Effects of repeated epinephrine administration and administer timing on witnessed out-of-hospital cardiac arrest patients.

BACKGROUND: Repeated administration of epinephrine is associated with unfavorable cerebral outcome after out-of-hospital cardiac arrests (OHCA), but the timing of epinephrine administration has not been considered. AIM: The aim of the study was to analyze the effects of repeated epinephrine administration after OHCA on favorable cerebral function coded by cerebral performance categories (CPC 1-2). METHODS: A nationwide, retrospective, population-based observational study was conducted by using Utstein-style data between 2010 and 2012 in Japan. The total of 11,876 cardiogenic and witnessed OHCA were stratified into 3 categories by the number of times epinephrine was administered (single, double, and three or more). In addition, the time elapsed between the emergency call and the initial epinephrine administration was divided into 3 time intervals (5 to 20min for the early administration group [EAG], 21 to 26min for the intermediate administration group [IAG], and 27 to 60min for the late administration group [LAG]). The primary endpoint was CPC 1-2 at 1month after cardiac arrest. A multivariable logistic regression was used for analysis. RESULTS: Achievement of CPC 1-2 at 1month was 4.8% for single, 2.4% for double, and 1.7% for three or more administered doses. For single and three or more administrations, CPC 1-2 was significantly higher in the IAG than in the LAG (adjusted odds ratio [AOR], 3.54, 3.02; 95% confidence interval [CI], 2.04-6.39, 1.16-9.43, for single and three or more administrations, respectively). The EAG showed significantly higher achievement of CPC 1-2 in all the epinephrine administration groups (AOR, 9.26, 7.57, 4.07; 95% CI, 5.44-16.59, 3.39-19.60, 1.59-12.69, for single, double, and three or more administrations, respectively). CONCLUSION: Repeated epinephrine administration improved CPC 1-2 outcome when epinephrine was administrated within 20min after an emergency call for witnessed cardiogenic OHCA.

Quick epinephrine administration induces favorable neurological outcomes in out-of-hospital cardiac arrest patients.

OBJECTIVE: This research is to study if quick administration of adrenaline on OHCA prior to hospitalization has an effect on improving CPC1-2 at one month. METHODOLOGY: A total 13,326 cases were extracted from 2011 to 2014 Utstein data for this retrospective cohort study, also, EMT reached the patients within 16min after 119 called and adrenaline was then administered within 22min of after contact. PATIENTS DIVIDED INTO TWO GROUPS: Patients were contacted within 8min of the 119 call (n=6956), and were contacted between 8 and 16min after the call (n=6370). Further divided into groups in which the adrenaline was administered within/without 10min after contact. Primary outcome was the rate of a good prognosis for cerebral performance (CPC1-2) at 1 month and secondary outcome was the return of spontaneous circulation (ROSC) rate. RESULTS: The odds ratio of the CPC1-2 at 1month by the EMS reached within 8min after 119 call and then adrenaline administered within 10min was 2.12 (1.54-2.92).Those reached between 8 and 16min was 2.66 (1.97-3.59). However, the ROSC rate was 2.00 (1.79-2.25) for those reached within 8min and also 2.00 (1.79-2.25) for those reached between 8min and 16min. CONSIDERATIONS: In cases of OHCA, it appears that the CPC1-2 rate after 1month can be improved even in cases where the victim is reached >8min after the 119 call, as long as the victim is reached within 16min and emergency responders administer the adrenaline as quickly as possible.

Favorable neurological outcomes by early epinephrine administration within 19 minutes after EMS call for out-of-hospital cardiac arrest patients.

OBJECTIVE: To evaluate the time-independent effect of the early administration of epinephrine (EPI) on favorable neurological outcome (as CPC [cerebral performance category] 1-2) at 1 month in patients with out-of-hospital cardiac arrest. MATERIALS AND METHODS: A total of 119 639 witnessed cardiac arrest patients from 2008 to 2012 were eligible for this nationwide, prospective, population-based observational study. Patients were divided into EPI group (n = 20 420) and non-EPI group (n = 99 219). To determine the time-dependent effects of EPI, EPI-administered patients were divided into 4 groups as follows: early EPI (5-18 min), intermediate EPI (19-23 min), late EPI (24-29 min), and very late EPI (30-62 min), respectively. Multiple logistic regression analyses and adjusted odds ratios (AORs) were determined for CPC 1-2 at 1 month (primary outcome) and field return of spontaneous circulation (as secondary outcome) among the groups. RESULTS: The EPI and non-EPI group had identical background, but EPI group shows higher incidence public access defibrillation and emergency medical technician defibrillation delivered than the non-EPI group. The differences were clinically negligible. Higher return of spontaneous circulation rate (18.0%) and lower CPC 1-2 (2.9%) shown in the EPI group than in the non-EPI group (9.4% and 5.2%). In the time dependent analysis, CPC 1 to 2 was greatest in the early EPI group (AOR, 2.49; 95% confidence interval [CI], 1.90-3.27), followed by the intermediate EPI group (AOR, 1.53; 95% CI, 1.14-2.05) then the late EPI group (AOR, 0.71; 95% CI, 0.47-1.08) as reference. CONCLUSION: Early EPI administration within 19 minutes after emergency medical service call independently improved the neurological outcome compared with late EPI (24-29 minutes) administration in patients with out-of-hospital cardiac arrest.

A comparative study of Video laryngoscope vs Macintosh laryngoscope for prehospital tracheal intubation in Hiroshima, Japan.

Background: In Japan, there are no studies comparing endotracheal intubation performed by emergency medical technicians (EMTs) during out-of-hospital cardiac arrest (OHCA) using a Macintosh laryngoscope and a video laryngoscope. Objective: The purpose of this study was to compare the success rate, complication rate, return of spontaneous circulation (ROSC), neurological prognosis (CPC1-2) and regional differences between Video laryngoscope (VL) and Macintosh laryngoscope (ML) for OHCA patients. Method: This study is a retrospective cohort study using 10,067 OHCA data extracted from the national Utstein Form and emergency medical transport data. The primary endpoint was the success rate of tracheal intubation and the complication rate and the secondary endpoints were the incidence of ROSC and CPC1-2. Results: A total of 885 tracheal Intubated OHCA patients were enrolled in this study. The success rate was 94.1% (490/521) in the VL group and 89.3% (325/364) in the ML group (RR, 1.05; 95%CI, 1.01-1.10, P = 0.01), the VL group shows significantly higher success rate than that of the ML group. In the complication rates, oesophageal intubation occurred in 0.2% (1/521) of in the VL group and in 6.0% (22/364) in the ML group, Indicating significantly higher complication rates in the ML group compared with the VL group (RR, 1.06; 95% CI, 1.03-1.09, P < 0.001). The ROSC rate and CPC1-2 rate are similar among the groups. Conclusion: Our data suggest that using VL had a little advantage with a higher success rate and lower complication rate. Further discussion is necessary for the future development of Emergency Medical Services (EMS) intubation devices.

Neurological outcomes of out-of-hospital cardiac arrest occurring in Tokyo train and subway stations.

OBJECTIVES: The purpose of this study was to identify a relationship between the background environment, bystander and emergency medical services intervention, and favourable neurological outcomes (CPC1-2) one-month after out-of-hospital cardiac arrest (OHCA) occurred at Tokyo train and subway stations. METHODS: This retrospective observational study used OHCA data between 2014 and 2018 that occurred at train stations in Tokyo. The eligible 954 patients were analysed for correlation between background, time frame, and location. Multivariable logistic regression models were used to estimate factors associated with CPC1-2 in patients with cardiogenic OHCA. RESULTS: A total of 886 OHCA cases, cardiogenic (n=562) and non-cardiogenic (n=324), met the inclusion criteria. Of the cardiogenic cases, 71.9% occurred at the platform and on-a-train. One-month CPC1-2 was achieved in 32.0% of cardiogenic OHCAs, which included 47.3% during morning rush hour, 24.7% during daytime hours, 40.2% during evening rush hour, and 20.5% during night-time/early morning hours. CPC1-2 had significant correlation with morning rush hour (adjusted odds ratio [AOR],4.52; 95% confidence interval [CI], 1.09-18.78), evening rush hour (AOR, 6.85; 95% CI, 1.51-31.15), public access defibrillation (AOR, 5.19; 95% CI, 1.38-19.51), and ventricular fibrillation or pulseless ventricular tachycardia (AOR, 7.56; 95% CI, 1.35-42.43). CONCLUSION: A total of 71.9% of cardiogenic OHCAs occurred at platforms and on trains. To improve neurological outcomes of OHCAs at stations, AED installations on train platforms are necessary. Additionally, using artificial intelligence-based platform monitoring for early detection of OHCAs and offering CPR training are required.

[Hearing loss in airplane crew].

From 1970 through 1984, 289 airplane crew who failed to satisfy criteria for physical examination for airplane crew were studied. The hearing loss in left ear was more frequently found than in the right. Because noise level (Leq) in cockpit was found to be about 90 dB, the noise did not seem to have caused the hearing loss. The authors presumed that hearing loss in cockpit crew might be either due to head phone sound from which the aircrew hear ATC (Air Traffic Control) from the control tower or to an individual hypersusceptibility.

[The data base of physical examination for airline pilots].

A data-base system which record new type physical examination of airline crew is now making in Ministry of Transportation. But old type physical records which had submitted for 15 years are still kept. In this report, the authors studied about the data base system which records old type physical examination data. The file structure of data base, data type of each items, interface of old type and new type record are discussed. Finally, to avoid all technical difficulties, the stimulation of generating large scale data base which uses 108,000 data was also studied.

[The influence of infrasound upon human body].

UNLABELLED: The authors reported the results of an experiment which used an infrasound generator with a loudspeaker attached. METHOD: Hearing threshold, body sway, respiration, pulse, blood pressure, ECG, ENG, GSR and OKN were evaluated with three different stimulations: whole body exposure, exposure by head phone and whole body exposure with ear plug. RESULTS: The hearing threshold showed no significant difference between whole body exposure and exposure by head phone, while it was significantly raised with whole body exposure with ear plug. Body sway was more prominent with stimulation at 15 Hz than at 10 Hz and individual variability was more marked at 15 Hz. Respiration, pulse, blood pressure, ECG, ENG, GSR and OKN showed no remarkable change. No nystagmus was seen any at exposure.

[The level of the musical loud sound and noise induced hearing impairment].

Recently, there has been an increasing number of reports concerning hearing impairment which musical loud sound is thought to be one of the causes. We are getting more of this musical loud sound as cassette tape recorders with head phones such as Walkman and so forth get popular as well as occasions to attending rock concerts and going to discotheques increase. This hearing impairment is generally called discotheque deafness and the following three types are considered; 1) deafness which have fixed by accumulation of loud sound over a long period of time as seen in people involved in musical performance such as rock musicians and mixing engineers; 2) abrupt noise induced hearing impairment triggered by loud sound and 3) state of deafness which is a progressing stage towards recovery of noise induced temporary threshold shift (NITTS), which occurs temporarily by a loud sound stimulus, and hearing ability recovers afterward. However, it is considered that these musical loud sounds not only changes every moment according to method of performing or type of music, but the volume of the sound actually reaching the auditory sense differs largely by locations and direction of the ear and speakers. So it becomes necessary to measure the accumulation of the noise which each individual is exposed under over a long period of time and at the same time carry out the regular medical checkups including hearing test to check the initiation and advancement of the noise induced hearing impairment. Then we can examine the relationship between loudness of the environmental noise and initiation and advancement of the hearing impairment. However, there has not been a device which is compact and measures noise exposure individually over a long period of time. So we have experimentally produced ultra compact noise dosimeter which we named Noise Badge, and with it we actually measured individual noise exposure over a long time in rock music, noise in discotheque and noisy factory. Then we examined the relationship between these loud sound and noise induced temporary threshold shift (NITTS) in discotheques and noise proof room using simulation of loud sound exposure. Moreover, we measured the most comfortable loudness level of head phones in each examine and different types of music with environmental noise in consideration, thus examining the relationship between musical loud sound and the hearing impairment.

[Joint-sounds--clinical experience of the knee joint].

We are exploring sounds of the joint by means of a new analyzing system. These results on the knee joint are summarized and discussed in this paper. A knee joint is moved passively in some ranges for four seconds in unechonic chamber. A special microphone (B & K 4165) is kept to touch manually on the pre-patellar skin throughout the motion. These collected sounds are analysed with a narrow band spectrum analyzer (B & K 2031) and a computer (Tektronix 4051) and we measured the over all value every 500 Hz from 500 Hz to 5000 Hz. We obtained the sounds from the normal control and the osteoarthritic knee joints, and compared these two groups by the data of each frequency analysis. Total over all value were less than 80 dB in the normal knee. In the osteoarthritic knee, they increased in especially low frequency range.