Kosuke Kiyohara

Dissemination of Chest Compression–Only Cardiopulmonary Resuscitation and Survival After Out-of-Hospital Cardiac Arrest

Background— The best cardiopulmonary resuscitation (CPR) technique for survival after out-of-hospital cardiac arrests (OHCAs) has been intensively discussed in the recent few years. However, most analyses focused on comparison at the individual level. How well the dissemination of bystander-initiated chest compression–only CPR (CCCPR) increases survival after OHCAs at the population level remains unclear. We therefore evaluated the impact of nationwide dissemination of bystander-initiated CCCPR on survival after OHCA. Methods and Results— A nationwide, prospective, population-based, observational study covering the whole population of Japan and involving consecutive OHCA patients with resuscitation attempts was conducted from January 2005 through December 2012. The main outcome measure was 1-month survival with favorable neurological outcome. The incidence of survival with favorable neurological outcome attributed to types of bystander CPR (CCCPR and conventional CPR with rescue breathing) was estimated. Among 816 385 people experiencing OHCAs before emergency medical services arrival, 249 970 (30.6%) received CCCPR, 100 469 (12.3%) received conventional CPR, and 465 946 (57.1%) received no CPR. The proportion of OHCA patients receiving CCCPR or any CPR (either CCCPR or conventional CPR) by bystanders increased from 17.4% to 39.3% (P for trend <0.001) and from 34.6% to 47.3% (P for trend <0.001), respectively. The incidence of survival with favorable neurological outcome attributed to CCCPR per 10 million population significantly increased from 0.6 to 28.3 (P for trend=0.010), and that by any bystander-initiated CPR significantly increased from 9.0 to 43.6 (P for trend=0.003). Conclusion— Nationwide dissemination of CCCPR for lay-rescuers was associated with the increase in the incidence of survival with favorable neurological outcome after OHCAs in Japan.

Trends in survival among elderly patients with out-of-hospital cardiac arrest: a prospective, population-based observation from 1999 to 2011 in Osaka.

BACKGROUND Little is known about the improvement in out-of-hospital cardiac arrest (OHCA) survival among elderly patients. The aim of this study was to evaluate the trends in the survival after bystander-witnessed OHCA of cardiac origin in this age group. METHODS This prospective, population-based, observation of the whole population of Osaka, Japan included consecutive OHCA patients aged ≥65 years with emergency responder resuscitation attempts from January 1999 to December 2011. The primary outcome measure was one-month survival with neurologically favorable outcome, and the trends in the outcome from OHCA were evaluated by location. Multiple logistic regression analysis was used to assess factors that were potentially associated with neurologically favorable outcome. RESULTS During the study period, a total of 10,876 bystander-witnessed OHCA of cardiac origin were eligible for our analyses. In whole arrests, the proportion of one-month survival with neurologically favorable outcome improved from 1.4% in 1999 to 4.8% in 2011 (P for trend <0.001). The proportion of neurologically favorable outcome in homes and public places improved from 0.7% in 1999 to 3.2% in 2011 (P for trend <0.001) and from 4.2% in 1999 to 20.9% in 2011 (P for trend <0.001), respectively, whereas, in nursing homes, the proportion of neurologically favorable outcome did not improve. In a multivariate analysis, bystander-initiated cardiopulmonary resuscitation and emergency response time were significant predictors for neurologically favorable outcome. CONCLUSIONS In this population, survival from OHCA among elderly patients significantly improved during the study period, but the trends differed by the OHCA location.

The Great East Japan Earthquake and Out-of-Hospital Cardiac Arrest

On March 11, 2011, a magnitude 9.0 earthquake struck the northeast region of Japan. During the first 4 weeks after the earthquake, the numbers of out-of-hospital cardiac arrests were significantly increased as compared with the numbers during the same weeks from 2005 to 2010.

Epidemiology and outcome of adult out-of-hospital cardiac arrest of non-cardiac origin in Osaka: a population-based study

Objectives To evaluate epidemiological characteristics of out-of-hospital cardiac arrests (OHCAs) by detailed non-cardiac cause and factors associated with the outcomes after OHCAs of non-cardiac origin. Design A prospective, population-based observational study. Setting The Utstein Osaka Project. Participants 14 164 adult patients aged ≥20 years old with OHCAs due to non-cardiac origin who were resuscitated by emergency-medical-service personnel or bystanders, and then were transported to medical institutions from January 2005 to December 2011. Primary outcome measures One-month survival after OHCA. Multiple logistic regression analysis was used to assess factors that were potentially associated with the outcome. Results During the study period, the 1-month survival rate was 5.3% (755/14 164). The proportion of 1-month survival was 6.2% (510/8239) in external causes, 6.5% (94/1148) in respiratory diseases, 0.8% (11/1309) in malignant tumours, 4.9% (55/1114) in strokes and 4.1% (85/2054) in others. As for external causes, the proportion of 1-month survival was 14.3% (382/2670) in asphyxia, 4.2% (84/1999) in hanging, 0.7% (9/1300) in fall, 1.1% (12/1062) in drowning, 1.6% (12/765) in traffic injury, 3.7% (7/187) in drug overuse and 1.6% (4/256) in unclassified external causes. In a multivariate analysis, adults aged <65 years old with arrests witnessed by bystanders, with normal activities of daily living before the arrests, having ventricular fibrillation arrests, having arrests in public places, intravenous fluid levels and early Emergency Medical Service response time were significant predictors for 1-month outcome after OHCAs of non-cardiac origin. The proportion of 1-month survival of all OHCAs of non-cardiac origin did not significantly increase (from 4.3% (86/2023) in 2005 to 4.9% (105/2126) in 2011) and the adjusted OR for one-increment of year was 1.01 (95% CI 0.97 to 1.06). Conclusions From a large OHCA registry in Osaka, we demonstrated that 1-month survival after OHCAs of non-cardiac origin was poor and stable.

Nationwide and regional trends in survival from out-of-hospital cardiac arrest in Japan: A 10-year cohort study from 2005 to 2014

BACKGROUND Little is known about the most recent nationwide and regional trends in out-of-hospital cardiac arrest (OHCA) outcome. We therefore sought to investigate the recent nationwide and regional trends in OHCA outcome in Japan. METHODS Using nationwide, population-based OHCA registry in Japan, we evaluated outcome from emergency-medical-services resuscitated OHCA of medical origin between 2005 and 2014. A total of 861,756 OHCA patients of medical origin were eligible for our analyses. We assessed annual nationwide OHCA outcome and regional trend among seven representative regions between two periods, 2005-2009 and 2010-2014. The primary outcome was one-month survival with favourable neurological outcome, defined as Cerebral Performance Category scale of 1 or 2. RESULTS The nationwide 1-month survival with favourable neurological outcome increased from 1.1% to 2.3% in OHCA of medical origin. Using multivariable analysis, favourable neurological outcome in 2014 significantly increased (adjusted OR, 2.81; 95% CI, 2.57-3.07), compared with that in 2005. Among seven regions, favourable neurological outcome from OHCA of medical origin varied in the 2005-2009 period (1.3%-2.2%) and 2010-2014 period (1.7%-2.8%). Using multivariable analysis, these disparities persisted in 2005-2009 (the range of adjusted OR, 0.88-1.85) and 2010-2014 (the range of adjusted OR, 1.00-1.83) periods, using Kanto region as the reference. All regions showed increase in favourable neurological outcome during 2010-2014 period (the range of adjusted OR, 1.44-1.82), using 2005-2009 period as the reference. CONCLUSIONS We found nationwide and regional improvement of favourable neurological outcomes from OHCA of medical origin with persistent regional variation.

Characteristics and Outcomes of Bath-Related Out-of-Hospital Cardiac Arrest in Japan

BACKGROUND Characteristics and outcomes of emergency patients with bath-related sudden cardiac arrest in prehospital settings have not been sufficiently investigated. METHODSANDRESULTS From a prospective population-based registry, which covers all out-of-hospital cardiac arrests (OHCAs) in Osaka City, a total of 642 patients who had a bath-related OHCA from 2012 to 2014 were enrolled in the analyses. The characteristics and outcomes of OHCA were compared by three locations of arrest: home baths (n=512), public baths (n=102), and baths in other public institutions (n=28). Overall, bath-related OHCAs mainly occurred in winter (December-February, 48.9%, 314/642). The proportion of OHCAs that were witnessed by bystanders was 6.4% (33/512) in home baths, 17.6% (18/102) in public baths, and 25.0% (7/28) in baths in other public institutions. The proportion of public-access automated external defibrillator pad application was 0.8% (4/512) in home baths, 6.9% (7/102) in public baths, and 50.0% (14/28) in baths in other public institutions. Only 1 survivor with a favorable neurologic outcome was observed in a home bath, whereas there were no patients who survived with favorable neurologic outcomes in public baths and baths in other public institutions. CONCLUSIONS Bath-related OHCAs mainly occurred in winter, and the outcome of victims was exceedingly poor, irrespective of location of arrest. The establishment of preventive measures as well as earlier recognition of cardiac arrest by bystanders are needed. (Circ J 2016; 80: 1564-1570).

Survival following witnessed pediatric out-of-hospital cardiac arrests during nights and weekends

BACKGROUND The relationship between survival rate following pediatric out-of-hospital cardiac arrests (OHCAs) and time of day or day of week is unknown. METHODS A nationwide, prospective, population-based observational investigation of consecutive witnessed pediatric OHCAs (<18 years) with resuscitation attempts was conducted from January 2005 to December 2011. Days were defined as 9:00 am to 4:59 pm, nights as 5:00 pm to 8:59 am, weekdays as Mondays to Fridays, and weekends as Saturdays, Sundays, and national holidays. Primary outcome was one-month survival and secondary outcome was survival with favorable neurologic outcome, defined as cerebral performance category 1 or 2. RESULTS A total of 3278 bystander-witnessed pediatric OHCAs were registered. One month survival rate was significantly lower during nights than days (15.5% [95% CI: 13.8-17.2%] versus 23.3% [95% CI: 21.1-25.6%]; P<0.001 and during weekends/holidays (15.7% [95% CI: 13.6-18.0%] than weekdays (20.4% [95% CI: 18.7-22.2%]; P=0.001. Survival rate with favorable neurologic outcome was substantially lower during nights 7.5% [95% CI: 6.3-8.8%] than days (12.2% [95% CI: 10.6-14.1%]; P<0.001), and during weekends/holidays (7.7% [95% CI: 6.2-9.5%] than weekdays (10.4% [95% CI: 9.2-11.8%]; P=0.012). After adjusting for potential confounding factors, one-month survival rate remained significantly lower during nights compared to days (odds ratio 0.68; 95% CI: 0.56-0.82), and during weekends/holidays compared to weekdays (odds ratio 0.79; 95% CI, 0.65-0.97). CONCLUSIONS One-month survival rate following bystander-witnessed pediatric OHCAs was lower during nights and weekends/holidays than days and weekdays, even when adjusted for potentially confounding factors.

Factors associated with the difficulty in hospital acceptance at the scene by emergency medical service personnel: a population-based study in Osaka City, Japan

Objectives To investigate the association between the difficulty in hospital acceptance at the scene by emergency medical service (EMS) personnel and prehospital demographic factors and reasons for EMS calls. Design A retrospective, observational study. Setting Osaka City, Japan. Participants A total of 100 649 patients transported to medical institutions by EMS from January 2013 to December 2013. Primary outcome measurements The definition of difficulty in hospital acceptance at the scene was EMS personnel making ≥5 phone calls to medical institutions until a decision to transport was determined. Multivariable analysis was used to assess the relationship between difficulty in hospital acceptance and prehospital factors and reasons for EMS calls. Results Multivariable analysis showed the elderly, foreigners, loss of consciousness, holiday/weekend, and night-time to be positively associated with difficulty in hospital acceptance at the scene. As reasons for EMS calls, gas poisoning (adjusted OR 3.281, 95% CI 1.201 to 8.965), trauma by assault (adjusted OR 2.662, 95% CI 2.390 to 2.966), self-induced drug abuse/gas poisoning (adjusted OR 4.527, 95% CI 3.921 to 5.228) and self-induced trauma (adjusted OR 1.708, 95% CI 1.369 to 2.130) were positively associated with the difficulty in hospital acceptance at the scene. Conclusions Ambulance records in Osaka City showed that certain prehospital factors such as night-time were positively associated with difficulty in hospital acceptance at the scene, and reasons for EMS calls, such as self-induced drug abuse/gas poisoning, were also positive predictors for difficulty in hospital acceptance at the scene.

Epidemiology of Out-of-Hospital Cardiac Arrests Among Japanese Centenarians: 2005 to 2013.

Although the number of centenarians has been rapidly increasing in industrialized countries, no clinical studies evaluated their characteristics and outcomes from out-of-hospital cardiac arrests (OHCAs). This nationwide, population-based, observation of the whole population of Japan enrolled consecutive OHCA centenarians with resuscitation attempts before emergency medical service arrival from 2005 to 2013. The primary outcome measure was 1-month survival from OHCAs. The multivariate logistic regression model was used to assess factors associated with 1-month survival in this population. Among a total of 4,937 OHCA centenarians before emergency medical service arrival, the numbers of those with OHCAs increased from 70 in 2005 to 136 in 2013 in men and from 227 in 2005 to 587 in 2013 in women. Women accounted for 80.3%. Ventricular fibrillation (VF) as first documented rhythm was 2.5%. The proportions of victims receiving bystander cardiopulmonary resuscitation were 64.2%. The proportion of 1-month survival from OHCAs in centenarians was only 1.1%. In a multivariate analysis, age was not associated with 1-month survival from OHCAs (adjusted odds ratio [OR] for one increment of age 1.01; 95% confidence interval [CI] 0.87 to 1.18). Witness by a bystander (adjusted OR 3.45; 95% CI 1.88 to 6.31) and VF as first documented rhythm (adjusted OR 5.49; 95% CI 2.24 to 13.43) were significant positive predictors for 1-month survival. Cardiac origin was significantly poor in 1-month survival compared with noncardiac origin (adjusted OR 0.37; 95% CI 0.21 to 0.64). In conclusion, survival from OHCAs in centenarians was very poor, but witness by a bystander and VF as first documented rhythm were associated with improved survival.

Impact of the Great East Japan earthquake on out-of-hospital cardiac arrest with cardiac origin in non-disaster reas

Background To examine changes in the incidence of out-of-hospital cardiac arrest (OHCA) with cardiac origin in the non-disaster areas of Japan before and after the Great East Japan Earthquake of 11 March 2011. Methods The 35 prefectures in Japan with no dead or missing caused directly by the earthquake were defined as the non-disaster areas. Data of adult OHCA patients in the non-disaster areas from March 4 to 24 each year from 2005 to 2011 were obtained from the All-Japan Utstein Registry. Risk ratios (RRs) of OHCA incidence and 95% CIs were estimated for three specific weeks in 2011 (1 week before and 2 weeks after the earthquake) by applying multivariable Poisson regression model. Incidence in the corresponding periods of March 4–24 from 2005 to 2010 was set as the baseline risk. Results In the analyses from a total of 17 353 OHCA patients, the incidence statistically significantly increased in the first week after the earthquake in all adults (adjusted-RR=1.13, 95% CI=1.05 to 1.22, p=0.001) and in elderly women (adjusted-RR=1.23, 95% CI=1.11 to 1.37, p<0.001). Conclusions The Great East Japan Earthquake caused the increase of OHCA among elderly women even in the non-disaster areas.