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学位論文 |
学位
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前田, 哲生 ; Maeda, Tetsuo
概要:
博士論文要旨Abstract 以下に掲載：Resuscitation 91(1) pp.122-130 2015. Elsevier. 共著者：Tetsuo Maeda, Takahisa Kamikura, Yoshio Tanaka, Akira Yamashita, Minoru Kubo, Yutaka Takei, Hideo Inaba
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| 2.
学位論文 |
学位
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前田, 哲生 ; Maeda, Tetsuo
概要:
博士論文本文Full 以下に掲載：Resuscitation 91(1) pp.122-130 2015. Elsevier. 共著者：Tetsuo Maeda, Takahisa Kamikura, Yoshio Tanaka, Akira Yamashita, Minoru Kubo, Yutaka Takei, Hideo Inaba
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| 3.
論文 |
論文
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Nishi, Taiki ; Maeda, Tetsuo ; Takase, Keiko ; Kamikura, Takahiro ; Tanaka, Yoshio ; Inaba, Hideo
概要:
Review: An increased number of rescuers may improve the survival rate from out-of-hospital cardiac arrests (OHCAs). The
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majority of OHCAs occur at home and are handled by family members. Materials and methods: Data from 5078 OHCAs that were witnessed by citizens and unwitnessed by citizens or emergency medical technicians from January 2004 to March 2010 were prospectively collected. The number of rescuers was identified in 4338 OHCAs and was classified into two (single rescuer (N = 2468) and multiple rescuers (N = 1870)) or three (single rescuer, two rescuers (N = 887) and three or more rescuers (N = 983)) groups. The backgrounds, characteristics and outcomes of OHCAs were compared between the two groups and among the three groups. Results: When all OHCAs were collectively analysed, an increased number of rescuers was associated with better outcomes (one-year survival and one-year survival with favourable neurological outcomes were 3.1% and 1.9% for single rescuers, 4.1% and 2.0% for two rescuers, and 6.0% and 4.6% for three or more rescuers, respectively (p = 0.0006 and p < 0.0001)). A multiple logistic regression analysis showed that the presence of multiple rescuers is an independent factor that is associated with one-year survival (odds ratio (95% confidence interval): 1.539 (1.088-2.183)). When only OHCAs that occurred at home were analysed (N = 2902), the OHCAs that were handled by multiple rescuers were associated with higher incidences of bystander CPR but were not associated with better outcomes. Conclusions: In summary, an increased number of rescuers improves the outcomes of OHCAs. However, this beneficial effect is absent in OHCAs that occur at home. © 2012 Elsevier Ireland Ltd. All rights reserved.
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| 4.
論文 |
論文
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Tanaka, Yoshio ; Maeda, Tetsuo ; Kamikura, Takahisa ; Nishi, Taiki ; Omi, Wataru ; Hashimoto, Masaaki ; Sakagami, Satoru ; Inaba , Hideo
概要:
Aim: To investigate whether the bystander-patient relationship affects bystander response to out-of-hospital cardiac arr
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est (OHCA) and patient outcomes depending on the time of day. Methods: This population-based observational study in Japan involving 139,265 bystander-witnessed OHCAs (90,426 family members, 10,479 friends/colleagues, and 38,360 others) without prehospital physician involvement was conducted from 2005 to 2009. Factors associated with better bystander response [early emergency call and bystander cardiopulmonary resuscitation (BCPR)] and 1-month neurologically favourable survival were assessed. Results: The rates of dispatcher-assisted CPR during daytime (7:00-18:59) and nighttime (19:00-6:59) were highest in family members (45.6% and 46.1%, respectively, for family members; 28.7% and 29.2%, respectively, for friends/colleagues; and 28.1% and 25.3%, respectively, for others). However, the BCPR rates were lowest in family members (35.5% and 37.8%, respectively, for family members; 43.7% and 37.8%, respectively, for friends/colleagues; and 59.3% and 50.0%, respectively, for others). Large delays (≥5. min) in placing emergency calls and initiating BCPR were most frequent in family members. The overall survival rate was lowest (2.7%) for family members and highest (9.1%) for friends/colleagues during daytime. Logistic regression analysis revealed that the effect of bystander relationship on survival was significant only during daytime [adjusted odds ratios (95% CI) for survival from daytime OHCAs with family as reference were 1.51 (1.36-1.68) for friends/colleagues and 1.23 (1.13-1.34) for others]. Conclusions: Family members are least likely to perform BCPR and OHCAs witnessed by family members are least likely to survive during daytime. Different strategies are required for family-witnessed OHCAs.
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| 5.
論文 |
論文
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Goto, Yoshikazu ; Maeda, Tetsuo ; Goto, Yumiko
概要:
Background-The impact of dispatcher-assisted bystander cardiopulmonary resuscitation (CPR) on neurological outcomes in c
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hildren 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.
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| 6.
論文 |
論文
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Maeda, Tetsuo ; Yamashita, Akira ; Myojo, Yasuhiro ; Wato, Yukihiro ; Inaba, Hideo
概要:
Purpose To investigate the impacts of emergency calls made using mobile phones on the quality of dispatcher-assisted car
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diopulmonary resuscitation (DA-CPR) and survival from out-of-hospital cardiac arrests (OHCAs) that were not witnessed by emergency medical service (EMS). Methods In this prospective study, we collected data for 2530 DA-CPR-attempted medical emergency cases (517 using mobile phones and 2013 using landline phones) and 2980 non-EMS-witnessed OHCAs (600 using mobile phones and 2380 using landline phones). Time factors and quality of DA-CPR, backgrounds of callers and outcomes of OHCAs were compared between mobile and landline phone groups. Results Emergency calls are much more frequently placed beside the arrest victim in mobile phone group (52.7% vs. 17.2%). The positive predictive value and acceptance rate of DA-CPR in mobile phone group (84.7% and 80.6%, respectively) were significantly higher than those in landline group (79.2% and 70.9%). The proportion of good-quality bystander CPR in mobile phone group was significantly higher than that in landline group (53.5% vs. 45.0%). When analysed for all non-EMS-witnessed OHCAs, rates of 1-month survival and 1-year neurologically favourable survival in mobile phone group (7.8% and 3.5%, respectively) were higher than those in landline phone group (4.6% and 1.9%; p < 0.05). Multiple logistic regression analysis, including other backgrounds, revealed that mobile phone calls were associated with increased 1-month survival in the subgroup of OHCAs receiving bystander CPR (adjusted odds ratio, 1.84; 95% CI, 1.15–2.92). Conclusion Emergency calls made using mobile phones are likely to augment the survival from OHCAs by improving DA-CPR. © 2016 Elsevier Ireland Ltd<br />Embargo Period 12 months
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| 7.
論文 |
論文
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Ishiyama, Ken ; Takami, Akiyoshi ; Kanda, Yoshinobu ; Nakao, Shinji ; Hidaka, Michihiro ; Maeda, Tetsuo ; Naoe, Tomoki ; Taniguchi, Shuichi ; Kawa, Keisei ; Nagamura, Tokiko ; Tabuchi, Ken ; Atsuta, Yoshiko ; Sakamaki, Hisashi
概要:
We have recently reported that the outcome of acute myeloid leukemia (AML) patients with t(6;9)(p23;q34) who underwent a
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llogeneic hematopoietic stem cell transplantation (allo-HSCT) was comparable to that of patients with a normal karyotype. We performed a further analysis regarding the prognostic factors for t(6;9)(p23;q34) AML patients who underwent a HSCT. Seven pediatric patients and 57 adult patients, transplanted between 1996 and 2007, were assessed in this study. The overall survival (OS) of the pediatric patients tended to be better than the OS of the adults, although there were no statistically significant differences. The present study focused on the adult patients revealed that the disease status at HSCT was the sole prognostic factor affecting the OS identified in the univariate analysis. A multivariate analysis showed that the disease status at HSCT and M2 in the FAB classification were extracted as the significant variables affecting the OS. The patients who were not in remission at HSCT and had non-FAB-M2 showed a poorer outcome; 6 deaths in the 9 patients were due to a relapse of the AML. These findings suggest that novel therapeutic approaches might be needed for patients with these poor prognostic factors.<br />発行後6か月より全文公開
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| 8.
論文 |
論文
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Ishiyama, Ken ; Takami, Akiyoshi ; Kanda, Yoshinobu ; Nakao, Shinji ; Hidaka, Michihiro ; Maeda, Tetsuo ; Naoe, Tomoki ; Taniguchi, Shuichi ; Kawa, Keisei ; Nagamura, Tokiko ; Atsuta, Yoshiko ; Sakamaki, Hisashi
概要:
Acute myeloid leukemia (AML) with t(6;9)(p23;q34) is well known to have a poor prognosis treated with chemotherapy and a
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utotransplantation. The presence of this karyotype is an indicator for allogeneic hematopoietic stem cell transplantation (HSCT); however, the impact of t(6;9)(p23;q34) on the HSCT outcome remains unclear. We conducted a matched-pair analysis of de novo AML patients with and without t(6;9)(p23;q34) using data obtained from the Japanese HSCT data registry. A total of 57 patients with t(6;9)(p23;q34) received transplants between 1996 and 2007, and 171 of 2056 normal karyotype patients matched for age, disease status at HSCT and graft source were selected. The overall survival, disease-free survival, cumulative incidence of relapse and the non-relapse mortality in t(6;9)(p23;q34) patients were comparable to those for normal karyotype patients. A univariate analysis showed that t(6;9)(p23;q34) had no significant impact on the overall survival. These findings suggest that allogeneic HSCT may overcome the unfavorable impact of t(6;9)(p23;q34) as an independent prognostic factor. © 2012 Macmillan Publishers Limited All rights reserved.
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| 9.
論文 |
論文
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Funada, Akira ; Goto, Yoshikazu ; Maeda, Tetsuo ; Teramoto, Ryota ; Hayashi, Kenshi ; Yamagishi, Masakazu
概要:
Background:There is sparse data regarding the survival and neurological outcome of elderly patients with out-of-hospital
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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.
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