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論文

論文
Goto, Yoshikazu ; Funada, Akira ; Goto, Yumiko ; 後藤, 由和 ; 舟田, 晃
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
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 wit hout 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

論文
Funada, Akira ; Goto, Yoshikazu ; Tada, Hayato ; Teramoto, Ryota ; Shimojima, Masaya ; Hayashi, Kenshi ; Yamagishi, Masakazu ; 舟田 , 晃 ; 後藤, 由和 ; 多田, 隼人 ; 寺本, 了太 ; 下島, 正也 ; 林, 研至 ; 山岸, 正和
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

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