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1.
J Am Coll Cardiol ; 75(2): 194-204, 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31948649

RESUMO

BACKGROUND: There is little evidence about pre-hospital advanced life support including epinephrine administration for pediatric out-of-hospital cardiac arrests (OHCAs). OBJECTIVES: This study aimed to assess the effect of pre-hospital epinephrine administration by emergency-medical-service (EMS) personnel for pediatric OHCA. METHODS: This nationwide population-based observational study in Japan enrolled pediatric patients age 8 to 17 years with OHCA between January 2007 and December 2016. Patients were sequentially matched with or without epinephrine during cardiac arrest using a risk-set matching based on time-dependent propensity score (probability of receiving epinephrine) calculated at each minute after initiation of cardiopulmonary resuscitation by EMS personnel. The primary endpoint was 1-month survival. Secondary endpoints were 1-month survival with favorable neurological outcome, defined as the cerebral performance category scale of 1 or 2, and pre-hospital return of spontaneous circulation (ROSC). RESULTS: During the study period, a total of 1,214,658 OHCA patients were registered, and 3,961 pediatric OHCAs were eligible for analyses. Of these, 306 (7.7%) patients received epinephrine and 3,655 (92.3%) did not receive epinephrine. After time-dependent propensity score-sequential matching, 608 patients were included in the matched cohort. In the matched cohort, there were no significant differences between the epinephrine and no epinephrine groups in 1-month survival (epinephrine: 10.2% [31 of 304] vs. no epinephrine: 7.9% [24 of 304]; risk ratio [RR]: 1.13 [95% confidence interval (CI): 0.67 to 1.93]) and favorable neurological outcome (epinephrine: 3.6% [11 of 304] vs. no epinephrine: 2.6% [8 of 304]; RR: 1.56 [95% CI: 0.61 to 3.96]), whereas the epinephrine group had a higher likelihood of achieving pre-hospital ROSC (epinephrine: 11.2% [34 of 304] vs. no epinephrine: 3.3% [10 of 304]; RR: 3.17 [95% CI: 1.54 to 6.54]). CONCLUSIONS: In this study, pre-hospital epinephrine administration was associated with ROSC, whereas there were no significant differences in 1-month survival and favorable neurological outcome between those with and without epinephrine.

2.
Circ J ; 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-31996488

RESUMO

BACKGROUND: The Osborn wave (OW) is often observed in hypothermic patients; however, whether OW in hypothermic patients is related to the development of fatal ventricular arrhythmia, including ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT), remains undetermined. This study aimed to estimate the association between OW and the incidence of fatal ventricular arrhythmias.Methods and Results: This retrospective study used the Japanese Accidental Hypothermia Network registry database and included 572 hypothermic patients. Patients were divided into the OW group (those with OW) and non-OW group (those without OW). The relationship between the development of fatal arrhythmias and presence of OW was assessed using the chi-squared test. All patients who developed VF/VT (n=10) had OW on electrocardiogram upon hospital arrival. The presence of OW had a sensitivity of 100%, specificity of 47.8%, positive predictive value of 4.0%, and negative predictive value of 100% for VF/VT development. The in-hospital mortality rate was 22.3% in the OW group and 21.2% in the non-OW group (P=0.781). CONCLUSIONS: OW was observed in all hypothermic patients with VF/VT. The occurrence of ventricular arrhythmias is highly unlikely in the absence of OW on the electrocardiogram. Although the presence of OW might be used to predict these fatal arrhythmias in hypothermic patients, there was no association between the presence of OW and in-hospital mortality.

3.
Medicine (Baltimore) ; 99(1): e18687, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895836

RESUMO

The impact of time of day or day of week on the survival of emergency trauma patients is still controversial. The purpose of this study was to evaluate the outcomes of these patients according to time of day or day of week of emergency admission by using data from the nationwide Japan Trauma Data Bank (JTDB).This study enrolled 236,698 patients registered in the JTDB database from 2004 to 2015, and defined daytime as 09:00 AM to 16:59 PM and nighttime as 17:00 PM to 08:59 AM, weekdays as Monday to Friday, and weekends as Saturday, Sunday, and national holidays. The outcome measures were death in the emergency room (ER) and discharge to death.In total, 170,622 patients were eligible for our analysis. In a multivariable logistic regression adjusted for confounding factors, both death in the ER and death at hospital discharge were significantly lower during the daytime than at nighttime (623/76,162 [0.82%] vs 954/94,460 [1.01%]; adjusted odds ratio [AOR] 0.79; 95% confidence interval [CI] 0.71-0.88 and 5765/76,162 [7.57%] vs 7270/94,460 [7.70%]; AOR 0.88; 95% CI 0.85-0.92). In contrast, the weekdays/weekends was not significantly related to either death in the ER (1058/114,357 [0.93%] vs 519/56,265 [0.92%]; AOR 0.95; 95% CI 0.85-1.06) or death at hospital discharge (8975/114,357 [7.85%] vs 4060/56,265 [7.22%]; AOR 1.02; 95% CI 0.97-1.06).In this population of emergency trauma patients in Japan, both death in the ER and death at hospital discharge were significantly lower during the daytime than at night, but the weekdays/weekends was not associated with outcomes of these patients.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Adulto , Idoso , Serviços Médicos de Emergência/normas , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
Int Heart J ; 61(1): 46-53, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31956145

RESUMO

We investigated the impact of bystander-initiated cardiopulmonary resuscitation (CPR), dispatcher assistance (DA), and location of arrest on survival and outcomes after out-of-hospital cardiac arrest (OHCA).From a nationwide population-based registry of OHCA patients in Japan, we enrolled adult patients with bystander-witnessed OHCA of medical origin between 2013 and 2015. The primary outcome measure was a neurologically favorable outcome, defined by cerebral performance category 1 or 2. Multivariable logistic regression analysis was used to assess the effects of bystander CPR and DA by location of arrest. A total of 104,621 cases were included (15,984 bystander CPR without DA [15.3%], 40,087 bystander CPR with DA [38.3%], and 48,550 no bystander CPR [46.4%]). In public locations, both the bystander-CPR-with-DA group (22.9% [1,068/4,665]; adjusted odds ratio (AOR), 1.62; 95% confidence interval (CI), 1.43-1.85) and the bystander-CPR-without-DA group (25.8% [918/3,557]; AOR, 1.43; 95% CI, 1.24-1.65) had neurologically favorable outcomes compared with the no-bystander-CPR group (9.9% [610/6,133]). In residential locations, the AORs were 1.44 (95% CI, 1.22-1.70) in the bystander-CPR-without-DA group and 1.60 (95% CI, 1.45-1.77) in the bystander-CPR-with-DA group. However, in nursing homes, bystander CPR was not associated with improved outcomes of OHCA, regardless of the implementation of DA.Bystander CPR with or without DA had better outcomes after OHCA in residential and public locations but not in nursing homes.

5.
Cancer Epidemiol Biomarkers Prev ; 29(1): 95-102, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31641013

RESUMO

BACKGROUND: The effect of meat and fish consumption on cancer risk has been well studied in humans. However, studies related to biliary tract cancer (BTC) are scarce. METHODS: We examined the association between meat and fish consumption and the risk of BTC in a population-based prospective cohort study in Japan. HRs and 95% confidence intervals (CI) were estimated using the Cox proportional hazard model. RESULTS: During 1995 and 1999, 43,177 men and 49,323 women ages 45 to 74 years were enrolled and followed up for 607,757.0 person-years (men) and 728,820.3 person-years (women) until 2012, during which time 217 male and 162 female BTC cases were identified. Higher total meat consumption was significantly associated with a decreased BTC risk in men (HR for the highest vs. lowest quartiles = 0.66; 95% CI, 0.44-0.98; P trend = 0.011) but not in women. Similar association was observed with red meat, but no association was observed with poultry. Fish was not associated with BTC risk. We further analyzed each BTC subtype to confirm the observed association with BTC. However, significant association with each BTC subtype was not observed, although a trend of decreased extrahepatic bile duct cancer risk was observed. CONCLUSIONS: BTC risk was lower among men who consumed more meat, particularly red meat, in Japan. IMPACT: This is the first prospective study that evaluated the relationship between meat and BTC. This may provide important suggestions to elucidate the etiology of BTC.

6.
J Cardiol ; 75(1): 97-104, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31350130

RESUMO

BACKGROUND: The use of public-access automated external defibrillators (AEDs) has become common in Japan. To provide a strategy for appropriate public-access AED deployment, we assessed public-access defibrillation (PAD) by laypersons and the outcomes following out-of-hospital cardiac arrest (OHCA) among adult patients by location of arrest. METHODS: From a nationwide, prospective, population-based registry of patients after OHCA in Japan, we enrolled adult patients with bystander-witnessed OHCA of medical origin in public locations between 2013 and 2015. The primary outcome measure was one-month favorable neurological outcome defined by cerebral performance category 1 or 2. Factors associated with favorable neurological outcome after ventricular fibrillation (VF) were assessed by multivariable logistic regression analysis. RESULTS: A total of 20,970 adult bystander-witnessed OHCAs of medical origin occurred in public locations. Of those, the proportions of PAD by location were: 13.1% (757/5761) in public areas, 15.9% (333/2089) at workplaces, 26.0% (544/2095) in recreation/sports areas, 36.1% (112/310) in educational institutions, and 5.8% (241/4151) on streets/highways. In a multivariable analysis of VF arrests, both bystander cardiopulmonary resuscitation [adjusted odds ratio (AOR), 1.78; 95% confidence interval (CI), 1.54-2.07] and PAD (AOR, 2.33; 95% CI, 2.05-2.66), and emergency medical service (EMS) response time (AOR, 0.89; 95% CI, 0.87-0.90) were associated with improved outcomes. Earlier PAD initiated by bystanders before EMS arrival was also associated with better outcomes after OHCA. CONCLUSIONS: In Japan, where public-access AEDs are well-disseminated, the PAD program worked effectively for adult OHCA of medical origin occurring in public locations. Notably, the proportions of PAD differed substantially according to specific public locations.

7.
Int J Cardiol ; 299: 140-146, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31400888

RESUMO

BACKGROUND: Randomized controlled trials or observational studies showed that the use of public-access automated external defibrillator (AED) was effective for patients with out-of-hospital cardiac arrest (OHCA). However, it is unclear whether public-access AED use is effective for all patients with OHCA irrespective of first documented rhythm. We aimed to evaluate the effect of public-access AED use for OHCA patients considering first documented rhythm (shockable or non-shockable) in public locations. METHODS: From the Utstein-style registry in Osaka City, Japan, we obtained information on adult patients with OHCA of medical origin in public locations before emergency-medical-service personnel arrival between 2011 and 2015. Primary outcome was 1-month survival with favorable neurological outcome. Multivariable logistic regression analysis was performed to assess the association between the public-access AED pad application and favorable neurological outcome after OHCA by using one-to-one propensity score matching analysis. RESULTS: Among 1743 eligible patients, a total of 336 (19.3%) patients received public-access AED pad application. The proportion of patients who survived 1-month with favorable neurological outcome was significantly higher in the pad application group than in the non-pad application group (29.8% vs. 9.7%; adjusted odds ratio [AOR], 2.85; 95% confidence interval [CI], 1.73-4.68, AOR after propensity score matching, 2.46; 95% CI, 1.29-4.68). In a subgroup analysis, the AORs of patients with shockable or non-shockable rhythms were 3.36 (95% CI, 1.78-6.35) and 2.38 (95% CI, 0.89-6.34), respectively. CONCLUSIONS: Public-access AED pad application was associated with better outcome among patients with OHCA of medical origin in public locations irrespective of first documented rhythm.

8.
Medicine (Baltimore) ; 98(51): e18315, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860982

RESUMO

The incidence of breast cancer among Japanese women is substantially increasing. This study evaluated the effects of reproductive and lifestyle factors with respect to breast cancer overall and separately among pre- and postmenopausal women using data from the Three-Prefecture Cohort Study of Japan.A total of 33,410 women aged 40 to 79 years completed a self-administered questionnaire, which included items about menstrual and reproductive history and other lifestyle factors. The follow-up period was from 1984 to 1992 in Miyagi and 1985 to 2000 in Aichi Prefectures. We used Cox proportional hazards regression models to estimate hazards ratios (HRs) and 95% confidence intervals (CIs) after adjusting for confounding factors.After 9.8 mean years of follow-up, 287 cases of breast cancer were recorded. In the overall analysis, later menarche (≥16 years) and parity were significantly associated with a decreased risk of breast cancer, with HRs of 0.69 (95% CI 0.48-0.99) and 0.72 (95% CI 0.52-0.99), respectively. Further, there was a significant decline in the risk of breast cancer with increasing number of birth among parous women (P for trend = .010). On the contrary, a family history of breast cancer in the mother was significantly associated with an increased risk of breast cancer (HR 3.22, 95% CI 1.52-6.84). Analyses based on menopausal status at baseline indicated that height (≥160 cm) and weight (≥65 kg) were significantly associated with an increased risk of postmenopausal breast cancer, with HRs of 1.34 (95% CI 0.72-2.50) and 3.13 (95% CI 1.75-5.60), respectively. Risk associated with BMI significantly differs by menopausal status.Our findings suggest the important role of reproductive factors in the development of breast cancer in Japanese women; however, body mass index (BMI) may have different effects on breast cancer in Japanese women compared with western women.


Assuntos
Neoplasias da Mama/etiologia , Adulto , Idoso , Índice de Massa Corporal , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/genética , Estudos de Coortes , Feminino , Humanos , Japão/epidemiologia , Estilo de Vida , Anamnese , Menarca , Pessoa de Meia-Idade , Paridade , Fatores de Risco , Inquéritos e Questionários
9.
Scand J Trauma Resusc Emerg Med ; 27(1): 105, 2019 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-31771645

RESUMO

BACKGROUND: Accidental hypothermia (AH) is defined as an involuntary decrease in core body temperature to < 35 °C. The management of AH has been progressing over the last few decades, and numerous techniques for rewarming have been validated. However, little is known about the association between rewarming rate (RR) and mortality in patients with AH. METHOD: This was a multicentre chart review study of patients with AH visiting the emergency department of 12 institutions in Japan from April 2011 to March 2016 (Japanese accidental hypothermia network registry, J-Point registry). We retrospectively registered patients using the International Classification of Diseases, Tenth Revision code T68: 'hypothermia'. We excluded patients whose body temperatures were unknown or ≥ 35 °C, who could not be rewarmed, whose rewarmed temperature or rewarming time was unknown, those aged < 18 years, or who or whose family members had refused to join the registry. RR was calculated based on the body temperature on arrival at the hospital, time of arrival at the hospital, the documented temperature during rewarming, and time of the temperature documentation. RR was classified into the following five groups: ≥2.0 °C/h, 1.5-< 2.0 °C/h, 1.0-< 1.5 °C/h, 0.5-< 1.0 °C/h, and < 0.5 °C/h. The primary outcome of this study was in-hospital mortality. The association between RR and in-hospital mortality was evaluated using multivariate logistic regression analysis. RESULT: During the study, 572 patients were registered in the J-Point registry, and 481 patients were included in the analysis. The median body temperature on arrival to the hospital was 30.7 °C (interquartile range [IQR], 28.2 °C-32.4 °C), and the median RR was 0.85 °C/h (IQR, 0.53 °C/h-1.31 °C/h). The in-hospital mortality rates were 19.3% (11/57), 11.1% (4/36), 14.4% (15/104), 20.1% (35/175), and 34.9% (38/109) in the ≥2.0 °C/h, 1.5-< 2.0 °C/h, 1.0-< 1.5 °C/h, 0.5-< 1.0 °C/h, and < 0.5 °C/h groups, respectively. Multivariate regression analysis revealed that in-hospital mortality rate increased with each 0.5 °C/h decrease in RR (adjusted odds ratio, 1.49; 95% confidence interval, 1.15-1.94; Ptrend < 0.01). CONCLUSION: This study showed that slower RR is independently associated with in-hospital mortality.

10.
Scand J Trauma Resusc Emerg Med ; 27(1): 103, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718708

RESUMO

BACKGROUND: Severe accidental hypothermia (AH) is life threatening. Thus, prognostic prediction in AH is essential to rapidly initiate intensive care. Several studies on prognostic factors for AH are known, but none have been established. We clarified the prognostic ability of the Sequential Organ Failure Assessment (SOFA) score in comparison with previously reported prognostic factors among patients with AH. METHODS: The J-point registry database is a multi-institutional retrospective cohort study for AH in 12 Japanese emergency departments. From this registry, we enrolled patients who were treated at the intensive care unit (ICU) in various critical care medical centers. In-hospital mortality was the primary outcome. We investigated the discrimination ability of each candidate prognostic factor and the in-hospital mortality by applying the logistic regression models with areas under the receiver operating characteristic curve (AUROC) with 95% confidence interval (CI). RESULTS: Of the 572 patients with AH registered in the J-point registry, 220 were eligible for the analyses. The in-hospital mortality was 23.2%. The AUROC of the SOFA score (0.80; 95% CI: 0.72-0.86) was the highest among all factors. The other factors were serum potassium (0.65; 95% CI: 0.55-0.73), lactate (0.67; 95% CI: 0.57-0.75), quick SOFA (qSOFA) (0.55; 95% CI: 0.46-0.65), systemic inflammatory response syndrome (SIRS) (0.60; 95% CI: 0.50-0.69), and 5A severity scale (0.77; 95% CI: 0.68-0.84). DISCUSSION: Although serum potassium and lactate had relatively good discrimination ability as mortality predictors, the SOFA score had slightly better discrimination ability. The reason is that lactate and serum potassium were mainly reflected by the hemodynamic state; conversely, the SOFA score is a comprehensive score of organ failure, basing on six different scores from the respiratory, cardiovascular, hepatic, coagulation, renal, and neurological systems. Meanwhile, the qSOFA and SIRS scores underestimated the severity, with low discrimination abilities for mortality. CONCLUSIONS: The SOFA score demonstrated better discrimination ability as a mortality predictor among all known prognostic factors in patients with AH.

11.
Alcohol ; 2019 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-31689482

RESUMO

Hangovers are associated with negative economic consequences due to decreased job performance or frequent visits to physicians. Thus, a new strategy for the alleviation of hangover-related symptoms is needed to avoid this detriment to the society. The purpose of this nationwide randomised, double-blind, placebo-controlled physicians' trial was to evaluate the efficacy of loxoprofen sodium for the alleviation of fatigue, headache, and nausea after hangover. A total of 229 participants were randomised to receive loxoprofen sodium (60 mg once orally) or placebo. The study was closed when the first 150 participants (n = 74 in the loxoprofen vs. n = 76 in the placebo groups) experienced hangovers. The primary endpoint was set as the difference in severity of general fatigue before and 3 hours after taking the test drugs and was evaluated using a visual analogue scale. Secondary endpoints included difference in severity of headache, nausea, and incidence of adverse events. The study participants were 34 (interquartile range; 30-39) years old, 92.0% were men, and both groups were comparable for baseline characteristics. The alleviation of general fatigue did not differ statistically between the loxoprofen and placebo groups (24 [14-49] vs. 19 [9-35], p = 0.07). However, the alleviation of headache was statistically greater in the loxoprofen group (25 [10-50] vs. 10 [2-30], adjusted difference 14, 95% confidence interval 8-21, p < 0.001), whereas, there was no difference in nausea (7 [0-27] vs. 10 [0-24], p = 0.68). The incidence of adverse symptoms such as epigastric discomfort was also comparable between groups (2.7% vs. 3.9%, p = 0.25). Loxoprofen sodium was effective for relieving headaches after hangovers but did not alleviate general fatigue or nausea.

12.
Geriatr Gerontol Int ; 19(11): 1088-1095, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31622019

RESUMO

AIM: The purpose of this study was to evaluate the out-of-hospital cardiac arrest (OHCA) characteristics of patients stratified by age who had resuscitation attempted and were transported to tertiary emergency medical institutions in Osaka Prefecture, Japan; especially those of advanced age. METHODS: A prospective, population-based, observational review was carried out of consecutive OHCA patients with emergency responder resuscitation attempts from July 2012 to December 2016 in Osaka, Japan. Patients were classified into four groups: (i) 18-64 years; (ii) 65-74 years; (iii) 75-84 years; and (iv) ≥85 years. Patient, event and treatment characteristics were examined for patients with presumed cardiac etiology of OHCA. The primary outcome was the 1-month survival with a neurologically favorable outcome. RESULTS: A total of 4636 patients with OHCA of presumed cardiac origin were transported to tertiary emergency medical institutions. The number of patients in the four groups was as follows: (i) 1290 (27.8%); (ii) 1102 (23.8%); (iii) 1420 (30.6%); and (iv) 824 (17.8%). The 1-month survival with a neurologically favorable outcome was: (i) 207 (16.0%); (ii) 96 (8.7%); (iii) 60 (4.2%); and (iv) seven (0.85%). In a multivariate analysis for 1-month survival with a neurologically favorable outcome, increased age was a significant prognostic factor (≥85 years; adjusted odds ratio 0.08, 95% confidence interval 0.03-0.23) for poor outcomes. CONCLUSIONS: In this population, advanced age (≥85 years) was strongly associated with poor outcomes. Further discussion of policies directed at resuscitation of very elderly OHCA patients is required, considering limited medical resources and the rapidly aging population in Japan. Geriatr Gerontol Int 2019; 19: 1088-1095.

13.
J Cardiol ; 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31542238

RESUMO

BACKGROUND: We evaluated the association between survival and bystandercardiopulmonary resuscitation (CPR) with or without dispatcher instructions (DI) considering the time from emergency call receipt by the dispatch center to emergency medical services (EMS) personnel's contact with the patient (i.e. time to EMS arrival). METHODS: This prospective study conducted in Osaka City, Japan, from 2009 to 2015 included patients with medical cause-related out-of-hospital cardiac arrest who were ≥18 years old. The primary outcome was one-month favorable neurological survival. Using multiple logistic regression models, the adjusted odds ratios (AOR) of independent and DI-dependent CPR for the primary outcome were compared with no CPR. Adjustments were made for patients' age, sex, activities of daily living before the cardiac arrest, year of cardiac arrest, location, presence or absence of witnesses, etiology of cardiac arrest, and the time from EMS contact with the patient to patient's arrival at the hospital. The effective estimated "time to EMS arrival" was also calculated. RESULTS: For analyses 10,925 individuals were eligible. Independent CPR had a significantly higher one-month favorable neurological survival than no CPR whereas there was no significant difference between DI-dependent CPR and no CPR (AOR, 1.90 [1.47-2.46] and 1.16 [0.91-1.47], respectively). The estimated "time to EMS arrival" for a one-month favorable neurological survival after independent CPR was ≤13min. CONCLUSIONS: Bystander CPR that did not need DI was associated with significantly higher one-month favorable neurological survival than no CPR, with an effective estimated "time to EMS arrival" of ≤13min.

14.
Resuscitation ; 145: 175-184, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31539609

RESUMO

BACKGROUND: Although prehospital advanced airway management (AAM) (i.e., endotracheal intubation [ETI] and insertion of supraglottic airways [SGA]) has been performed for paediatric out-of-hospital cardiac arrest (OHCA), the effect of AAM has not been fully studied. We evaluated the association between prehospital AAM for paediatric OHCA and patient outcomes. METHODS: We conducted an observational cohort study, using the All-Japan Utstein Registry between 2014 and 2016. We included paediatric patients (age <18 years) with OHCA. We calculated time-dependent propensity score at each minute after initiation of cardiopulmonary resuscitation by EMS providers, using a Fine-Gray regression model. We sequentially matched patients who received AAM during cardiac arrest to patients at risk of receiving AAM within the same minute (risk-set matching). The primary outcome was 1-month survival. Secondary outcome was 1-month survival with favourable functional status, defined as Cerebral Performance Category score of 1 or 2. RESULTS: We analysed 3801 paediatric patients with OHCA. 481 patients (12.7%) received AAM and 3320 (87.3%) did not. Among the 3801 analysed patients, 912 patients underwent risk-set matching. In the matched cohort, AAM was not associated with 1-month survival (AAM: 52/456 [11.4%] vs. no AAM: 44/456 [9.6%]; risk ratio [RR], 1.15 [95% CI, 0.76-1.73]; risk difference [RD], 1.5% [-3.0 to 6.1%]) or favourable functional status (AAM: 9/456 [2.0%] vs. no AAM: 10/456 [2.2%]; RR, 0.69 [95% CI, 0.26-1.79]; RD, -0.8% [-2.9 to 1.3%]). CONCLUSION: Among paediatric patients with OHCA, we found that prehospital AAM was not associated with 1-month survival or favourable functional status.

15.
Artigo em Inglês | MEDLINE | ID: mdl-31478074

RESUMO

PURPOSE: Posttraumatic meningitis is one of the severe complications that can result in increased mortality and longer hospital stay among trauma patients. Factors such as cerebrospinal fluid (CSF) fistula and basilar skull fracture are associated with posttraumatic meningitis. However, it remains unclear whether procedures such as burr hole surgery in the emergency department and decompressive craniectomy are associated with posttraumatic meningitis. The aim of this study was to assess factors associated with posttraumatic meningitis with a nationwide hospital-based trauma registry in Japan. METHODS: This was a retrospective observational study with a 12-year study period from January 2004 to December 2015. We included trauma patients registered in the Japanese Trauma Data Bank, whose head Abbreviated Injury Scale score was ≥ 3 in this study. The main endpoint was the occurrence of meningitis during hospitalization. Multivariable logistic regression analysis was used to assess independent parameters associated with posttraumatic meningitis such as CSF fistula, burr hole surgery in the emergency department, and decompressive craniectomy. RESULTS: Among 60,390 head injury patients with head AIS score 3 or more, 284 (0.5%) patients had posttraumatic meningitis. Factors associated with posttraumatic meningitis were burr hole surgery in the emergency department (adjusted odds ratio [AOR] 2.158 [95% confidence interval (CI) 1.401-3.325]), decompressive craniectomy (AOR 2.123 [95% CI 1.506-2.993]), external ventricular drainage (AOR 1.843 [95% CI, 1.157-2.935]), CSF leakage (AOR 3.328 [95% CI 2.205-5.022]), and basilar skull fracture (AOR 1.651 [95% CI 1.178-2.314]). CONCLUSIONS: In this population of trauma patients, burr hole surgery in the emergency department and decompressive craniectomy was associated with posttraumatic meningitis.

16.
Scand J Trauma Resusc Emerg Med ; 27(1): 79, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443673

RESUMO

BACKGROUND: Little is known about the associations between the duration of prehospital cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) and outcomes among paediatric patients with out-of-hospital cardiac arrests (OHCAs). We investigated these associations and the optimal prehospital EMS CPR duration by the location of arrests. METHODS: We included paediatric patients aged 0-17 years with OHCAs before EMS arrival who were transported to medical institutions after resuscitation by bystanders or EMS personnel. We excluded paediatric OHCA patients for whom CPR was not performed, who had cardiac arrest after EMS arrival, whose EMS CPR duration were < 0 min or ≥120 min and who had cardiac arrest in healthcare facilities. Prehospital EMS CPR duration was defined as the time from CPR initiation by EMS personnel to the time of prehospital return of spontaneous circulation or to the time of hospital arrival. The primary outcome was 1-month survival with a favourable neurological outcome (cerebral performance category scale 1 or 2). Statistical analysis was performed with Mann-Whitney U tests for numerical variables and chi-squared test for categorical variables. Univariable and multivariable logistic regression analyses were applied to assess the association between prehospital EMS CPR duration and a favourable neurological outcome, and crude and adjusted odds ratios and their 95% confidence intervals were calculated. RESULTS: The proportion of patients with a favourable neurological outcome was lower in residential locations than in public locations (2.3% [66/2865] vs 10.8% [113/1048]; P < .001). In both univariable and multivariable logistic regression analyses, the proportion of patients with a favourable neurological outcome decreased as prehospital EMS CPR duration increased, regardless of the location of arrests (P for trend <.001). However, some patients achieved a favourable neurological outcome after a prolonged prehospital EMS CPR duration (> 30 min) in both groups (1.4% [6/417] in residential locations and 0.6% [1/170] in public locations). CONCLUSIONS: A longer prehospital EMS CPR duration is independently associated with a lower proportion of patients with a favourable neurological outcome. The association between prehospital EMS CPR duration and neurological outcome differed significantly by location of arrests.


Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Doenças do Sistema Nervoso/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Adolescente , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Japão , Masculino , Razão de Chances , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Sistema de Registros , Fatores de Tempo
17.
Artigo em Inglês | MEDLINE | ID: mdl-31329028

RESUMO

The impact of the location where accidental hypothermia (AH) occurs has not been fully investigated thus far. This was a multicenter retrospective study of patients with a body temperature ≤35°C obtained at the emergency department of 12 hospitals in Japan between April 2011 and March 2016. We divided the patients into two groups according to the location where AH occurred (indoor group versus outdoor group). The association between each location of the occurrence of AH and in-hospital mortality was evaluated via a multivariable logistic regression analysis. The primary outcome of this study was in-hospital death. The secondary outcomes were the lengths of ICU and hospital stay. A total of 572 patients were enrolled in the hypothermia database, and 537 patients were included in the analyses. A total of 119 and 418 patients experienced hypothermia with outdoor and indoor occurrence, respectively. The indoor group was older and had worse activities of daily living compared with the outdoor group. With regard to the outcome, the proportion of in-hospital death was higher in the indoor group than in the outdoor group (28.2% [118/418] vs. 10.9% [13/119], p < 0.001). The multivariable logistic regression analysis showed that the adjusted odds ratio of the indoor group was 2.48 (95% confidence interval, 1.18-5.17). In terms of secondary outcomes, both the lengths of ICU and hospital stay of the survivors were longer in the indoor group than in the outdoor group. Hypothermia with indoor occurrence accounts for ∼78% of the total AH cases in this study, and the proportion of in-hospital deaths was higher in the indoor group than in the outdoor group. Warnings about the indoor onset of AH must be provided, and countermeasures for the prevention and early recognition of AH with indoor occurrence must be taken.

18.
Resuscitation ; 143: 165-172, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302105

RESUMO

OBJECTIVES: This study aimed to evaluate whether intra-aortic balloon pump (IABP) use in nontraumatic out-of-hospital cardiac arrest (OHCA) patients who achieved return of spontaneous circulation (ROSC) is associated with favorable neurological outcome after OHCA. BACKGROUND: The association between the IABP use in OHCA patients and favorable neurological outcome has not been extensively evaluated. METHODS: The Comprehensive Registry of Intensive Cares for OHCA Survival (CRITICAL) study, a multicenter, prospective observational registry in Osaka, Japan, included consecutive nontraumatic OHCA patients aged ≥18 years who achieved ROSC from July 2012 to December 2016. The primary outcome was 1-month survival with favorable neurological outcome. Logistic regression analysis was used to evaluate the association between the IABP use or non-IABP use and favorable neurological outcome using one-to-one propensity score (PS) matching analysis. RESULTS: Among the 2894 eligible patients, 10.4% used IABP, and 89.6% did not use IABP. In all patients, the proportion of 1-month survival with favorable neurological outcome was higher in the IABP use group than in the non-IABP use group (30.7% [92/300] vs. 13.2% [342/2594]). However, in PS-matched patients, the proportions of 1-month survival with favorable neurological outcome were almost consistent, and there were no significant differences between the IABP use group and the non-IABP use group (37.3% [59/158] vs. 41.1% [65/158]; adjusted odds ratio, 0.97; 95% confidence interval, 0.48-1.96). CONCLUSIONS: In this population, the current PS matching analysis did not reveal any association between the IABP use and 1-month survival with favorable neurological outcome among adult patients with ROSC after OHCA.

20.
JAMA Netw Open ; 2(5): e195111, 2019 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-31150086

RESUMO

Importance: Bystander interventions are a factor for improving survival of out-of-hospital cardiac arrest (OHCA), but it is hypothesized that girls and women experiencing OHCA may be less likely to receive bystander interventions than boys and men. Objective: To investigate sex disparities in receiving public-access automated external defibrillator (AED) pad application and bystander-initiated cardiopulmonary resuscitation (CPR) among students who experienced OHCA in school settings. Design, Setting, and Participants: This nationwide cohort study used the Stop and Prevent Cardiac Arrest, Injury, and Trauma in Schools (SPIRITS) database to link databases from 2 nationally representative registries-the Injury and Accident Mutual Aid Benefit System of the Japan Sport Council and the All-Japan Utstein Registry of the Fire and Disaster Management Agency. Students from elementary schools (ages 6-12 years), junior high schools (ages 12-15 years), high schools (ages 15-21 years), and technical colleges (ages 15-21 years) who experienced nontraumatic OHCA involving attempted resuscitation by emergency medical service personnel or bystanders in school settings from April 1, 2008, to December 31, 2015, were included. Data analysis was performed from January 5, 2019, to April 11, 2019. Exposures: Sex and school level. Main Outcomes and Measures: Application of public-access AED pads or initiation of CPR by a bystander. Results: A total of 232 students who experienced OHCA with nontraumatic causes in school settings (mean [SD] age, 14.5 [2.9] years; 175 [75.4%] male) were included. In multivariable analysis of the full cohort of students who experienced OHCA, female sex was associated with significantly lower odds of receiving public-access AED pad application compared with male sex (36 of 57 female students [63.2%] received AED pad application vs 141 of 175 male students [80.6%]; adjusted odds ratio [OR], 0.44; 95% CI, 0.20-0.97; P = .04). In the subgroup analysis of students who experienced OHCA in high schools or technical schools, female sex was associated with significantly lower odds of receiving public-access AED pad application compared with male sex (10 of 18 female students [55.6%] vs 84 of 101 male students [83.2%]; adjusted OR, 0.26; 95% CI, 0.08-0.87; P = .03). Among the full cohort, 48 of 57 female students (84.2%) and 151 of 175 male students (86.3%) received CPR from bystanders (adjusted OR, 0.81; 95% CI, 0.30-2.22), and there were no significant differences in receiving bystander-initiated CPR between sexes, irrespective of school level. Conclusions and Relevance: Among students who experienced OHCA in schools in Japan, female sex was associated with lower odds of receiving public-access AED pad application compared with male sex.

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