Resuscitation最新文献

Background: Japan is a microcosm of an aging society and represents the future for many countries worldwide. We aimed to assess the impact of aging, period, and birth cohort effects on the temporal trends of out-of-hospital cardiac arrest (OHCA) in Japan, and further projected the future OHCA burden.

Methods: We conducted a retrospective, nationwide, population-based study using the All-Japan Utstein Registry between 2009 and 2023. The age-period-cohort model for evaluating and decomposing the effects of age, period, and birth cohort on the incidence of OHCA due to presumed cardiac origin was employed. Furthermore, using the Bayesian age-period-cohort model based on integrated nested Laplace approximations, we projected the OHCA incidence in Japan between 2024 and 2030.

Results: During these 15 years, a total of 1,158,691 patients with OHCA of presumed cardiac origin were confirmed. The crude incidence rate per 100,000 persons increased from 50.9 in 2009 to 72.8 in 2023. The OHCA risk increased substantially with increasing age. Compared with patients aged 45-49 years old, the rate ratio (RR) of those aged ≥90 years old was 41.0 (95% confidence interval [CI]; 39.8-42.3). The effect of the 2019-2023 period was similar to that of the 2009-2013 period (RR; 1.00, 95%CI; 0.99-1.02). Compared with patients born in 1948, cohort effects showed increasing the OHCA risk in older birth cohorts, peaking in those born before 1921 (RR; 1.22, 95%CI; 1.20-1.24). In the decomposition analysis regarding changes from 2009 to 2023, population aging and age-specific incidence accounted for 100.5% and 7.1% of the increase and population growth for 7.6% of the decrease in the OHCA number changes (+25,591). As forecasting the OHCA burden, the crude incidence rate per 100,000 persons is projected to increase from 76.0 (95% predictive interval [PI]: 73.6-78.3) in 2024 to 97.2 (95%PI: 66.6-127.7) in 2030.

Conclusions: In Japan, the crude incidence rate of OHCA due to presumed cardiac origin increased from 2009 to 2023, and the incidence is projected to continue increasing through 2030. Japan's aging population and population decline represent a future scenario for countries worldwide, and our projections might apply to nations globally.

Background: Initial respiratory management is critical during drowning resuscitation. We studied the effect of prehospital airway adjuncts and supplemental oxygen on pediatric drowning outcomes.

Methods: This cross-sectional study was a sub-analysis of children 0-18 years old who presented post-drowning to one of 32 pediatric emergency departments from 2010 to 2017. Submersion and clinical data were obtained from prehospital and medical records. Patients were categorized based on presence of out-of-hospital cardiac arrest (OHCA). Airway adjuncts included prehospital bag-valve mask (BVM) or endotracheal intubation for OHCA patients and supplemental oxygen or room air in non-OHCA patients. Primary outcomes were survival or favorable neurological outcomes at hospital discharge using Cerebral Performance Category. Covariates included demographics, body of water, bystander CPR, submersion duration, and witnessed drowning. Outcomes were compared by cardiac arrest status and respiratory intervention using logistic regression.

Results: There were 3188 patients (No OHCA: 2975 (93%); OHCA: 213 (7%)). Median age was 3.3 years (IQR: 2.0, 5.6); 61% were male. Among OHCA patients, intubation did not have significantly different odds of favorable neurological outcome [aOR: 0.6 (95%CI: 0.1, 3.5)] or survival [aOR: 2.0 (95%CI: 0.6, 7.2)] at hospital discharge compared to BVM. No significant difference in outcomes occurred in non-cardiac arrest patients based on provision of prehospital supplemental oxygen.

Conclusion: In pediatric patients in OHCA following drowning, endotracheal intubation was not associated with significantly different odds of favorable neurological outcome or survival at hospital discharge compared to BVM. No differences in outcomes also occurred in non-OHCA patients based on provision of prehospital supplemental oxygen.

Introduction: Brain tissue hypoxia and ischemia are central to the pathophysiology of hypoxic-ischemic brain injury (HIBI). Magnetic resonance imaging (MRI) techniques including diffusion-weighted imaging (DWI) and associated apparent diffusion coefficient (ADC) maps offer a non-invasive method for identifying ischemic tissue, but their use is often limited to the provision of summary data. We developed a reproducible, semi-automated analysis pipeline to three-dimensionally quantify and anatomically localize ischemic brain injury using DWI-ADC data in HIBI patients.

Methods: A retrospective cohort of post-cardiac arrest patients with HIBI (n=10) was included. MRI preprocessing included skull stripping, spatial normalization to MNI152 space, and anatomical parcellation using FreeSurfer atlases. Ischemic regions were defined by an ADC threshold (< 650e^-6 mm²/s), and lesion burden was computed voxel-wise by segment, hemisphere, and tissue type. Susceptibility-weighted imaging (SWI) hypointensities were also quantified.

Results: Ischemic injury was spatially heterogeneous but consistently affected the putamen, thalamus, and posterior cortical regions (e.g., pericalcarine and perirolandic cortices). The overall mean relative lesion volume was 28.4 ± 14.1% of total brain volume, with greater involvement in white matter (33.3 ± 17.8%) than gray matter (24.1 ± 11.4%; P=0.005). Overlap of SWI and ADC hypointensities was minimal (<1% of all voxels), indicating negligible confounding by intraparenchymal blood.

Discussion: We present a robust, observer-independent workflow for anatomically resolved quantification of ischemic injury in HIBI. Atlas-based segmentation integrated with voxel-intensity ADC analysis, enabled generation of granular data on the pattern and extent of ischemic brain injury following cardiac arrest.

Background: Rescue breathing is considered essential in pediatric out-of-hospital cardiac arrest (OHCA) due to drowning, a type of asphyxial arrest where hypoxia precedes circulatory collapse. However, the increasing promotion of compression-only CPR (CO-CPR) may have contributed to changes in bystander CPR practices, including a decline in rescue-breathing CPR (RB-CPR). Whether such temporal changes have influenced outcomes in pediatric drowning OHCA remains unclear.

Methods: We analyzed nationwide data from the All-Japan Utstein Registry (2012-2023), including pediatric OHCA patients (≤17 years old) whose arrests were caused by drowning and received bystander CPR from laypersons. Patients were categorized into RB-CPR and CO-CPR groups. The primary outcome was 30-day mortality; secondary outcomes included prehospital absence of return of spontaneous circulation (ROSC) and 30-day unfavorable neurological survival, defined as Cerebral Performance Category score 3-5. We used multivariable Poisson regression to estimate adjusted risk ratio (aRR) and conducted analyses by age and witnessed status.

Results: Among 740 eligible patients, 41.6% received RB-CPR and 58.4% received CO-CPR. The proportion of RB-CPR declined over the study period. CO-CPR was associated with higher 30-day mortality (aRR 1.38, 95% CI 1.14-1.67), higher prehospital absence of ROSC, and worse neurological outcomes compared with RB-CPR. The adverse association of CO-CPR was most pronounced in unwitnessed arrests, where ventilation may be particularly important.

Conclusions: In pediatric drowning OHCA, CO-CPR was associated with worse survival and neurological outcomes than RB-CPR. These findings underscore the necessity for rescue breathing and the importance of ventilation-focused bystander CPR training in pediatric and drowning-related scenarios.

Introduction: Electrocardiogram (ECG) signals during cardiac arrest contain detailed information on cardiac rhythm characteristics and have been associated with resuscitation outcomes. We aimed to develop a convolutional neural network (CNN) model to predict return of spontaneous circulation (ROSC) and identify novel ECG phenotypes in patients with out-of-hospital cardiac arrest (OHCA).

Methods: This retrospective cohort study used Korean OHCA Registry and ECG data from Seoul emergency medical services between July 2021 and December 2023. Adult patients with nontraumatic OHCA who had prehospital ECG signals were included. Five-second ECG segments obtained during resuscitation were analyzed. A one-dimensional CNN was developed to simultaneously predict the probability of ROSC within 2 min and to classify the concurrent ECG rhythm as shockable or non-shockable. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC). ECG phenotypes were identified by applying K-means clustering to feature representations extracted from the trained CNN.

Results: 3452 patients (median age, 73 years [interquartile range, 61-81]; 34.4% female) were included. The AUCs for predicting ROSC within 2 min and shockable rhythm in the test set were 0.921 (95% confidence interval [CI], 0.897-0.945) and 0.983 (95% CI, 0.979-0.988), respectively. Five ECG phenotype categories with varying morphologies and ROSC probabilities were identified. Phenotype 1 consisted of shockable rhythms with high ROSC probability (30.4%), whereas Phenotype 2 showed shockable rhythms with low ROSC probability (4.8%). Phenotypes 3 and 4 included pulseless electrical activities with relatively high (5.2%) and lower (0.5%) ROSC probabilities, respectively. Phenotype 5 primarily consisted of asystole or near-asystole rhythms. Transitions between ECG phenotypes were associated with CPR quality.

Conclusions: The CNN-based model accurately predicted ROSC and shockable rhythm from ECG signals and identified five novel ECG phenotypes in OHCA. These findings can enable accurate ROSC prediction and individualized prehospital resuscitation for patients with OHCA.

Aim: Since 2018, Denmark has implemented a national community first-responder system, activated by the emergency dispatch centre, to supplement local first-responder programs. The responders are dispatched to all out-of-hospital cardiac arrests (OHCA). This study aimed to investigate the effect of community first-responders on survival following OHCA.

Methods: A manual review of prehospital medical records for all 29,445 OHCA cases in Denmark from 2018 through 2023. The type of responder who initiated resuscitative efforts was stratified into three main groups: bystanders present at the incident, community first-responders, or ambulance personnel. The primary outcome was survival at 30 days and 365 days.

Results: After exclusions, 21,413 patients were analysed, of which initial resuscitation efforts were provided by on-scene bystanders (12,613), community first-responders (2155), or emergency medical service (EMS) personnel (6140). In 505 cases, the provider of the initial CPR was unclear. Provision of initial resuscitative efforts by on-scene bystanders before ambulance arrival was associated with odds ratios of 2.42 for 30-day survival and 2.51 for 365-day survival, compared with patients whose first resuscitation was not initiated before EMS arrival. There was no significant difference in outcome when first resuscitation efforts were provided by community first responders or delayed until EMS arrival.

Conclusion: In OHCA, basic life support initiated by bystanders was associated with a survival rate more than twice that of OHCA patients whose first resuscitation was provided by community first-responders or ambulance personnel. Our findings support early resuscitation, but we found no evidence to support dispatching community first-responders to OHCA.