Part 1: Executive summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations☆,☆☆

The effectiveness of advanced airway management (AAM) for out-of-hospital cardiac arrest (OHCA) has been reported differently in each region; however, no study has accounted for the regional differences in the association between the timing of AAM implementation and neurological outcomes.

This study aimed to evaluate the association between the timing of patient or prefecture level AAM and a favorableneurological outcome defined by cerebral performance category 1 or 2 (CPC 1–2).

A retrospective cohort study was conducted using data from the All-Japan Utstein Registry between 2013 and 2017. We included patients aged ≥8 years with OHCA for whom AAM (i.e., supraglottic airway or endotracheal intubation) was performed in a prehospital setting (n = 182,913). We divided the patients into shockable (n = 11,740) and non-shockable (n = 171,173) cohorts based on the initial electrocardiogram rhythm. Multilevel logistic regression analysis estimated the association between AAM time (patient contact-to-AAM performance interval) at the patient level (1-min unit increments), prefecture level (> 9.2 min vs. ≤ 9.2 min) and CPC 1–2.

A delay in AAM time was negatively associated with CPC 1–2 (adjusted odds ratio [AOR], 0.92, 0.96; 95% confidence interval [CI], 0.90–0.93, 0.95–0.97, respectively), regardless of initial rhythm. At the prefecture level, a delay in AAM time was negatively associated with CPC 1–2 (AOR, 0.77, 0.68; 95% CI, 0.58–1.04, 0.50–0.94, respectively) only in the non-shockable cohort.

A delay in AAM performance was negatively associated with CPC 1–2 in both shockable and non-shockable cohorts. Moreover, a delay in AAM performance at the prefecture level was negatively associated with CPC 1–2 in the non-shockable cohort.

Several studies have examined the association between advanced airway management (AAM) and survival for arrest that is non-shockable, noncardiac in origin, or due to suffocation; however, the efficacy of prehospital AAM compared with no AAM following foreign body removal by emergency medical services (EMS) has not been examined. We aimed to compare neurological outcomes in patients after out-of-hospital cardiac arrest (OHCA) due to foreign body airway obstruction (FBAO) managed with and without AAM after foreign body removal.

This retrospective observational cohort study used all emergency transportation data of Japan and the All-Japan Utstein Registry. We included patients with OHCA aged ≥18 years undergoing resuscitation and removal of airway foreign bodies by EMS from January 2015 to December 2017. The exposure of interest was prehospital AAM by EMS after foreign body removal, and the primary outcome was a favorable neurological outcome at hospital discharge (i.e., a cerebral performance category of 1–2).

Overall, 329,098 adults had OHCAs and 23,060 had foreign bodies removed from their airways; 3681 adult patients met our eligibility criteria and were divided as: AAM (2045) and non-AAM (1636) groups. Propensity score matching resulted in 1210 matched pairs with balanced baseline characteristics between the groups. The rate of favorable neurological outcome was significantly lower in the AAM group than in the non-AAM group (OR 0.34, 95% CI 0.19–0.62). However, survival was not significantly different between the two groups (OR 1.08, 95% CI 0.84–1.37).

We have not demonstrated the benefit of AAM for patients with OHCA due to FBAO. Further study will be required to confirm the efficacy of AAM for those patients.

Continuous renal replacement therapy (CRRT) was currently demonstrated to be an effective way to induce fast hypothermia and had proective effects on cardiac dysfunction and brain damage after cardiac pulmonary resuscitation (CPR). In the present study, we aimed to investigate the influence of extracorporeal circuit cooling using CRRT on renal and intestinal damage after CPR based on a porcine model.

32 pigs were subjected to ventricular fibrillation for 8 min, followed by CPR for 5 min before defibrillation. All were randomized to receive extracorporeal circuit cooling using CRRT (CRRT, n = 9), surface cooling (SC, n = 9), normothermia (NT, n = 9) or sham control (n = 5) at 5 min post resuscitation. Pigs in the CRRT group were cooled by 8-h CRRT cooling with the infusion line initially submerged in 4 °C of ice water and 16-h SC, while in the SC group by a 24-h SC. Temperatures were maintained at a normal range in the other two groups. Biomarkers in serum were measured at baseline and 1, 3, 6, 12, 24 and 30 h post resuscitation to assess organ functions. Additionally, tissues of kidney and intestine were harvested, from which the degree of tissue inflammation, oxidative stress, and apoptosis levels were analyzed.

The blood temperature decreased faster by extracorporeal circuit cooling using CRRT than SC (9.8 ± 1.6 vs. 1.5 ± 0.4 °C/h, P < 0.01). Post-resuscitation renal and intestinal injury were significantly improved in the 2 hypothermic groups compared to the NT group. And the improvement was significantly greater in animals received extracorporeal circuit cooling than those received surface cooling, from both the results of biomarkers in serum and pathological evidence.

Fast hypothermia induced by extracorporeal circuit cooling was superior to.

surface cooling in mitigating renal and intestinal injury post resuscitation.

This 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.

This 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 7 min, 8−10 min, and 11−20 min 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.

There 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; ≤7 min, 8–10 min, and 11–20 min, 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; ≤7 min, 8–10 min, and 11–20 min, respectively).

Providing 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.

Background: Early recognition of cardiac arrest is essential for increasing the likelihood of successful resuscitation. However, many factors could obstruct the recognition of cardiac arrest and delay the delivery of cardiopulmonary resuscitation and automated external defibrillator use. We have developed a new system using infrared light to recognize cardiac arrests during emergency. The aim of this study was to evaluate whether cardiac arrests could be appropriately diagnosed by this system in clinical practice.

Methods: During the initial treatment patients 18 years old and older with unconscious level of 300 on Japan Coma Scale were prospectively registered from May 1st 2016 through May 31st 2017 (University Hospital Medical Information Network-Clinical Trials Registry 000022137). The settings for this study were two critical care medical centers in Osaka Prefecture and two suburban emergency medical services in Chiba Prefecture and Osaka Prefecture in Japan. We evaluated each patient, using the diagnosis of cardiac arrest by relevant physicians or emergency medical services personnel as the “gold standard”. Finally, the sensitivity and specificity of the system in understanding whether the patient has cardiac arrest were assessed.

Results: Out of 207 unconscious patients, 163 patients were diagnosed as suffering from cardiac arrest and 44 patients were identified as experiencing pulsating cardiac rhythm. The developed system for diagnosing cardiac arrest when used within 10 s from the activation of the system had a sensitivity of 100% and a specificity of 55.2%. Additionally, the system had a sensitivity of 100% and a specificity of 63.6% for diagnosing cardiac arrest when used within 20 s from activation.

Conclusions: The newly developed system has 100% sensitivity in detecting cardiac arrests within 10 s from activation of the system in emergency settings. This developed system could help bystanders to promptly initiate resuscitation.