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1.
Prehosp Emerg Care ; 28(4): 598-608, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38345309

RESUMEN

BACKGROUND: An ambulance traffic crash not only leads to injuries among emergency medical service (EMS) professionals but also injures patients or their companions during transportation. We aimed to describe the incidence of ambulance crashes, seating location, seatbelt use for casualties (ie, both fatal and nonfatal injuries), ambulance safety efforts, and to identify factors affecting the number of ambulance crashes in Japan. METHODS: We conducted a nationwide survey of all fire departments in Japan. The survey queried each fire department about the number of ambulance crashes between January 1, 2017, and December 31, 2019, the number of casualties, their locations, and seatbelt usage. Additionally, the survey collected information on fire department characteristics, including the number of ambulance dispatches, and their safety efforts including emergency vehicle operation training and seatbelt policies. We used regression methods including a zero-inflated negative binomial model to identify factors associated with the number of crashes. RESULTS: Among the 726 fire departments in Japan, 553 (76.2%) responded to the survey, reporting a total of 11,901,210 ambulance dispatches with 1,659 ambulance crashes (13.9 for every 100,000 ambulance dispatches) that resulted in a total of 130 casualties during the 3-year study period (1.1 in every 100,000 dispatches). Among the rear cabin occupants, seatbelt use was limited for both EMS professionals (n = 3/29, 10.3%) and patients/companions (n = 3/26, 11.5%). Only 46.7% of the fire departments had an internal policy regarding seatbelt use. About three-fourths of fire departments (76.3%) conducted emergency vehicle operation training internally. The output of the regression model revealed that fire departments that conduct internal emergency vehicle operation training had fewer ambulance crashes compared to those that do not (odds of being an excessive zero -2.20, 95% CI: -3.6 to -0.8). CONCLUSION: Two-thirds of fire departments experienced at least one crash during the study period. The majority of rear cabin occupants who were injured in ambulance crashes were not wearing a seatbelt. Although efforts to ascertain seatbelt compliance were limited, Japanese fire departments have attempted a variety of methods to reduce ambulance crashes including internal emergency vehicle operation training, which was associated with fewer ambulance crashes.


Asunto(s)
Accidentes de Tránsito , Ambulancias , Cinturones de Seguridad , Humanos , Japón , Ambulancias/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Cinturones de Seguridad/estadística & datos numéricos , Encuestas y Cuestionarios , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Masculino
2.
Circulation ; 142(16_suppl_1): S41-S91, 2020 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-33084391

RESUMEN

This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 5 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review. Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest. The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.


Asunto(s)
Reanimación Cardiopulmonar/normas , Enfermedades Cardiovasculares/terapia , Servicios Médicos de Urgencia/normas , Cuidados para Prolongación de la Vida/normas , Adulto , Reanimación Cardiopulmonar/métodos , Enfermedades Cardiovasculares/diagnóstico , Desfibriladores , Práctica Clínica Basada en la Evidencia , Humanos , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/terapia
3.
Circulation ; 136(23): e424-e440, 2017 12 05.
Artículo en Inglés | MEDLINE | ID: mdl-29114010

RESUMEN

The International Liaison Committee on Resuscitation has initiated a near-continuous review of cardiopulmonary resuscitation science that replaces the previous 5-year cyclic batch-and-queue approach process. This is the first of an annual series of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations summary articles that will include the cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation in the previous year. The review this year includes 5 basic life support and 1 pediatric Consensuses on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Each of these includes a summary of the science and its quality based on Grading of Recommendations, Assessment, Development, and Evaluation criteria and treatment recommendations. Insights into the deliberations of the International Liaison Committee on Resuscitation task force members are provided in Values and Preferences sections. Finally, the task force members have prioritized and listed the top 3 knowledge gaps for each population, intervention, comparator, and outcome question.


Asunto(s)
Cardiología/normas , Reanimación Cardiopulmonar/normas , Servicios Médicos de Urgencia/normas , Medicina de Emergencia/normas , Medicina Basada en la Evidencia/normas , Paro Cardíaco/terapia , Factores de Edad , Consenso , Paro Cardíaco/diagnóstico , Paro Cardíaco/mortalidad , Humanos , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/mortalidad , Paro Cardíaco Extrahospitalario/terapia , Resultado del Tratamiento
4.
J Emerg Med ; 44(2): 389-97, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22541878

RESUMEN

BACKGROUND: The effect of prehospital use of supraglottic airway devices as an alternative to tracheal intubation on long-term outcomes of patients with out-of-hospital cardiac arrest is unclear. STUDY OBJECTIVES: We compared the neurological outcomes of patients who underwent supraglottic airway device insertion with those who underwent tracheal intubation. METHODS: We conducted a nationwide population-based observational study using a national database containing all out-of-hospital cardiac arrest cases in Japan over a 3-year period (2005-2007). The rates of neurologically favorable 1-month survival (primary outcome) and of 1-month survival and return of spontaneous circulation before hospital arrival (secondary outcomes) were examined. Multiple logistic regression analyses were performed to adjust for potential confounders. Advanced airway devices were used in 138,248 of 318,141 patients, including an endotracheal tube (ETT) in 16,054 patients (12%), a laryngeal mask airway (LMA) in 34,125 patients (25%), and an esophageal obturator airway (EOA) in 88,069 patients (63%). RESULTS: The overall rate of neurologically favorable 1-month survival was 1.03% (1426/137,880). The rates of neurologically favorable 1-month survival were 1.14% (183/16,028) in the ETT group, 0.98% (333/34,059) in the LMA group, and 1.04% (910/87,793) in the EOA group. Compared with the ETT group, the rates were significantly lower in the LMA group (adjusted odds ratio 0.77, 95% confidence interval [CI] 0.64-0.94) and EOA group (adjusted odds ratio 0.81, 95% CI 0.68-0.96). CONCLUSIONS: Prehospital use of supraglottic airway devices was associated with slightly, but significantly, poorer neurological outcomes compared with tracheal intubation, but neurological outcomes remained poor overall.


Asunto(s)
Manejo de la Vía Aérea/instrumentación , Servicios Médicos de Urgencia , Escala de Consecuencias de Glasgow , Intubación Intratraqueal , Paro Cardíaco Extrahospitalario/terapia , Anciano , Análisis de Varianza , Bases de Datos Factuales , Femenino , Humanos , Japón/epidemiología , Masculino , Análisis Multivariante , Paro Cardíaco Extrahospitalario/epidemiología , Tasa de Supervivencia
5.
Crit Care ; 16(6): R219, 2012 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-23148767

RESUMEN

INTRODUCTION: Conventional monophasic defibrillators for out-of-hospital cardiac-arrest patients have been replaced with biphasic defibrillators. However, the advantage of biphasic over monophasic defibrillation for pediatric out-of-hospital cardiac-arrest patients remains unknown. This study aimed to compare the survival outcomes of pediatric out-of-hospital cardiac-arrest patients who underwent monophasic defibrillation with those who underwent biphasic defibrillation. METHODS: This prospective, nationwide, population-based observational study included pediatric out-of-hospital cardiac-arrest patients from January 1, 2005, to December 31, 2009. The primary outcome measure was survival at 1 month with minimal neurologic impairment. The secondary outcome measures were survival at 1 month and the return of spontaneous circulation before hospital arrival. Multivariable logistic regression analysis was performed to identify the independent association between defibrillator type (monophasic or biphasic) and outcomes. RESULTS: Among 5,628 pediatric out-of-hospital cardiac-arrest patients (1 through 17 years old), 430 who received defibrillation shock with monophasic or biphasic defibrillator were analyzed. The number of patients who received defibrillation shock with monophasic defibrillator was 127 (30%), and 303 (70%) received defibrillation shock with biphasic defibrillator. The survival rates at 1 month with minimal neurologic impairment were 17.5% and 24.4%, the survival rates at 1 month were 32.3% and 35.6%, and the rates of return of spontaneous circulation before hospital arrival were 24.4% and 27.4% in the monophasic and biphasic defibrillator groups, respectively. Hierarchic logistic regression analyses by using generalized estimation equations found no significant difference between the two groups in terms of 1-month survival with minimal neurologic impairment (odds ratio (OR), 1.57; 95% confidence interval (CI), 0.87 to 2.83; P = 0.14) and 1-month survival (OR, 1.38; 95% CI, 0.87 to 2.18; P = 0.17). CONCLUSIONS: The present nationwide population-based observational study could not confirm an advantage of biphasic over monophasic defibrillators for pediatric OHCA patients.


Asunto(s)
Cardioversión Eléctrica/métodos , Paro Cardíaco Extrahospitalario/terapia , Adolescente , Niño , Preescolar , Desfibriladores , Femenino , Humanos , Lactante , Japón/epidemiología , Masculino , Estudios Prospectivos
6.
Masui ; 61(7): 738-41, 2012 Jul.
Artículo en Japonés | MEDLINE | ID: mdl-22860303

RESUMEN

We report successful awake intubation using AWS combined with surface anesthesia of the upper airway via nebulizer. The two cases are suitable for awake intubation due to difficult airway. After inhaled lidocaine 4% and nebulized 4 ml, while giving fentanyl i. v, we performed awake intubation. As a preparatory step to the procedure described above, awake intubation was tested on the author himself with only surface anesthesia. The patients and author did not buck during intubation. The present case shows that it is possible to perform awake intubate safely with less stress with the combination of AWS and surface airway anesthesia via nebulizer.


Asunto(s)
Anestesia por Inhalación/métodos , Anestésicos Locales/administración & dosificación , Intubación Intratraqueal/métodos , Laringoscopios , Obesidad/complicaciones , Espondilosis/complicaciones , Vigilia/fisiología , Adulto , Humanos , Masculino , Persona de Mediana Edad , Nebulizadores y Vaporizadores
7.
Resuscitation ; 159: 85-96, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33253767

RESUMEN

INTRODUCTION: Cardiac arrest is a time-sensitive condition requiring urgent intervention. Prompt and accurate recognition of cardiac arrest by emergency medical dispatchers at the time of the emergency call is a critical early step in cardiac arrest management allowing for initiation of dispatcher-assisted bystander CPR and appropriate and timely emergency response. The overall accuracy of dispatchers in recognizing cardiac arrest is not known. It is also not known if there are specific call characteristics that impact the ability to recognize cardiac arrest. METHODS: We performed a systematic review to examine dispatcher recognition of cardiac arrest as well as to identify call characteristics that may affect their ability to recognize cardiac arrest at the time of emergency call. We searched electronic databases for terms related to "emergency medical dispatcher", "cardiac arrest", and "diagnosis", among others, with a focus on studies that allowed for calculating diagnostic test characteristics (e.g. sensitivity and specificity). The review was consistent with Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method for evidence evaluation. RESULTS: We screened 2520 article titles, resulting in 47 studies included in this review. There was significant heterogeneity between studies with a high risk of bias in 18 of the 47 which precluded performing meta-analyses. The reported sensitivities for cardiac arrest recognition ranged from 0.46 to 0.98 whereas specificities ranged from 0.32 to 1.00. There were no obvious differences in diagnostic accuracy between different dispatching criteria/algorithms or with the level of education of dispatchers. CONCLUSION: The sensitivity and specificity of cardiac arrest recognition at the time of emergency call varied across dispatch centres and did not appear to differ by dispatch algorithm/criteria used or education of the dispatcher, although comparisons were hampered by heterogeneity across studies. Future efforts should focus on ways to improve sensitivity of cardiac arrest recognition to optimize patient care and ensure appropriate and timely resource utilization.


Asunto(s)
Reanimación Cardiopulmonar , Asesoramiento de Urgencias Médicas , Operador de Emergencias Médicas , Servicios Médicos de Urgencia , Paro Cardíaco Extrahospitalario , Sistemas de Comunicación entre Servicios de Urgencia , Humanos , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/terapia
8.
Resuscitation ; 162: 73-81, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33582257

RESUMEN

BACKGROUND: Cardiopulmonary resuscitation (CPR) improves cardiac arrest survival. Cough CPR, percussion pacing and precordial thump have been reported as alternative CPR techniques. We aimed to summarise in a systematic review the effectiveness of these alternative CPR techniques. METHODS: We searched Ovid MEDLINE, EMBASE and the Cochrane Library on 24/08/2020. We included randomised controlled trials, observational studies and case series with five or more patients. Two reviewers independently reviewed title and abstracts to identify studies for full-text review, and reviewed bibliographies and 'related articles' (using PubMed) of full-texts for further eligible studies. We extracted data and performed risk-of-bias assessments on studies included in the systematic review. We summarised data in a narrative synthesis, and used GRADE to assess evidence certainty. RESULTS: We included 23 studies (cough CPR n = 4, percussion pacing n = 4, precordial thump n = 16; one study studied two interventions). Only two (both precordial thump) had a comparator group ('standard' CPR). For all techniques evidence certainty was very low. Available evidence suggests that precordial thump does not improve survival to hospital discharge in out-of-hospital cardiac arrest. The review did not find evidence that cough CPR or percussion pacing improve clinical outcomes following cardiac arrest. CONCLUSION: Cough CPR, percussion pacing and precordial thump should not be routinely used in established cardiac arrest. In specific inpatient, monitored settings cough CPR (in conscious patients) or percussion pacing may be attempted at the onset of a potential lethal arrhythmia. These must not delay standard CPR efforts in those who lose cardiac output. PROSPERO REGISTRATION NUMBER: CRD42019152925.


Asunto(s)
Reanimación Cardiopulmonar , Paro Cardíaco Extrahospitalario , Tos/etiología , Humanos , Alta del Paciente , Percusión
9.
Resuscitation ; 146: 188-202, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31536776

RESUMEN

AIM: To understand whether the science to date has focused on single or multiple chest compression components and identify the evidence related to chest compression components to determine the need for a full systematic review. METHODS: This review was undertaken by members of the International Liaison Committee on Resuscitation and guided by a specific methodological framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were peer-reviewed human studies that examined the effect of different chest compression depths or rates, or chest wall or leaning, on physiological or clinical outcomes. The databases searched were MEDLINE complete, Embase, and Cochrane. RESULTS: Twenty-two clinical studies were included in this review: five observational studies involving 879 patients examined both chest compression rate and depth; eight studies involving 14,285 patients examined chest compression rate only; seven studies involving 12001 patients examined chest compression depth only, and two studies involving 1848 patients examined chest wall recoil. No studies were identified that examined chest wall leaning. Three studies reported an inverse relationship between chest compression rate and depth. CONCLUSION: This scoping review did not identify sufficient new evidence that would justify conducting new systematic reviews or reconsideration of current resuscitation guidelines. This scoping review does highlight significant gaps in the research evidence related to chest compression components, namely a lack of high-level evidence, paucity of studies of in-hospital cardiac arrest, and failure to account for the possibility of interactions between chest compression components.


Asunto(s)
Reanimación Cardiopulmonar/métodos , Paro Cardíaco/terapia , Masaje Cardíaco , Reanimación Cardiopulmonar/normas , Masaje Cardíaco/métodos , Masaje Cardíaco/normas , Masaje Cardíaco/estadística & datos numéricos , Humanos , Guías de Práctica Clínica como Asunto
10.
Resuscitation ; 156: A35-A79, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33098921

RESUMEN

This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 20 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 3 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review. Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest. The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.


Asunto(s)
Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Paro Cardíaco , Adulto , Consenso , Urgencias Médicas , Paro Cardíaco/terapia , Humanos
12.
Resuscitation ; 121: 201-214, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-29128145

RESUMEN

The International Liaison Committee on Resuscitation has initiated a near-continuous review of cardiopulmonary resuscitation science that replaces the previous 5-year cyclic batch-and-queue approach process. This is the first of an annual series of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations summary articles that will include the cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation in the previous year. The review this year includes 5 basic life support and 1 paediatric Consensuses on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Each of these includes a summary of the science and its quality based on Grading of Recommendations, Assessment, Development, and Evaluation criteria and treatment recommendations. Insights into the deliberations of the International Liaison Committee on Resuscitation task force members are provided in Values and Preferences sections. Finally, the task force members have prioritised and listed the top 3 knowledge gaps for each population, intervention, comparator, and outcome question.


Asunto(s)
Cardiología/normas , Reanimación Cardiopulmonar/normas , Consenso , Servicios Médicos de Urgencia/normas , Medicina de Emergencia/normas , Medicina de Emergencia Basada en la Evidencia/normas , Paro Cardíaco Extrahospitalario/terapia , Factores de Edad , Masaje Cardíaco/normas , Humanos , Paro Cardíaco Extrahospitalario/mortalidad
14.
Resuscitation ; 96: 16-22, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26215479

RESUMEN

AIM: Our study aimed at filling the fundamental knowledge gap on the characteristics of regional brain oxygen saturation (rSO2) levels in out-of-hospital cardiac arrest (OHCA) patients with or without return of spontaneous circulation (ROSC) upon arrival at the hospital for estimating the quality of cardiopulmonary resuscitation and neurological prognostication in these patients. METHODS: We enrolled 1921 OHCA patients from the Japan - Prediction of Neurological Outcomes in Patients Post-cardiac Arrest Registry and measured their rSO2 immediately upon arrival at the hospital by near-infrared spectroscopy using two independent forehead probes (right and left). We also assessed the percentage of patients with a good neurological outcome (defined as cerebral performance categories 1 or 2) 90 days post cardiac arrest. RESULTS: After 90 days, 79 (4%) patients had good neurological outcomes and a median lower rSO2 level of 15% (15-20%). Compared to patients without ROSC upon arrival at the hospital, those with ROSC had significantly higher rSO2 levels (56% [39-65%] vs. 15% [15-17%], respectively; P<0.01), and significantly correlated right- and left-sided regional brain oxygen saturation levels (R=0.94 vs. 0.66, respectively). In both groups, the percentage of patients with a good 90-day neurological outcome increased significantly in proportion to their rSO2 levels upon arrival at the hospital (P<0.01). CONCLUSION: Our data indicate that measuring rSO2 levels might be effective for both monitoring the quality of resuscitation and neurological prognostication in patients with OHCA.


Asunto(s)
Encéfalo/metabolismo , Circulación Cerebrovascular/fisiología , Paro Cardíaco Extrahospitalario/terapia , Consumo de Oxígeno/fisiología , Oxígeno/metabolismo , Recuperación de la Función/fisiología , Anciano , Anciano de 80 o más Años , Reanimación Cardiopulmonar/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/metabolismo , Oximetría , Pronóstico , Estudios Prospectivos , Espectroscopía Infrarroja Corta/métodos
15.
Resuscitation ; 96: 135-41, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26291387

RESUMEN

AIM: This study investigated the value of regional cerebral oxygen saturation (rSO2) monitoring upon arrival at the hospital for predicting post-cardiac arrest intervention outcomes. METHODS: We enrolled 1195 patients with out-of-hospital cardiac arrest of presumed cardiac cause from the Japan-Prediction of Neurological Outcomes in Patients Post-cardiac Arrest Registry. The primary endpoint was a good neurologic outcome (cerebral performance categories 1 or 2 [CPC1/2]) 90 days post-event. RESULTS: A total of 68 patients (6%) had good neurologic outcomes. We found a mean rSO2 of 21%±13%. A receiver operating characteristic curve analysis indicated an optimal rSO2 cut-off of ≥40% for good neurologic outcomes (area under the curve 0.92, sensitivity 0.81, specificity 0.96). Good neurologic outcomes were observed in 53% (55/103) and 1% (13/1092) of patients with high (≥40%) and low (<40%) rSO2, respectively. Even without return of spontaneous circulation (ROSC) upon arrival at the hospital, 30% (9/30) of patients with high rSO2 had good neurologic outcomes. Furthermore, 16 patients demonstrating ROSC upon arrival at the hospital and low rSO2 had poor neurologic outcomes. Multivariate analyses indicated that high rSO2 was independently associated with good neurologic outcomes (odds ratio=14.07, P<0.001). Patients with high rSO2 showed favourable neurologic prognoses if they had undergone therapeutic hypothermia or coronary angiography (CPC1/2, 69% [54/78]). However, 24% (25/103) of those with high rSO2 did not undergo these procedures and exhibited unfavourable neurologic prognoses (CPC1/2, 4% [1/25]). CONCLUSION: rSO2 is a good indicator of 90-day neurologic outcomes for post-cardiac arrest intervention patients.


Asunto(s)
Encéfalo/metabolismo , Reanimación Cardiopulmonar/métodos , Circulación Cerebrovascular/fisiología , Cardiopatías/complicaciones , Paro Cardíaco Extrahospitalario/terapia , Consumo de Oxígeno/fisiología , Oxígeno/metabolismo , Anciano , Encéfalo/fisiopatología , Femenino , Estudios de Seguimiento , Cardiopatías/metabolismo , Humanos , Japón/epidemiología , Masculino , Paro Cardíaco Extrahospitalario/complicaciones , Paro Cardíaco Extrahospitalario/mortalidad , Oximetría , Pronóstico , Estudios Prospectivos , Espectroscopía Infrarroja Corta/métodos , Tasa de Supervivencia
16.
J Anesth ; 11(1): 27-31, 1997 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28921266

RESUMEN

We developed a continuous oxygen consumption (Vo2) measurement system employed the reversed Fick method, in which Vo2 in computed from continuously measured sured arterial and mixed venous oxygen saturation assed by pulse oximetry and mixed venous oximetry, respectively, and cardiac output by the heat deprivation technique. This system was compared with the conventional intermittent reversed fick method in 7 patients during surgery and with indirect calorimetry in 4 intensive care unit (ICU) patients. The Vo2 measured by the continuous reversed Fick method showed a high correlation with those simultaneously measured by the intermittent Fick method (r=0.97,P<0.01) and by indirect calorimetry (r=0.74,P<0.01). The 95% confidence limits (bias±2 SD) of the continuous reversed Fick method were -0.6±45 ml·min-1 with the intermittent Fick method and -31±56 ml·min-1 with indirect calorimetry. The continuous Fick method is in satisfactory agreement with the conventional methods for the measured of Vo2 and potentially allows for convenient assessment of Vo2 in critically ill patients.

17.
J Anesth ; 8(1): 72-77, 1994 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28921204

RESUMEN

The aim of this study was to investigate the influence of critically low cardiac output (CO) upon oxygen transport. We especially focused on the changes of mixed venous oxygen saturation (S-vO2) in the presence of oxygen consumption ([Formula: see text]) debts. Additionally, we examined the correlation between the cumulative oxygen deficit (Def[Formula: see text]) and serum lactate. Def[Formula: see text] was calculated as the integrated area under the tissue[Formula: see text]) deficit (baseline[Formula: see text]-acutal[Formula: see text]) and time curve. To produce severe low CO, we performed openchest cardiopulmonary resuscitation (CPR) in 11 anesthetized dogs for 1 h. We made the measurements before (baseline values) and during the CPR at 10-min intervals. Supplydependent[Formula: see text] was observed when CO decreased below 40 ml·min-1·kg-1. The mean value of S-vO2 in the range of supply-dependent[Formula: see text] was 13±2% and did not change significantly during 1 h of CPR. The changes of lactate from baseline values were linearly correlated with Def[Formula: see text] (r=0.62,P<0.01), but absolute values of serum lactate were not.

18.
Resuscitation ; 85(6): 778-84, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24606889

RESUMEN

AIM: To investigate the association between regional brain oxygen saturation (rSO2) at hospital arrival and neurological outcomes at 90 days in patients with out-of-hospital cardiac arrest (OHCA). METHODS: The Japan-Prediction of neurological Outcomes in patients post cardiac arrest (J-POP) registry is a prospective, multicenter, cohort study to test whether rSO2 predicts neurological outcomes after OHCA. We measured rSO2 in OHCA patients immediately after hospital arrival using a near-infrared spectrometer placed on the forehead with non-blinded fashion. The primary endpoint was "neurological outcomes" at 90 days after OHCA. RESULTS: EMS providers are not permitted to terminate CPR in the field in Japan, and so most patients with OHCA who are treated by EMS personnel are transported to emergency hospitals. Among 1017 OHCA patients, 672 patients including 52 comatose patients with pulses detectable (8%) and 620 cardiac arrest patients (92%) at hospital arrival were enrolled prospectively and consecutively. Twenty-nine patients with good neurological outcome had a significantly higher value of rSO2 at hospital arrival than 643 patients with poor neurological outcome (mean [±SD] 55.6±20.8% vs. 19.7±11.0%, p<0.001). Receiver operating curve analysis indicated an optimal rSO2 cutoff point of >42% for predicting good neurological outcome, with sensitivity 0.79 (95% confidence interval [CI], 0.60-0.92), specificity 0.95 (95% CI, 0.93-0.96), positive predictive value, 0.41 (95% CI, 0.28-0.55), negative predictive value, 0.99 (95% CI, 0.98-1.00), and area under the curve 0.90 (95% CI, 0.88-0.92). CONCLUSION: The rSO2 at hospital arrival can predict good neurological outcome at 90 days after OHCA.


Asunto(s)
Encefalopatías/diagnóstico , Encefalopatías/metabolismo , Encéfalo/metabolismo , Paro Cardíaco Extrahospitalario/metabolismo , Oxígeno/metabolismo , Espectroscopía Infrarroja Corta , Anciano , Encefalopatías/etiología , Técnicas de Diagnóstico Neurológico , Femenino , Humanos , Masculino , Paro Cardíaco Extrahospitalario/complicaciones , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos
19.
Resuscitation ; 83(1): 46-50, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22051579

RESUMEN

AIM: To investigate the association between regional brain oxygen saturation (rSO(2)) on hospital arrival and neurological outcomes at hospital discharge in patients with out-of-hospital cardiac arrest (OHCA). METHODS: A prospective cohort study was conducted, registering 179 patients with OHCA who were referred to Senri Critical Care Medical Centre between April 2009 and June 2010. Of these patients, 92 met the inclusion criteria. The primary end point was "neurological outcomes" at hospital discharge according to the "Utstein style" guidelines. RESULTS: The overall rate of good neurological outcome at hospital discharge was 14% (n=13). Sixty-one patients with rSO(2) ≤25% showed poor neurological outcome in the receiver operating curve analysis (optimal cut-off point, 25%; sensitivity, 0.772; specificity, 1.000; positive predictive value, 1.000; area under the curve (AUC), 0.919; p<0.0001). The AUC for rSO(2) was greater than that for base excess (p=0.0461) or lactate (p=0.0128) measured on hospital arrival. Since rSO(2) >40% was previously collated with good neurological outcome after cardiovascular surgery, we categorised our patients into three groups in a post hoc analysis: patients with rSO(2) ≤25% (n=61); patients with rSO(2) 26-40% (n=9) and patients with rSO(2) >40% (n=22). Patients with good neurological outcome were as follows: 0 (0%)/61 with rSO(2) ≤25%; two (22.2%)/9 with rSO(2) 26-40% and 11 (50.0%)/22 with rSO(2) >40% (p<0.0001). CONCLUSION: rSO(2) on hospital arrival may help predict neurological outcomes at hospital discharge in patients with OHCA.


Asunto(s)
Isquemia Encefálica/prevención & control , Reanimación Cardiopulmonar/métodos , Circulación Cerebrovascular/fisiología , Hospitalización , Monitoreo Fisiológico/métodos , Paro Cardíaco Extrahospitalario/metabolismo , Consumo de Oxígeno/fisiología , Anciano , Isquemia Encefálica/etiología , Servicios Médicos de Urgencia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Paro Cardíaco Extrahospitalario/complicaciones , Paro Cardíaco Extrahospitalario/terapia , Oximetría , Alta del Paciente , Valor Predictivo de las Pruebas , Estudios Prospectivos , Índices de Gravedad del Trauma
20.
Circ Cardiovasc Qual Outcomes ; 5(5): 689-96, 2012 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-22967787

RESUMEN

BACKGROUND: The use and popularity of the biphasic waveform defibrillator as a replacement for the monophasic waveform defibrillator are increasing, but it is unclear whether this can improve the rate of survival among out-of-hospital cardiac arrest patients. This study aimed to verify the hypothesis that the outcome of out-of-hospital cardiac arrest patients who received defibrillation shock with the biphasic waveform defibrillator was better than that of patients who received defibrillation shock with the monophasic defibrillator. METHODS AND RESULTS: This prospective, nationwide, population-based, observational study included 21 172 out-of-hospital cardiac arrest patients with initial ventricular fibrillation or pulseless ventricular tachycardia from January 1, 2005, through December 31, 2007. Defibrillation shock was performed by monophasic defibrillator on 8224 (39%) patients and by biphasic defibrillator on 12 948 (61%) patients. The rate of survival at 1 month with minimal neurological impairment was 11.6% (951/8192) in the monophasic defibrillator group and 12.8% (1653/12 928) in the biphasic defibrillator group. Hierarchical logistic regression analysis using a generalized estimation equation showed no significant difference between the biphasic and monophasic groups in 1-month survival with minimal neurological impairment (adjusted odds ratio, 1.07; 95% confidence interval, 0.91-1.26; P=0.42). Confirmatory propensity score analyses showed similar results. CONCLUSIONS: Although monophasic defibrillators are being replaced by biphasic defibrillators, our nationwide population-based observational study failed to demonstrate a statistically significant association between defibrillation waveform and 1-month survival rate with minimal neurological impairment.


Asunto(s)
Desfibriladores , Cardioversión Eléctrica/instrumentación , Paro Cardíaco Extrahospitalario/terapia , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Desfibriladores/efectos adversos , Cardioversión Eléctrica/efectos adversos , Cardioversión Eléctrica/mortalidad , Diseño de Equipo , Femenino , Encuestas de Atención de la Salud , Humanos , Japón , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/mortalidad , Puntaje de Propensión , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Análisis de Supervivencia , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento
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