A New Rule for Terminating Resuscitation of Out-of-Hospital Cardiac Arrest Patients in Japan: A Prospective Study
| Autor: | Naoki Shimizu, Naoshige Harada, Tomohito Sadahiro, Shinichi Ishimatsu, Takashi Shiga, Takayuki Suda, Yuichi Koido, Kikuo Yoh, Kunihiro Mashiko, Tetsuya Sakamoto, Keiichi Ikegami, Junichi Suzuki, Manabu Sugita, Shin Inaba, Katsunori Yoshihara, Takao Arai, Mitsuhide Kitano, Kosaku Kinoshita, Hiroshi Toyoda, Kazuya Nakanishi, Fumiaki Iwase, Munetaka Hayashi, Ryosuke Furuya, Kiyoshi Matsuda, Takatoshi Sakurai, Kazuhiko Sekine, Haruhiko Tsutsumi, Shinichi Izuka, Kiyotsugu Takuma, Kotaro Tanaka, Tadanaga Shimada, Yoshihiro Masui, Shigeru Kanesaka, Minoru Nakano, Ishihara Atsushi, Yasuhiro Otomo, Tomohisa Shoko, Takashi Muguruma, Kenji Kobayashi, Yoshiro Kobe, Yasuaki Koyama, Shigeto Oda, Asuka Tsuchiya, Nobuya Kitamura, Hideo Yokokawa, Akio Kimura, Yasufumi Miyake, Takefumi Yamamoto, Masayuki Kanai, Shingo Hori, Hiroyuki Yokota, Masayuki Iyanaga, Sadaki Inokuchi, Yasusei Okada, Hiroshi Tanaka, Yuichi Hamabe, Ken Nagao, Kyoko Unemoto, Kiyohiro Oshima, Tetsuya Kashiyama, Asaki Muraoka, Kunihisa Miura, Arino Yaguchi, Naoto Morimura, Kazuyuki Ono, Kazuya Kiyota, Munehiro Hayashi |
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| Rok vydání: | 2016 |
| Předmět: |
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medicine.medical_specialty Resuscitation Emergency Medical Services medicine.medical_treatment 030204 cardiovascular system & hematology Return of spontaneous circulation Sensitivity and Specificity Out of hospital cardiac arrest Decision Support Techniques 03 medical and health sciences 0302 clinical medicine Japan Predictive Value of Tests medicine Emergency medical services Humans Cardiopulmonary resuscitation Prospective Studies Asystole Intensive care medicine Prospective cohort study Aged Resuscitation Orders business.industry 030208 emergency & critical care medicine Service personnel Middle Aged medicine.disease Cardiopulmonary Resuscitation Outcome and Process Assessment Health Care Emergency Medicine Female business Out-of-Hospital Cardiac Arrest |
| Zdroj: | The Journal of emergency medicine. 53(3) |
| ISSN: | 0736-4679 |
| Popis: | Background The American Heart Association and European Resuscitation Council guidelines for cardiopulmonary resuscitation present rules for termination of resuscitation (TOR) in cases of out-of-hospital cardiac arrest (OHCA). In Japan, only doctors are legally allowed TOR in OHCA cases. Objective This study aimed to develop a new TOR rule that suits the actual situations of the Japanese emergency medical services system. Methods Five different combinations of the TOR rule criteria were compared regarding specificity and positive predictive value (PPV) for 1-month survival with unfavorable neurologic outcomes. The criteria were unwitnessed by emergency medical service personnel, unwitnessed by bystanders, initial unshockable rhythm in the field, initial asystole in the field, no shock delivered, no prehospital return of spontaneous circulation, unshockable rhythm at hospital arrival, and asystole at hospital arrival. Results A total of 13,291 cases were included. The following combination provided the highest specificity and PPV for predicting 1-month unfavorable neurologic outcomes and death: unwitnessed by bystanders, initial asystole in the field, and asystole at hospital arrival. The specificity and PPV for the combination of the three criteria for predicting 1-month unfavorable neurologic outcomes were 0.992 and 0.999, and for predicting death at 1 month after OHCA were 0.986 and 0.998, respectively. Conclusions OHCA patients fulfilling the criteria unwitnessed by bystanders and asystole in the field and at hospital arrival had universally poor outcomes. Termination of resuscitation after hospital arrival for these patients may decrease unwarranted treatments. |
| Databáze: | OpenAIRE |
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