Resuscitation In Japan Research Articles

103 Underlying Etiology of Sudden Out-of-Hospital Cardiac Arrest in Survivors vs Non-Survivors After Initial Resuscitation in Japan

103 Underlying Etiology of Sudden Out-of-Hospital Cardiac Arrest in Survivors vs Non-Survivors After Initial Resuscitation in Japan

Association between neuromuscular blocking agent use and outcomes among out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and target temperature management: A secondary analysis of the SAVE-J II study

BackgroundNeuromuscular blocking agents are used to control shivering in cardiac arrest patients treated with target temperature management. However, their effect on outcomes in patients treated with extracorporeal cardiopulmonary resuscitation is unclear. MethodsThis study was a secondary analysis of the SAVE-J II study, a retrospective multicenter study of 2175 out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation in Japan. We classified patients into those who received neuromuscular blocking agents and those who did not and compared in-hospital mortality and incidence rates of favorable neurological outcome and in-hospital pneumonia between the groups using multivariable regression models and stabilized inverse probability weighting with propensity scores. ResultsSix hundred sixty patients from the SAVE-J II registry were analyzed. Neuromuscular blocking agents were used in 451 patients (68.3%). After adjusting for potential confounders, neuromuscular blocking agents use was not significantly associated with in-hospital mortality (aHR 0.88; 95% CI, 0.67–1.14), favorable neurological outcome (aOR 0.85; 95% CI, 0.60–1.11), or pneumonia (aOR 1.52; 95% CI, 0.85–2.71). The results for in-hospital mortality (aHR 0.89; 95% CI, 0.64–1.25), favorable neurological outcome (aOR 0.94; 95% CI, 0.59–1.48) and pneumonia (aOR 1.59; 95% CI, 0.74–3.41) were similar after weighting was performed. ConclusionsAlthough data on the rationale for using neuromuscular blocking agents were unavailable, their use was not significantly associated with outcomes in out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and targeted temperature management. Neuromuscular blocking agents should be used based on individual clinical indications.

Executive Summary ― Acute Coronary Syndrome in the Japan Resuscitation Council Guidelines for Resuscitation 2020 ―

Executive Summary ― Acute Coronary Syndrome in the Japan Resuscitation Council Guidelines for Resuscitation 2020 ―

Maternal cardiopulmonary resuscitation.

The perinatal resuscitation history in Japan is short, with the earliest efforts in the field of neonatology. In contrast, the standardization and dissemination of maternal resuscitation is lagging. With the establishment of the Maternal Death Reporting Project and the Maternal Death Case Review and Evaluation Committee in 2010, with the aim of reducing maternal deaths, the true situation of maternal deaths came to light. Subsequently, in 2015, the Japan Council for the Dissemination of Maternal Emergency Life Support Systems (J-CIMELS) was established to educate and disseminate simulations in maternal emergency care; training sessions on maternal resuscitation are now conducted in all prefectures. Since the launch of the project and council, the maternal mortality rate in Japan (especially due to obstetric critical hemorrhage) has gradually decreased. This has been probably achieved due to the tireless efforts of medical personnel involved in perinatal care, as well as the various activities conducted so far. However, there are no standardized guidelines for maternal resuscitation yet. Therefore, a committee was set up within the Japan Resuscitation Council to develop a maternal resuscitation protocol, and the Guidelines for Maternal Resuscitation 2020 was created in 2021. These guidelines are expected to make the use of high-quality resuscitation methods more widespread than ever before. This presentation will provide an overview of the Guidelines for Maternal Resuscitation 2020.

Physicians’ perceptions of followership in resuscitation in Japan and the USA: a qualitative study

ObjectivesWhile leadership is accepted as a crucial aspect of a successful resuscitation team, the role of followership has not been sufficiently explored. This study aims to explore physicians’ perceptions of...

JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias.

JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias.

Increasing the shockable rhythm and survival rate by dispatcher-assisted cardiopulmonary resuscitation in Japan

PurposeThis study aimed to examine the effectiveness of cardiopulmonary resuscitation (CPR) directions by dispatchers. We analysed the relationship of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) with favourable cerebral function, shockable rhythm rate, and emergency medical service (EMS) arrival time. MethodsThis nationwide study was based on CPR statistical data of out-of-hospital cardiac arrest (OHCA) patients (n=629,471) from 1 January 2011 to 31 December 2015, and included 107,669 patients with bystander-witnessed cardiogenic cardiac arrest.The primary outcome was good brain function prognosis after 1 month, while the secondary outcome was the rate of shockable rhythm on ECG at the time of EMS arrival.EMS arrival time at the site was stratified into 7min, 8−10min, and 11−20min using tertiles. Adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were estimated using multivariate logistic regression analysis to assess the association between DA-BCPR and outcomes in each tertile. ResultsThere were 37,269 (35%), 18,109 (17%), and 52,291 (49%) patients in the DA-BCPR, Only-BCPR, and no-BCPR groups, respectively. Compared to No-BCPR, DA-BCPR was associated with favourable neurological outcomes regardless of the time from 119 call to EMS contact (AOR, 1.56, 2.01, 1.82; 95% CI, 1.43−1.71, 1.80–2.24, 1.52−2.19; ≤7min, 8–10min, and 11–20min, respectively). DA-BCPR showed association with the shockable rhythm rate upon EMS arrival regardless of the time 119 call to EMS contact (AOR, 1.30, 1.60, 1.90; 95% CI, 1.23−1.38, 1.51−1.70, 1.75–2.06; ≤7min, 8–10min, and 11–20min, respectively). ConclusionProviding dispatcher assistance with CPR to 119 callers improves the long-term outcome regardless of the patient’s age and EMS response time. Thus, encouraging dispatchers to promote BCPR is important for increasing the shockable rhythm rate and improving the brain function prognosis.

Summary of Japanese Neonatal Cardiopulmonary Resuscitation Guidelines 2015.

The Japan Resuscitation Council joined the International Liaison Committee on Resuscitation (ILCOR) as a member of the Resuscitation Council of Asia in 2006. In 2007, the Japan Society of Perinatal and Neonatal Medicine (JSPNM), which is a member of an affiliated body, launched the Neonatal Cardiopulmonary Resuscitation (NCPR) program as an authorized project to ensure that all staff involved in perinatal and neonatal medicine can learn and practice neonatal cardiopulmonary resuscitation based on the Consensus on Science with Treatment Recommendations developed by ILCOR. The content of courses in the NCPR program is based on the NCPR guidelines. These guidelines are revised by the Japan Resuscitation Council according to the Consensus on Science with Treatment Recommendations, which is updated by ILCOR every 5years. The latest updated edition in Japanese was published in 2016 and we translated these Japanese guidelines to English in 2018. Here, we introduce a summary of the NCPR guidelines 2015 in Japan. The NCPR 2015 algorithm has two flows, "lifesaving flow" and "stabilization of breathing flow" at the first branching point after the initial step of resuscitation.

Effect of the 2010 Japan Resuscitation Council Guidelines for neonatal cardiopulmonary resuscitation on respiratory support and pulmonary air leak of term infants

Effect of the 2010 Japan Resuscitation Council Guidelines for neonatal cardiopulmonary resuscitation on respiratory support and pulmonary air leak of term infants

院外心肺停止患者予後予測基準の外的妥当性：救急蘇生統計を用いた後方視的検討(External validation of the prediction criteria for the outcome after out–of–hospital cardiac arrest: a retrospective population–based study in Japan)

要旨【目的】我々は以前に（1）73歳以上，（2）目撃がない，（3）初回心電図波形が非除細動適応波形である，の3項目により院外心肺停止患者の機能予後不良を高い精度で予測することが可能であると報告した。本研究は同予後予測基準の外的妥当性を検証することを目的として実施された。【対象と方法】総務省消防庁の提供する救急蘇生統計（2013年から2016年）を用いて，予後予測基準該当の有無と，1か月後機能予後不良（脳機能カテゴリー3から5）の有無を調査し，同基準の予後予測精度を評価した。地域特異的な検査精度を評価すべく，人口密度に基づいたサブグループ解析を行った。【結果】解析対象となった498,040例のうち，188,233例（37.8%）が予後予測基準に合致した。同基準による１か月後機能予後不良予測の特異度は0.951（95%信頼区間 0.948–0.954），陽性的中率は0.995（95%信頼区間 0.995–0.996）であった。陽性的中率は各年代を通して0.995–0.996であった。サブグループ解析の結果，地域人口密度によらず，陽性的中率は0.995–0.997であった。【結語】（1）73歳以上，（2）目撃がない，（3）初回心電図波形が非除細動適応波形である，の3項目を救急隊到着時に満たす場合，院外心肺停止患者の機能予後は極めて高い確率で不良であることが示された。

Capsule Commentary on Hayashi et al., Predictors associated with survival among elderly inpatients who receive cardiopulmonary resuscitation in Japan: an observational cohort study.

Capsule Commentary on Hayashi et al., Predictors associated with survival among elderly inpatients who receive cardiopulmonary resuscitation in Japan: an observational cohort study.

Predictors Associated with Survival Among Elderly In-Patients Who Receive Cardiopulmonary Resuscitation in Japan: An Observational Cohort Study.

Little is known about the outcomes of in-hospital cardiopulmonary resuscitation (CPR) in Asian populations including elderly patients in Japan. To determine the survival outcome of in-hospital CPR among elderly patients in Japan, and to identify predictors associated with survival. Retrospective cohort study in 81 Japanese hospitals from April 1, 2010 to March 31, 2016. We included elderly patients (age ≥ 65years) who received CPR after 2days of hospitalization. The primary outcome was survival at hospital discharge and the secondary outcomes were the discharge disposition and consciousness level of patients who survived to hospital discharge. To determine predictors associated with survival after in-hospital CPR, we fit multivariable models for patient-level and institutional-level factors. Among the 5365 patients who received CPR, 595 (11%) survived to discharge. Of those who survived to discharge, 46% of patients were discharged home, and 10% of patients were comatose at discharge. Older age and higher burden of comorbidities were associated with reduced survival. The adjusted OR was 0.35 (95% CI, 0.22-0.55) for age ≥ 90years compared to age 65-69years, and 0.68 (95% CI, 0.48-0.97) for Charlson Comorbidity Index score of ≥ 4 compared with score of 0. Other predictors of reduced survival included receiving CPR on weekends compared to weekdays (AOR, 0.63; 95% CI, 0.51-0.77) and in small hospitals compared to large hospitals (AOR, 0.58; 95% CI, 0.40-0.83). Among elderly patients in Japan, the survival rate of in-hospital CPR was approximately one in ten, and less than half of these patients were discharged home. In addition to older age and higher illness burden, receiving CPR on weekends and/or in small hospitals were significant predictors of reduced survival. These findings should be considered in advanced care planning discussions with elderly patients to avoid subjecting patients to CPR that are likely futile.

The ten-year transition of the favorable neurological outcomes by dispatcher-assisted cardiopulmonary resuscitation in Japan

The ten-year transition of the favorable neurological outcomes by dispatcher-assisted cardiopulmonary resuscitation in Japan

日本蘇生協議会蘇生ガイドライン ～小児の蘇生：心拍再開後集中治療

日本蘇生協議会蘇生ガイドライン ～小児の蘇生：心拍再開後集中治療

JRC蘇生ガイドライン2015 成人の二次救命処置：心拍再開後の集中治療，予後評価

成人心拍再開後の集中治療および予後評価における改訂の要点（学会担当分）を示す。心拍再開後の集中治療【呼吸管理】酸素化に関して，低酸素症の回避を推奨し，高酸素症の回避を提案する。また，心拍再開（return of spontaneous circulation, ROSC）後，動脈血酸素飽和度または動脈血酸素分圧が確実に測定されるまでは100％吸入酸素濃度の使用を提案する。PaCO2に関してバンドル治療の一部としてPaCO2を生理的な正常範囲内に維持することを提案する。【循環管理】バンドル治療の一部として循環管理の目標（例：平均血圧，収縮期血圧）設定を考慮することを提案する。【体温管理療法】ROSC後に刺激に反応がない場合は，体温管理療法の施行を推奨/提案し，体温管理療法を行わないことには反対する。体温管理療法は，初期ECG（electrocardiogram）波形が電気ショック適応の院外心停止に対しては推奨し，初期ECG波形が電気ショック非適応の院外心停止および全ての初期ECG波形の院内心停止に対しては提案する。体温管理療法施行時には，32～36℃の間で目標体温を設定し，その温度で一定に維持することを推奨する。体温管理療法を施行する場合は，維持期間を少なくとも24時間とすることを提案する。ROSC直後，急速な大量冷却輸液による病院前冷却をルーチンには行わないことを推奨する。体温管理療法終了後も昏睡状態が遷延している場合は発熱を防止し治療することを提案する。【てんかん発作の管理】てんかん発作の予防をルーチンには行わないことを提案する。てんかん発作の治療を推奨する。【血糖管理】標準的血糖管理プロトコルを変更せず適応することを提案する。 予後評価【低体温による体温管理療法が施行されたROSC後昏睡患者の予後評価】ROSC後72時間以前に臨床所見のみで予後を評価しないよう提案する。鎮静や筋弛緩の残存が疑われる場合は，臨床所見を継続して観察することを提案する。 それにより予後評価の偽陽性を最小化することができる。単一の検査または所見のみを信用することなく，多元的な検査（臨床所見，神経生理学的な手法，イメージング，あるいは血液マーカー）を，予後評価のため使用することを提案する。予後不良を評価するには，ROSCから少なくとも72時間以後において，両側対光反射消失，もしくは両側の瞳孔および角膜反射消失を使用することを推奨する。予後不良を評価するためにROSCから少なくとも72時間後に計測された短潜時体性感覚誘発電位（short latency somatosensory evoked potential, SSEP）のN20波の両側消失を使用することを推奨する。予後不良を評価するために，BIS（bispectral index）の使用を避けるように推奨する。【体温管理療法を施行していないROSC後昏睡患者の予後評価】ROSC後72時間以降における対光反射消失を予後不良の評価に用いることを推奨する。ROSC後から72時間以内でのSSEP N20波の両側消失を，予後不良の評価に用いることを推奨する。

Status of and problems concerning neonatal resuscitation in Japan in 2015.

The International Liaison Committee on Resuscitation (ILCOR) published Consensus 2015 in October 2015. Thereafter, the Japanese version of neonatal cardiopulmonary resuscitation programs was revised. Prior to the revision, we re-conducted questionnaire surveys in three types of medical facilities in January 2015. Targeted groups included (i) 277 training hospitals authorized by the Japanese Society of Perinatal/Neonatal Medicine for training of physicians specialized in perinatal care (neonatology) in January 2015 (training hospitals; response rate, 70.8%); (ii) 459 obstetric hospitals/clinics (response rate, 63.6%); and (iii) 453 midwife clinics (response rate, 60.9%). The survey included systems of neonatal resuscitation, medical equipment and practices, and education systems. The results were compared with that of similar surveys conducted in 2005, 2010 and 2013. Almost all results were generally improved compared with past surveys. In training hospitals, however, the use of oxygen blenders or manometers was not widespread. Only 35% of institutions used continuous positive airway pressure systems frequently, and expert neonatal resuscitation doctors attended all deliveries in only 6% of training centers. In addition, only 71% of training hospitals had brain therapeutic hypothermia facilities. Not all obstetric hospitals/clinics prepared pulse oximeters, and only a few used manometers frequently. Some midwife clinics did not keep warming equipment, and few midwife clinics were equipped with pulse oximeters. In addition, some midwife clinics did not prepare ventilation bags (masks). The equipment in Japanese delivery rooms is variable. Further efforts need to be made in the distribution of neonatal resuscitation devices and the dissemination of techniques.

Respiratory Stabilization after Delivery in Term Infants after the Update of the Japan Resuscitation Council Guidelines in 2010

Background: The Japan Resuscitation Council (JRC) updated the guidelines for neonatal cardiopulmonary resuscitation in 2010, which recommended appropriate oxygen supplementation under the assessment of oximetry, with continuous positive airway pressure (CPAP) as a consideration in the delivery room. Whether this update has resulted in an improvement of respiratory stabilization in term neonates has not been well investigated to date. Objectives: The aim of this study is to evaluate the impact of the update of the JRC Guidelines in 2010 on the frequency of respiratory support for term neonates within 24 h of life in the nursery or neonatal intensive care unit (NICU). Methods: We conducted a retrospective, single-center study using data of term neonates born between 2008 and 2009 (defined as ‘group 1', before the update of the guidelines), and between 2011 and 2012 (defined as ‘group 2', after the update of the guidelines). We compared resuscitation procedures in the delivery room and respiratory support in the nursery or NICU within 24 h of life between the two groups. Respiratory support included oxygen therapy, nasal CPAP and mechanical ventilation. Results: A total of 5,036 infants were analyzed. In group 2, oxygen administration in the delivery room was significantly decreased (38.9 vs. 22.1%, p < 0.001) and face mask CPAP in the delivery room increased (1.7 vs. 11.1%, p < 0.001). The prevalence of respiratory support within 24 h of life in the nursery or NICU increased significantly in group 2 (group 1, 6.8% vs. group 2, 16.6%, p < 0.001). Conclusions: The update of the JRC Guidelines in 2010 resulted in an increase of respiratory support for term infants within 24 h of life.

Pulmonary air leak associated with CPAP at term birth resuscitation

ObjectiveThe Japan Resuscitation Council (JRC) Guidelines 2010 for neonatal resuscitation introduced continuous positive airway pressure (CPAP) in delivery room. The present study evaluated the effect of CPAP for pulmonary air...

Correlation between umbilical cord hemoglobin and rate of jaundice requiring phototherapy in healthy newborns.

Delay of umbilical cord clamping by at least 1 min is recommended for newborns not requiring resuscitation in the International Liaison Committee On Resuscitation-Consensus on Science with Treatment Recommendations (ILCOR-CoSTR) 2010 guidelines. The delay in clamping improves iron status through early infancy but may increase the likelihood of jaundice requiring phototherapy. The present study investigated the relationship between umbilical cord hemoglobin and the rate of jaundice requiring phototherapy in healthy Japanese newborns. Cord hemoglobin was measured in healthy newborns and the rate of infants receiving phototherapy for jaundice and other data were obtained from medical records. Jaundice requiring phototherapy mostly occurred in association with high cord blood hemoglobin, which is increased by delayed cord clamping. Higher cord hemoglobin may increase neonatal jaundice in newborns in Japan, therefore the present results support the Japan Resuscitation Council guideline 2010, which does not recommend delay of umbilical cord clamping by at least 1 min, in contrast to the ILCOR guidelines.

Systematic review of the use of intravenous amiodarone and nifekalant for cardiopulmonary resuscitation in Japan

BackgroundIntravenous amiodarone is considered to be the first-line drug for the treatment of ventricular tachycardia or fibrillation. However, in Japan, nifekalant had been used before the introduction of amiodarone; therefore, most clinical studies on amiodarone use have been small-scale studies. The aim of the present study was to review the literature concerning the actual use of amiodarone and nifekalant in order to evaluate the effects of both drugs and the most appropriate mode of administration. MethodsThe Japan Medical Abstracts Society, PubMed, and Scopus databases were used to identify the reports. The resulting data were used for a systematic review focusing on the effectiveness of amiodarone in comparison with that of nifekalant and the dose differential effect of amiodarone. ResultsThe search returned 9 studies, including 310 patients, that compared the effectiveness of amiodarone and nifekalant, as well as 3 studies, including 108 patients, that analyzed the effectiveness of treatment according to amiodarone dose. Of 418 patients, 187 in whom amiodarone was used for cardiopulmonary resuscitation (CPR) were included in a review that compared the doses recommended by Japanese guidelines 2009 (125mg intravenous [i.v.] over 10min) and the American Heart Association guidelines (300mg bolus i.v.). Amiodarone and nifekalant were equally effective in preventing electrical storm (67% vs. 67%). The defibrillation effect for CPR was also equal in the 2 groups (60% vs. 54%). Hypotension and bradycardia were recorded as adverse effects in the amiodarone group (9.5% and 5.3%), whereas torsades de pointes was observed in the nifekalant group (1.4%). In the analysis of the dose-differential effect of amiodarone, the rates of successful return of spontaneous circulation and discharge survival were higher in the 125-mg slow i.v. group than in the 300-mg bolus i.v. group (76% vs. 53% and 54% vs. 26%, respectively). ConclusionsAmiodarone and nifekalant were equivalent in their prophylactic and defibrillation efficacy. Concerning the initial amiodarone dose, the 125mg intravenous [i.v.] over 10min seemed to be more appropriate for the Japanese population.