P069: Prehospital amiodarone use could improve favorable neurological recovery among patients with out-of-hospital shockable cardiac arrest

Introduction: Amiodarone may be used for shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), but the effect of prehospital use upon neurological outcomes still unclear. Methods: A prospective province-wide, population based observational study was conducted from January 2006 to March 2016. Adult emergency medical service-treated non-traumatic OHCA patients who received at least one electric defibrillation were included. Amiodarone was administered to patients with VF/ pVT by paramedics based on their clinical assessment, according to provincial guidelines. The outcome of interest was favorable neurological outcomes to hospital discharge, defined as modified Rankin scale of 3 or less. Multivariable logistic regression was performed to compare the proportion of patients with the primary outcome between amiodarone and non-amiodarone groups, further stratified by the number of electrical defibrillation. In addition, to mitigate the potential selection bias, the same logistic regression was conducted in 1:1 propensity score matched groups adjusting for baseline covariates. Results: Of 3,374 overall OHCA patients, 915 (27.1%) were managed with amiodarone. In the amiodarone group, 150 / 915 (16.4 %) patients had a favorable neurological outcome, compared to 455/2,459 (18.5%) in the non-amiodarone group (crude odds ratio [OR] 0.86, 95% CI 0.71 to 1.06). In the multiple logistic regression model, prehospital amiodarone was associated with increased probability of favorable neurological outcomes (adjusted OR 2.11, 95% CI 1.46 to 3.05). With stratification by the number of electrical defibrillation performed, amiodarone treated group showed higher probability of favorable neurological outcomes (1 or 2: adjusted OR 2.71, 95% CI 1.33 to 5.50, 3 and more: adjusted OR 1.67, 95% CI 0.99 to 2.39). Similarly, in 1:1 propensity matched cohort including 882 OHCA patients, the adjusted association persisted (adjusted OR 2.14, 95% CI 1.33 to 3.44). Conclusion: Prehospital administration of amiodarone to non-traumatic OHCA patients was associated with better neurological recovery, especially in those who received fewer electrical defibrillations.

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LO74: Prehospital sodium bicarbonate use was associated with worse neurological outcomes among patients with out-of-hospital non-traumatic cardiac arrest

CJEM ◽

10.1017/cem.2017.136 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S53

Author(s):

T. Kawano ◽

F.X. Scheuermeyer ◽

J. Christenson ◽

R. Stenstrom ◽

B.E. Grunau

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Sodium Bicarbonate ◽

Treated Group ◽

Population Based ◽

Lower Probability ◽

Crude Odds Ratio ◽

Neurological Outcomes ◽

Traumatic Cardiac Arrest ◽

Favorable Neurological Outcome

Introduction: Sodium bicarbonate (SB) is still widely used for resuscitation in out-of- hospital cardiac arrest (OHCA) despite limited clinical indications but the effect on neurological recovery is unclear. Methods: From 2006 to 2016, we prospectively conducted a province-wide population-based observational study of adult non-traumatic OHCA patients managed by EMS. According to provincial guidelines, paramedics administered SB to OHCA patients based on their clinical assessment. Outcome of interest was favorable neurological outcome at hospital discharge, defined as CPC of 1 and 2 or modified Rankin scale of 3 or less. We performed multivariable logistic regression, comparing the proportion of outcome between SB and non-SB groups, further stratified by the median of the length of resuscitation. We also applied propensity score matching technique adjusting for baseline characters to the same model to reduce potential selection bias. Results: Of 13,008 OHCA patients, 4,699 (36.1%) were managed with SB. In the SB treated group, 64 / 4,699 (1.3%) patients had favorable neurological outcomes, compared to 823 / 8,309 (9.9%) in the non-SB treated group (crude odds ratio [OR] 0.12, 95% CI 0.09 to 0.16). In logistic regression model, SB was associated with decreased probability of favorable outcomes (adjusted OR 0.63, 95% CI 0.45 to 0.89). Similarly, with stratification by length of resuscitation, the SB group had a lower probability of favorable outcomes (≦24 min: adjusted OR 0.68, 95% CI 0.46 to 1.02, >24 min: adjusted OR 0.47, 95% CI 0.23 to 0.97). In 1:1 propensity matched cohort including 5,126 OHCA patients, the adjusted association also persisted (adjusted OR 0.59, 95% CI 0.39 to 0.89). Conclusion: Prehospital administration of SB to OHCA patients was associated with worse neurological outcomes and the trend persisted even after stratification by resuscitation length.

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Abstract 10436: The Association of Time to First Epinephrine Administration With Neurological Outcomes in Out of hospital Cardiac Arrest in Japan: Sos-kanto 2012 Study Report

Circulation ◽

10.1161/circ.132.suppl_3.10436 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Yosuke Homma ◽

Hiraku Funakoshi ◽

Takashi Shiga ◽

Dai Miyazaki ◽

Naohiro Yonemoto ◽

...

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Intensive Care ◽

Clinical Effectiveness ◽

Multivariate Logistic Regression ◽

Epinephrine Administration ◽

Neurological Outcomes ◽

Bystander Cpr ◽

Favorable Neurological Outcome ◽

Mean Time

Introduction: The clinical effectiveness of the timing of first epinephrine administration (EA) including prehospital setting has not been established, especially in regards to neurological outcomes in patients subsequently receiving intensive care after admission. Study Objectives: The aim of this study was to evaluate the effectiveness of time to first EA on neurological outcomes following OHCA. Methods: This was a multicenter retrospective cohort study in Japan from January 2012 to March 2013. We used data from the Survey of Survivors after Cardiac Arrest in the Kanto Area in 2012 (SOS-KANTO 2012) database. All adult patients who were registered in this database and were administered epinephrine were included; unwitnessed OHCA and initial asystolic rhythms were excluded. Collected variables included age, gender, activities of daily living, witnessed status, bystander CPR, first documented rhythm, cause, and intensive care after admission. Multivariate logistic regression was performed to investigate the association between time to first EA and 1) ROSC, 2) 1-month survival, and 3) 1-month favorable neurological outcome. Results: Of 16,452 OHCAs, 5,281 met the inclusion criteria (male, 63.1%; mean age, 71.5 years). Mean time between call to first EA is 33.7min. 1,501patients (28.4%) had ROSC. Multivariate logistic regression showed that the earlier the EA, the better chance of ROSC if initial documented rhythm was both VF/VT (adjusted odds ratio [OR] for one minute delay, 0.98; 95% confidence interval [CI], 0.97-0.99) and Asystole/PEA (adjusted OR, 0.97; 95%CI, 0.97-0.98). In contrast, the earlier the EA, the better chance of 1-month survival if initial documented rhythm was only Asystole/PEA (adjusted OR, 0.95; 95%CI, 0.93-0.98). There were no significant differences between early EA and good neurological outcomes (VF/VT, 1.01 [95% CI, 0.97-1.04] and Asystole/PEA, 1.01 [95% CI, 0.96-1.05]). Conclusions: If initial documented rhythm was VF/VT, early EA was associated with increased chance of only ROSC. In contrast, early EA was associated with increased chance of ROSC and 1 month survival if initial documented rhythm was Asystole/PEA. Time to first EA was not associated with good neurological outcomes in any initial documented rhythm.

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Abstract 340: Effect of the 2015 CPR Guidelines for Patients With Out-Of-Hospital Cardiac Arrest Due to Non-Shockable Rhythm: Results From the All-Japan Utstein Registry

Circulation ◽

10.1161/circ.140.suppl_2.340 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Tsukasa Yagi ◽

Ken Nagao ◽

Eizo Tachibana ◽

Naohiro Yonemoto ◽

Yoshio Tahara ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Population Based ◽

Inclusion Criteria ◽

Neurological Outcomes ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Favorable Neurological Outcome ◽

Population Based Registry ◽

Hospital Cardiac Arrest

Background: The 2015 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from cardiac arrest (CA). In particular, the guidelines recommended that it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min in adult CA patients. However, it is unknown whether the 2015 guidelines contributed to favorable neurological outcome in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines in adult CA patients, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA). Methods: From the data of this registry between 2011 and 2016, we included adult witnessed OHCA patients due to cardiac etiology, who had non-shockable rhythm, PEA and asystole, as an initial rhythm. Study patients were divided into two groups based on the different CPR guidelines; the era of the 2010 guidelines (2010G), and the era of the 2015 guidelines (2015G). The endpoint was the favorable neurological outcome at 30 days after OHCA. Results: The 109,175 patients who met the inclusion criteria comprised 18,764 who received CPR based on 2015G and 90,411 who received CPR based on 2010G. The figure showed favorable neurological outcomes at 30 days in the two groups. In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in 2015G patients as compared to 2010G patients was 1.28 (95%CI 1.11-1.46, p<0.001). Conclusion: In the OHCA patients with non-shockable rhythm, the 2015 guidelines were superior to the 2010 guidelines, in terms of neurological benefits.

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Benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest: a community-based, observational study in Niigata, Japan

BMJ Open ◽

10.1136/bmjopen-2019-032967 ◽

2019 ◽

Vol 9 (11) ◽

pp. e032967 ◽

Cited By ~ 2

Author(s):

Nobuhiro Sato ◽

Tasuku Matsuyama ◽

Kohei Akazawa ◽

Kyoko Nakazawa ◽

Yasuo Hirose

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Neurological Outcome ◽

Cerebral Performance Category ◽

Population Based ◽

Secondary Outcome ◽

Community Based ◽

Neurological Outcomes ◽

Urban City ◽

Hospital Cardiac Arrest

ObjectiveThis study aimed to assess the benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest using a community-based registry.DesignPopulation-based, retrospective cohort study.SettingAn urban city with approximately 800 000 residents.ParticipantsPatients aged ≥18 years with bystander-witnessed out-of-hospital cardiac arrests of medical aetiology in Niigata City, Japan, between January 2012 and December 2016, according to the Utstein style.Primary and secondary outcome measuresThe primary outcome was 1-month survival with a favourable neurological outcome, defined as a cerebral performance category score of 1 or 2. We used logistic regression analysis to assess the association between favourable neurological outcome and prehospital physician involvement.ResultsDuring the study period, a total of 4172 cardiac arrests were registered; of these, 892 patients with out-of-hospital cardiac arrest were eligible for this analysis, among whom 135 (15.1%) had prehospital physician involvement and 757 (84.9%) did not have prehospital physician involvement. The percentage of favourable neurological outcomes was 20.7% (28 of 135) in those with physician involvement and 10.4% (79 of 757) in those without physician involvement (p=0.001). Using multivariable logistic regression, prehospital physician involvement had an OR for a favourable neurological outcome of 3.44 (95% CI 1.64 to 7.23).ConclusionsAmong adults with out-of-hospital cardiac arrest, adding a physician-staffed ambulance was associated with significantly greater favourable neurological outcomes than standard emergency medical services.

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Extended Right Sided Colon Resection Increases the Risk of Post-Operative Complications and Does Not Reduce the Risk of Colon Cancer Local-Regional Recurrence: Nation-Wide Population-Based Study from Danish Colorectal Cancer Group Database

SSRN Electronic Journal ◽

10.2139/ssrn.3736154 ◽

2020 ◽

Author(s):

Alaa El-Hussuna ◽

Theodore Lytras ◽

Niels Henrik Bruun ◽

Mads Klein ◽

Sameh Hany Emil ◽

...

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Population Based ◽

Colon Resection ◽

Regional Recurrence ◽

Population Based Study ◽

Cancer Group ◽

Operative Complications ◽

Local Regional Recurrence ◽

Wide Population

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Effect of fluid administration on scene to traffic accident patients by EMS personnel: a propensity score-matched study using population-based ambulance records and nationwide trauma registry in Japan

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01590-z ◽

2021 ◽

Author(s):

Yusuke Katayama ◽

Tetsuhisa Kitamura ◽

Kosuke Kiyohara ◽

Kenichiro Ishida ◽

Tomoya Hirose ◽

...

Keyword(s):

Logistic Regression ◽

Propensity Score ◽

Hospital Mortality ◽

Regression Model ◽

Traffic Accident ◽

Logistic Regression Model ◽

Cardiopulmonary Arrest ◽

Population Based ◽

Fluid Administration ◽

Secondary Outcome

Abstract Purpose The aim of this study was to assess the effect of fluid administration by emergency life-saving technicians (ELST) on the prognosis of traffic accident patients by using a propensity score (PS)-matching method. Methods The study included traffic accident patients registered in the JTDB database from January 2016 to December 2017. The main outcome was hospital mortality, and the secondary outcome was cardiopulmonary arrest on hospital arrival (CPAOA). To reduce potential confounding effects in the comparisons between two groups, we estimated a propensity score (PS) by fitting a logistic regression model that was adjusted for 17 variables before the implementation of fluid administration by ELST at the scene. Results During the study period, 10,908 traffic accident patients were registered in the JTDB database, and we included 3502 patients in this study. Of these patients, 142 were administered fluid by ELST and 3360 were not administered fluid by ELST. After PS matching, 141 patients were selected from each group. In the PS-matched model, fluid administration by ELST at the scene was not associated with discharge to death (crude OR: 0.859 [95% CI, 0.500–1.475]; p = 0.582). However, the fluid group showed statistically better outcome for CPAOA than the no fluid group in the multiple logistic regression model (adjusted OR: 0.231 [95% CI, 0.055–0.967]; p = 0.045). Conclusion In this study, fluid administration to traffic accident patients by ELST was associated not with hospital mortality but with a lower proportion of CPAOA.

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