Tomoya Kinoshi

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.

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...