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| 1.
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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| 2.
論文 |
論文
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Kamikura, Takahisa ; Iwasaki, Hose ; Myojo, Yasuhiro ; Sakagami, Satoru ; Takei, Yutaka ; Inaba, Hideo
概要:
Aim: To assess the benefit of immediate call or cardiopulmonary resuscitation (CPR) for survival from out-of-hospital ca
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rdiac arrests (OHCAs). Methods: Of 952,288 OHCAs in 2005-2012, 41,734 were bystander-witnessed cases without prehospital involvement of physicians but with bystander CPR (BCPR) on bystander's own initiative. From those OHCAs, we finally extracted the following three call/BCPR groups: immediate Call + CPR (N= 10,195, emergency call/BCPR initiated at 0 or 1 min after witness, absolute call-BCPR time interval = 0 or 1. min), immediate Call-First (N= 1820, emergency call placed at 0 or 1 min after witness, call-to-BCPR interval = 2-4. min), immediate CPR-First (N= 5446, BCPR initiated at 0 or 1. min after witness, BCPR-to-call interval = 2-4 min). One-month neurologically favourable survivals were compared among the groups. Critical comparisons between Call-First and CPR-First groups were made considering arrest aetiology, age, and bystander-patient relationship after confirming the interactions among variables. Results: The overall survival rates in immediate Call + CPR, Call-First, and CPR-First groups were 11.5, 12.4, and 11.5%, respectively without significant differences (p= 0.543). Subgroup analyses by multivariate logistic regression following univariate analysis disclosed that CPR-first group is more likely to survive in subgroups of noncardiac aetiology (adjusted odds ratio; 95% confidence interval, 2.01; 1.39-2.98) and of nonelderly OHCAs (1.38; 1.09-1.76). Conclusions: Immediate CPR-first action followed by an emergency call without a large delay may be recommended when a bystander with sufficient skills to perform CPR witnesses OHCAs in nonelderly people and of noncardiac aetiology. © 2015 Elsevier Ireland Ltd.<br />Embargo Period 12 months
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