Ryo Sagisaka

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.

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 16 min after 119 called and adrenaline was then administered within 22 min of after contact. Patients divided into two groups: Patients were contacted within 8 min of the 119 call (n = 6956), and were contacted between 8 and 16 min after the call (n = 6370). Further divided into groups in which the adrenaline was administered within/without 10 min 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 1 month by the EMS reached within 8 min after 119 call and then adrenaline administered within 10 min was 2.12 (1.54–2.92).Those reached between 8 and 16 min was 2.66 (1.97–3.59). However, the ROSC rate was 2.00 (1.79–2.25) for those reached within 8 min and also 2.00 (1.79–2.25) for those reached between 8 min and 16 min. Considerations: In cases of OHCA, it appears that the CPC1‐2 rate after 1 month can be improved even in cases where the victim is reached > 8 min after the 119 call, as long as the victim is reached within 16 min and emergency responders administer the adrenaline as quickly as possible.

Mobile Automated External Defibrillator Response System during Road Races

Mobile AED Response System during Road Races In Japan, an automated external defibrillator (AED) response system for runners included paramedics on bicycles who carried AEDs, on-foot teams, and a c...

Does dispatcher-assisted CPR generate the same outcomes as spontaneously delivered bystander CPR in Japan?

Aim: We investigated whether DA‐CPR would have the same effect as spontaneously‐delivered bystander CPR. Methods: A total of 37,899 witnessed cardiogenic out of hospital cardiac arrest (OHCA) selected from a nationwide Utstein‐Japanese database between 2008 and 2012. Patients were divided into four groups as follows: CPR initiated with dispatcher assistance (DA‐CPR; n = 10,424), no CPR provided with dispatcher assistance (DA‐No CPR; n = 4658), spontaneously‐delivered bystander CPR provided without DA (BCPR; n = 6630), and both BCPR and dispatcher assistance was not provided (No BCPR‐No DA; n = 16,187). The primary endpoint was rate of shockable rhythm on the initial ECG, return of spontaneous circulation (ROSC) on the field. A multivariable logistic regression analysis was used. Adjusted odds ratios (AOR) are presented as 95% confidence intervals (95% CIs) among the groups. Results: The rate of DA‐CPR implementation has gradually increased since 2005. In comparison with DA‐No CPR, both spontaneously‐delivered BCPR and DA‐CPR were significantly associated with the following factors: increased rate of shockable rhythm on the initial ECG (AOR, 1.75 and 1.72; 95% CI, 1.67 to 1.85 and 1.63 to 1.83),improved field ROSC (AOR, 1.42 and 1.40; 95% CI, 1.33 to 1.52 and 1.30 to 1.51) and 1‐month favorable neurological outcomes (AOR, 1.72 and 1.80; 95% CI, 1.59 to 1.88 and 1.64 to 1.97), respectively. Conclusions: We found that the spontaneously delivered BCPR group showed favorable results. In comparison to the DA‐No BCPR group, DA‐CPR group resulted in the nearly equivalent effect as spontaneously‐delivered BCPR group. Further standard dispatcher education is indicated.

CPR performance in the presence of audiovisual feedback or football shoulder pads

Objective The initiation of cardiopulmonary resuscitation (CPR) can be complicated by the use of protective equipment in contact sports, and the rate of success in resuscitating the patient depends on the time from incident to start of CPR. The aim of our study was to see if (1) previous training, (2) the presence of audiovisual feedback and (3) the presence of football shoulder pads (FSP) affected the quality of chest compressions. Methods Six basic life support certified athletic training students (BLS-ATS), six basic life support certified emergency medical service personnel (BLS-EMS) and six advanced cardiac life support certified emergency medical service personnel (ACLS-EMS) participated in a crossover manikin study. A quasi-experimental repeated measures design was used to measure the chest compression depth (cm), rate (cpm), depth accuracy (%) and rate accuracy (%) on four different conditions by using feedback and/or FSP. Real CPR Help manufactured by ZOLL (Chelmsford, Massachusetts, USA) was used for the audiovisual feedback. Three participants from each group performed 2 min of chest compressions at baseline first, followed by compressions with FSP, with feedback and with both FSP and feedback (FSP+feedback). The other three participants from each group performed compressions at baseline first, followed by compressions with FSP+feedback, feedback and FSP. Results CPR performance did not differ between the groups at baseline (median (IQR), BLS-ATS: 5.0 (4.4–6.1) cm, 114(96–131) cpm; BLS-EMS: 5.4 (4.1–6.4) cm, 112(99–131) cpm; ACLS-EMS: 6.4 (5.7–6.7) cm, 138(113–140) cpm; depth p=0.10, rate p=0.37). A statistically significant difference in the percentage of depth accuracy was found with feedback (median (IQR), 13.8 (0.9–49.2)% vs 69.6 (32.3–85.8)%; p=0.0002). The rate accuracy was changed from 17.1 (0–80.7)% without feedback to 59.2 (17.3–74.3)% with feedback (p=0.50). The use of feedback was effective for depth accuracy, especially in the BLS-ATS group, regardless of the presence of FSP (median (IQR), 22.0 (7.3–36.2)% vs 71.3 (35.4–86.5)%; p=0.0002). Conclusions The use of audiovisual feedback positively affects the quality of the depth of CPR. Both feedback and FSP do not alter the rate measurements. Medically trained personnel are able to deliver the desired depth regardless of the presence of FSP even though shallower chest compressions depth can be seen in CPR with FSP. A feedback device must be introduced into the athletic training settings.

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 20 min for the early administration group [EAG], 21 to 26 min for the intermediate administration group [IAG], and 27 to 60 min for the late administration group [LAG]). The primary endpoint was CPC 1–2 at 1 month after cardiac arrest. A multivariable logistic regression was used for analysis. Results: Achievement of CPC 1–2 at 1 month 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 20 min after an emergency call for witnessed cardiogenic OHCA.