confounder-adjusted odds ratios of two vaccine doses against fatigue, dry eyes and mouth, insomnia, fever, shortness of breath, unusual muscle pains, and loss of taste or smell were 0.18 (95% confidence interval [CI]: 0.09–0.38), 0.22 (95% CI: 0.08–0.59), 0.33 (95% CI: 0.14–0.80), 0.31 (95% CI: 0.15–0.63), 0.36 (95% CI: 0.16–0.76), 0.40 (95% CI: 0.19–0.82), and 0.44 (95% CI: 0.22–0.87), respectively. Post-vaccination infections after two mRNA COVID-19 vaccine doses show milder and fewer symptoms than infections in unvaccinated patients, highlighting the effectiveness of vaccination

Thromboelastometric analysis of the risk factors for return of spontaneous circulation in adult patients with out-of-hospital cardiac arrest - Fig 3

<p><b>Relationship between ROSC ratio and independent predictors by multivariate analysis (A). The “novel” ROTEM-based predictors for ROSC in the emergency department and its accuracy (B).</b> ROTEM, rotational thromboelastometry; ROSC, return of spontaneous circulation; ED, emergency department.</p

Logistic regression analysis for ROSC in the ED.

<p>Logistic regression analysis for ROSC in the ED.</p

Study design.

<p>Seventy-five adult OHCA patients were analyze in this study. OHCA: out-of-hospital cardiac arrest; ROTEM: rotational thromboelastometry; ROSC: return of spontaneous circulation.</p

Patient characteristics and records of prehospital care between the ROSC and non-ROSC groups.

<p>Patient characteristics and records of prehospital care between the ROSC and non-ROSC groups.</p

Receiver-Operating Characteristic (ROC) curve analysis of lactate (A and C) and EXTEM A30 (B and C) for Return of Spontaneous Circulation (ROSC) in the emergency department.

<p>The cut-off value of lactate was 12.0 mmol/L, the area under the curve (AUC) was 0.674, sensitivity was 56.5%, and specificity was 80.0%. The cut-off value of A30 of EXTEM was 48.0 mm, the AUC was 0.715, sensitivity was 72.7%, and specificity was 65.0%.</p

Standard blood tests and ROTEM findings between the ROSC and non-ROSC groups.

<p>Standard blood tests and ROTEM findings between the ROSC and non-ROSC groups.</p