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Goto, Yoshikazu ; Funada, Akira ; Goto, Yumiko ; 後藤, 由和 ; 舟田, 晃
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金沢大学医薬保健研究域医学系<br />Embargo Periods 12 Months
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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
概要:
Background:The appropriate duration of prehospital cardiopulmonary resuscitation (CPR)administered by emergency medical
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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
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後藤, 由和 ; Goto, Yoshikazu
概要:
金沢大学医薬保健研究域医学系<br />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
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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 />Using Japanese nationwide registry for out-of-hospital cardiac arrest (OHCA), we have developed a termination-of-resuscitation (TOR) rule in the field for patients with refractory OHCA, including the resuscitation duration by emergency medical services (EMS) personnel. The developed TOR rule is as follows: EMS personnel could consider termination of resuscitation in the field if patients meet all 3 of following criteria; (1) unwitnessed arrest (2)initial non-shockable rhythm, and (3) no return of spontaneous circulation after 15 minutes of EMS-initiated cardiopulmonary resuscitation. The specificity and positive predictive value for predicting 1-month death in patients who met these 3 criteria were 99.1% and 98.8%, respectively. Implementation of this TOR rule would have reduced the percentage of patients transported to the emergency department, approximately 9%, and the number of attendant hazards to EMS personnel, and have improved the utilization of hospital healthcare resources.<br />研究課題/領域番号:15K08543, 研究期間(年度):2015-04-01 - 2018-03-31
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後藤, 由和 ; Goto, Yoshikazu
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
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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 />The 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation recommended that emergency medical services (EMS) personnel consider prehospital termination of resuscitation (TOR) for patients who experienced out-of-hospital cardiac arrest (OHCA) following futile resuscitation efforts in the field. However, EMS personnel in Japan are not legally allowed to perform TOR for OHCA patients in the prehospital settings. To better utilize healthcare resources in a full-fledged aged society, we aimed to establish new Japanese TOR rules for EMS personnel in the field. We analyzed a prospectively collected, nationwide Utstein-style Japanese database between 2005 and 2011 (n = 797,422) from the Fire and Disaster Management Agency of Japan. We have recommended that new TOR rules for EMS personnel should fulfill all 3 criteria (no return of spontaneous circulation, unshockable initial rhythm, and unwitnessed arrest) and require the limitation of length for the on-scene effort.<br />研究課題/領域番号:23659253, 研究期間(年度):2011-2013
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