1.

論文

論文
Takei, Yutaka ; Inaba, Hideo ; Yachida, Takahiro ; Enami, Miki ; Goto, Yoshikazu ; Ohta, Keisuke
出版情報: Resuscitation.  81  pp.1492-1498,  2010-11-01.  Elsevier
URL: http://hdl.handle.net/2297/30223
概要: Review: The interval between collapse and emergency call influences the prognosis of out-of-hospital cardiac arrest (OHCA). To reduce the interval, it is essential to identify the causes of delay. Methods: Basal data were collected prospectively by fire departments from 3746 OHCAs witnessed or recognised by citizens and in which resuscitation was attempted by emergency medical technicians (EMTs) between 1 April 2003 and 31 March 2008. EMTs identified the reasons for call delay by interview. Results: The delay, defined as an interval exceeding 2 min (median value), was less frequent in the urban region, public places and for witnessed OHCAs. Delay was more frequent in care facilities and for elderly patients and OHCAs with longer response times. Multiple logistic regression analysis indicated that urban regions, care facilities and arrest witnesses are independent factors associated with delay. The ratio of correctable causes (human factors) was high at care facilities and at home, compared with other places. Calling others was a major reason for delay in all places. Performing cardiopulmonary resuscitation (CPR) and other treatments was another major reason at care facilities. Large delay, defined as an interval exceeding 5 min (upper-quartile value), was an independent factor associated with a low 1-year survival rate. Conclusion: The incidence of correctable causes of delay is high in the community. Correction of emergency call manuals in care facilities and public relation efforts to facilitate an early emergency call may be necessary. Basic life support (BLS) education should be modified to minimise delays related to making an emergency call. © 2010 Elsevier Ireland Ltd. 続きを見る
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論文
Enami, Miki ; Takei, Yutaka ; Inaba, Hideo ; Yachida, Takahiro ; Ohta, Keisuke ; Maeda, Testuo ; Goto, Yoshikazu
出版情報: Resuscitation.  82  pp.577-583,  2011-05-01.  Elsevier
URL: http://hdl.handle.net/2297/30222
概要: Purpose of study: To determine the effects of ageing and training experience on attitude towards performing basic life support (BLS). Methods: 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. Results: 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. Conclusion: 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. © 2011 Elsevier Ireland Ltd. 続きを見る
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論文
Enami, Miki ; Takei, Yutaka ; Goto, Yoshikazu ; Ohta, Keisuke ; Inaba, Hideo
出版情報: Resuscitation.  81  pp.562-567,  2010-05-01.  Elsevier
URL: http://hdl.handle.net/2297/30225
概要: Background: There is no study regarding the influence of cardiopulmonary resuscitation (CPR) guideline renewal on citizen's attitude towards all basic life support (BLS) actions. Methods and results: We conducted a questionnaire survey to new driver licence applicants who participated in the BLS course at driving schools either before (January 2007 to April 2007) or after (October 2007 to April 2008) the revision of the textbook. Upon completion of the course, participants were given a questionnaire concerning willingness to participate in CPR, early emergency call, telephone-assisted chest compression and use of an automated external defibrillator (AED). After the revision, the proportions of positive respondents to use of AED as well as to all the four scenarios significantly increased from 2331/3564 to 3693/5156 (odds ratio (OR)=1.34) and from 1889/3443 to 3028/5126 (OR=1.18), respectively. However, the new guideline slightly but significantly augmented the unwillingness to make an early call (236/3568 vs. 416/5283, OR = 0.83). Approximately 95% of respondents were willing to follow the telephone-assisted instruction of chest compression, while approximately 85% were eager to perform CPR on their own initiative. Multiple logistic regression analysis confirmed the results of mono-variate analysis, and identified previous CPR training, sex, rural area and student as other significant factors relating to attitude. Conclusions: Future guidelines should emphasise the significance and benefit of early call in relation to telephone-assisted instruction of CPR or chest compression. The course instructors should be aware of the backgrounds of participants as to how this may relate to their willingness to participate. © 2010 Elsevier Ireland Ltd. 続きを見る
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論文
Goto, Yoshikazu ; Funada, Akira ; Nakatsu-Goto, Yumiko
出版情報: Critical Care.  19  pp.410-,  2015-11-18.  BioMed Central Ltd.
URL: http://hdl.handle.net/2297/43899
概要: Introduction: Obtaining favorable neurological outcomes is extremely difficult in children transported to a hospital without a prehospital return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). However, the crucial prehospital factors affecting outcomes in this cohort remain unclear. We aimed to determine the prehospital factors for survival with favorable neurological outcomes (Cerebral Performance Category 1 or 2 (CPC 1-2)) in children without a prehospital ROSC after OHCA. Methods: Of 9093 OHCA children, 7332 children (age <18years) without a prehospital ROSC after attempting resuscitation were eligible for enrollment. Data were obtained from a prospectively recorded Japanese national Utstein-style database from 2008 to 2012. The primary endpoint was 1-month CPC 1-2 after OHCA. Results: The 1-month survival and 1-month CPC 1-2 rates were 6.92% (n=508) and 0.99% (n=73), respectively. The proportions of the following prehospital variables were significantly higher in the 1-month CPC 1-2 cohort than in the 1-month CPC 3-5 cohort: age (median, 3years (interquartile range (IQR), 0-14) versus 1year (IQR, 0-11), p<0.05), bystander-witnessed arrest (52/73 (71.2%) versus 1830/7259 (25.2%), p<0.001), initial ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT) rhythm (28/73 (38.3%) versus 241/7259 (3.3%), p<0.001), presumed cardiac causes (42/73 (57.5%) versus 2385/7259 (32.8%), p<0.001), and actual shock delivery (25/73 (34.2%) versus 314/7259 (4.3%), p<0.0001). Multivariate logistic regression analysis indicated that 2 prehospital factors were associated with 1-month CPC 1-2: initial non-asystole rhythm (VF/pulseless VT: adjusted odds ratio ( aOR), 16.0; 95% confidence interval (CI), 8.05-32.0; pulseless electrical activity (PEA): aOR, 5.19; 95% CI, 2.77-9.82) and bystander-witnessed arrest (aOR, 3.22; 95% CI, 1.84-5.79). The rate of 1-month CPC 1-2 in witnessed-arrest children with an initial VF/pulseless VT was significantly higher than that in those with other initial cardiac rhythms (15.6% versus 2.3% for PEA and 1.2% for asystole, p for trend<0.001). Conclusions: The crucial prehospital factors for 1-month survival with favorable neurological outcomes after OHCA were initial non-asystole rhythm and bystander-witnessed arrest in children transported to hospitals without a prehospital ROSC. © 2015 Goto et al. 続きを見る
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論文
Goto, Yoshikazu ; Maeda, Tetsuo ; Goto, Yumiko
出版情報: Journal of the American Heart Association.  3  pp.000499-,  2014-01-01.  American Heart Association: JAHA / John Wiley and Sons Inc.
URL: http://hdl.handle.net/2297/45524
概要: Background-The impact of dispatcher-assisted bystander cardiopulmonary resuscitation (CPR) on neurological outcomes in children is unclear. We investigated whether dispatcher-assisted bystander CPR shows favorable neurological outcomes (Cerebral Performance Category scale 1 or 2) in children with out-of-hospital cardiac arrest (OHCA). Methods and Results-Children (n=5009, age < 18 years) with OHCA were selected from a nationwide Utstein-style Japanese database (2008-2010) and divided into 3 groups: no bystander CPR (n=2287); bystander CPR with dispatcher instruction (n=2019); and bystander CPR without dispatcher instruction (n=703) groups. The primary endpoint was favorable neurological outcome at 1 month post-OHCA. Dispatcher CPR instruction was offered to 53.9% of patients, significantly increasing bystander CPR provision rate (adjusted odds ratio [aOR], 7.51; 95% confidence interval [CI], 6.60 to 8.57). Bystander CPR with and without dispatcher instruction were significantly associated with improved 1-month favorable neurological outcomes (aOR, 1.81 and 1.68; 95% CI, 1.24 to 2.67 and 1.07 to 2.62, respectively), compared to no bystander CPR. Conventional CPR was associated with increased odds of 1-month favorable neurological outcomes irrespective of etiology of cardiac arrest (aOR, 2.30; 95% CI, 1.56 to 3.41). However, chest-compression-only CPR was not associated with 1-month meaningful outcomes (aOR, 1.05; 95% CI, 0.67 to 1.64). Conclusions-In children with OHCA, dispatcher-assisted bystander CPR increased bystander CPR provision rate and was associated with improved 1-month favorable neurological outcomes, compared to no bystander CPR. Conventional bystander CPR was associated with greater likelihood of neurologically intact survival, compared to chest-compression-only CPR, irrespective of cardiac arrest etiology. © 2014 The Authors. 続きを見る
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論文

論文
Funada, Akira ; Goto, Yoshikazu ; Tada, Hayato ; Teramoto, Ryota ; Shimojima, Masaya ; Hayashi, Kenshi ; Yamagishi, Masakazu
出版情報: Circulation journal.  81  pp.652-659,  2017-04-25.  Japanese Circulation Society = 日本循環器学会
URL: http://hdl.handle.net/2297/48500
概要: Background:The appropriate duration of prehospital cardiopulmonary resuscitation (CPR)administered by emergency medical service (EMS) providers for patients with out-of-hospital cardiac arrest (OHCA) necessary to achieve 1-month survival with favorable neurological outcome (Cerebral Performance Category 1 or 2, CPC 1–2) is unclear and could differ by age. Methods and Results:We analyzed the records of 35,709 adult OHCA patients with return of spontaneous circulation (ROSC) before hospital arrival in a prospectively recorded Japanese registry between 2011 and 2014. The CPR duration was defined as the time from CPR initiation by EMS providers to prehospital ROSC. The rate of 1-month CPC 1–2 was 21.4% (7,650/35,709). The CPR duration was independently and inversely associated with 1-month CPC 1–2 (adjusted odds ratio, 0.93 per 1-min increment; 95% confidence interval, 0.93–0.94). The CPR duration increased with age (P<0.001). However, the CPR duration beyond which the proportion of OHCA patients with 1-month CPC 1–2 decreased to <1% declined with age: 28 min for patients aged 18–64 years, 25 min for 65–74 years, 23 min for 75–84 years, 20 min for 85–94 years, and 18 min for ≥95 years. Conclusions:In patients who achieved prehospital ROSC after OHCA, the duration of CPR administered by EMS providers necessary to achieve 1-month CPC 1–2 varied by age.<br />出版者照会後に全文公開 続きを見る
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論文
Funada, Akira ; Goto, Yoshikazu ; Maeda, Tetsuo ; Teramoto, Ryota ; Hayashi, Kenshi ; Yamagishi, Masakazu
出版情報: Circulation Journal.  80  pp.1153-1162,  2016-01-01.  日本循環器学会 = The Japanese Circulation Society
URL: http://hdl.handle.net/2297/44912
概要: Background:There is sparse data regarding the survival and neurological outcome of elderly patients with out-of-hospital cardiac arrest (OHCA).Methods and Results:OHCA patients (334,730) aged ≥75 years were analyzed using a nationwide, prospective, population-based Japanese OHCA database from 2008 to 2012. The overall 1-month survival with favorable neurological outcome (Cerebral Performance Category Scale, category 1 or 2; CPC 1-2) rate was 0.88%. During the study period, the annual 1-month CPC 1-2 rate in whole OHCA significantly improved (0.73% to 0.96%, P for trend <0.001). In particular, outcomes of OHCA patients aged 75 to 84 years and those aged 85 to 94 years significantly improved (0.98% to 1.28%, P for trend=0.01; 0.46% to 0.70%, P for trend <0.001, respectively). However, in OHCA patients aged ≥95 years, the outcomes did not improve. Multivariate logistic regression analysis indicated that younger age, shockable first documented rhythm, witnessed arrest, earlier emergency medical service (EMS) response time, and cardiac etiology were significantly associated with the 1-month CPC 1-2. Under these conditions, elderly OHCA patients who had cardiac etiology, shockable rhythm and had a witnessed arrest had acceptable 1-month CPC1-2 rate; 7.98% in cases where OHCA was witnessed by family, 15.2% by non-family, and 25.6% by EMS.Conclusions:The annual 1-month CPC 1-2 rate after OHCA among elderly patients significantly improved, and the resuscitation of elderly patients in a selected population is not futile. 続きを見る
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論文
Goto, Yoshikazu ; Funada, Akira ; Goto, Yumiko
出版情報: Resuscitation.  124  pp.e9-e10,  2018-03-01.  Elsevier Ireland Ltd
URL: http://hdl.handle.net/2297/00050464
概要: 金沢大学医薬保健研究域医学系<br />Embargo Periods 12 Months
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論文

論文
後藤, 由和 ; Goto, Yoshikazu
出版情報: 平成25(2013)年度 科学研究費補助金 挑戦的萌芽研究 研究成果報告書.  2011-2013  pp.4p.-,  2014-05-07.  金沢大学医薬保健研究域医学系
URL: http://hdl.handle.net/2297/00051590
概要: 2010年発行の米国心臓協会による心肺蘇生ガイドラインによると、心肺蘇生に反応しない心停止者は、救急隊は現場で蘇生中止ができるとされている。しかし、本邦では救急隊による蘇生中止は法律で禁止されている。高齢化社会における医療資源の有効活用に寄 与する目的で本研究が行われた。2005年から2011年の間に消防庁が全国集計した心停止者搬送データ(797,422例)を用い解析を行った。その結果、救急隊が判断する院外心停止傷病者不搬送基準として、「心拍再開なし」、「初期心電図が非除細動適応」、「目撃のない心停止」の3病院前因子すべてを満たし、さらに救急隊の現場活動時間の新たな設定が必要であると考えられた。<br />研究課題/領域番号:23659253, 研究期間(年度):2011-2013 続きを見る
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論文
後藤, 由和 ; Goto, Yoshikazu
出版情報: 平成29(2017)年度 科学研究費補助金 基盤研究(C) 研究成果報告書.  2015-04-01 - 2018-03-31  pp.4p.-,  2018-05-30.  金沢大学医薬保健研究域医学系
URL: http://hdl.handle.net/2297/00051589
概要: 我が国で初めてとなる救急隊の現場活動時間を考慮した「現場蘇生中止基準」を開発するべく, 消防庁の全国集計データを用いて観察研究を行った. 開発した基準は, 次の3基準すべてを満たす症例に適応できると考えられた. すなわち, 目撃なし・電気シ ョック適応の初期心電図なし・救急隊の蘇生処置が15分で自己心拍再開なしの3項目である.本基準に該当する症例は全院外心停止例の約9%と推定され, 心停止後1か月死亡に対する陽性適中率と特異度は, それぞれ99.1%と98.8%であった. 本基準の導入は, 救急隊の搬送例の減少, 搬送時に生じるリスク回避および病院における医療資源の効率化に役立つと考えられる.<br />研究課題/領域番号:15K08543, 研究期間(年度):2015-04-01 - 2018-03-31 続きを見る