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  • Ovid Technologies (Wolters Kluwer Health)  (2)
  • Okada, Hirofumi  (2)
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  • Ovid Technologies (Wolters Kluwer Health)  (2)
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  • 1
    Online Resource
    Online Resource
    Abstract 111: Impact of Time to Return of Spontaneous Circulation on Neurologically Intact Survival in Patients With Out-of-Hospital Cardiac Arrest According to Age: Evidence From a Large-Scale Registry in Japan
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Circulation Vol. 138, No. Suppl_2 ( 2018-11-06)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 138, No. Suppl_2 ( 2018-11-06)
    Abstract: Introduction: Time to return of spontaneous circulation (ROSC) is a more important predictor of neurologically intact survival than the presence of ROSC in patients with out-of-hospital cardiac arrest (OHCA). However, the differences in the relationship between time to ROSC and neurologically intact survival in patients with OHCA based on age is unclear. Hypothesis: We hypothesized that the impact of time to ROSC on neurologically intact survival differs according to age. Methods: We analyzed the data of 34,905 patients with OHCA (age ≥18 years) who exhibited prehospital ROSC from the prospectively recorded all-Japan OHCA registry (2011-2014). The primary outcome was neurologically intact survival at 1 month after OHCA (cerebral performance category [CPC] 1 or 2). Time to ROSC was defined as the interval from the initiation of cardiopulmonary resuscitation (CPR) by emergency medical service (EMS) providers to the achievement of ROSC. We categorized time to ROSC by every 4-min interval (2 cycles of CPR) from 1 to 32 min and ≥33 min, and age into 4 groups: 18-64, 65-74, 75-89, and ≥90 years. Results: The overall CPC 1-2 rate was 21.1% (7,353/34,905). Increasing time to ROSC (per min) was negatively associated with CPC 1-2 (adjusted odds ratio, 0.91; 95% confidence interval, 0.90-0.91). The CPC 1-2 rates decreased as time to ROSC increased in each age group: from 58.8% (1,247/2,122) in 1-4 min to 2.8% (7/246) in ≥33 min for patients aged 18-64 years, from 51.1% (721/1,410) in 1-4 min to 1.6% (4/244) in ≥33 min for 65-74 years, from 37.3% (765/2,051) in 1-4 min to 0.7% (4/539) in 29-32 min for 75-89 years, and from 23.4% (92/393) in 1-4 min to 0.2% (1/481) in 17-20 min for ≥90 years (all p for trend 〈 0.001). Conclusions: The CPC 1-2 rates of patients aged 18-64 and 65-74 years were above the 1% futility rate when prehospital ROSC was achieved after prolonged CPR, ≥33 min from initiation by EMS providers. However, the CPC 1-2 rates were below the 1% futility rate when prehospital ROSC was achieved ≥29 min and ≥17 min for patients aged 75-89 years and ≥90 years, respectively.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.138.suppl_2.111
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1466401-X
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  • 2
    Online Resource
    Online Resource
    Abstract 176: Effects of the Presence of Emergency Medical Service Physician on Neurologically Intact Survival After an Out-of-Hospital Cardiac Arrest: A Nationwide Population-Based Observational Study
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Circulation Vol. 138, No. Suppl_2 ( 2018-11-06)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 138, No. Suppl_2 ( 2018-11-06)
    Abstract: Introduction: Previous observational studies have suggested that prehospital emergency medical services (EMS) physician-guided cardiopulmonary resuscitation (CPR) is associated with improved survival after an out-of-hospital cardiac arrest (OHCA) when compared with paramedic-guided CPR. Hypothesis: EMS physician-guided CPR for OHCA is associated with improved 1-month neurologically intact survival compared with paramedic-guided CPR, from the 2010 guideline updates onward. Methods: The study included 613,251 Japanese adults (aged ≥18 years) from a prospectively recorded nationwide Utstein-style database who had OHCA between 2011 and 2015. The patients were divided into two groups on the basis of the presence of a physician during CPR before hospital arrival: EMS physician- (n=19,551, 3.2%) and paramedic-guided CPR groups (n=593,700, 96.8%). The study end-points were 1-month and neurologically intact survivals, defined as Cerebral Performance Category scores of 1 or 2 (CPC 1-2). Results: Proportions of crude 1-month survival and CPC 1-2 in the EMS physician-guided CPR group were significantly higher than those in paramedic-guided CPR group: 10.9% (2138/19,551) vs. 4.8% (28,448/593,700) for 1-month survival and 5.7% (1114/19,551) vs. 2.5% (14,859/593,700) for 1-month CPC 1-2, both p-values 〈 0.0001. Multivariate logistic regression analysis showed that EMS physician-guided CPR was associated with increased adjusted odds ratios (aORs) for 1-month favorable outcomes: 1.70; 95% confidence interval [CI], 1.61-1.79 for 1-month survival; and 1.51; 95% CI, 1.46-1.62 for 1-month CPC 1-2. In the propensity-matched cohort, EMS physician-guided CPR also showed more favorable outcomes 1 month after OHCA than did paramedic-guided CPR: 11.6% (1931/16,612) vs. 7.9% (1310/16,612) for 1-month survival and 6.0% (996/16,612) vs. 4.6% (766/16,612) for 1-month CPC 1-2, both p-values 〈 0.0001 (aOR, 1.68; 95% CI, 1.55-1.82 for survival; and 1.45; 95% CI, 1.30-1.62 for CPC 1-2. Conclusions: This large-scale registry-based study in Japan shows that EMS physician-guided CPR in OHCA before hospital arrival is associated with improved 1-month neurologically intact survival compared with paramedic-guided CPR.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.138.suppl_2.176
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1466401-X
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
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