Confirmed cardiac output on emergency medical services arrival as confounding by indication: an observational study of prehospital airway management in patients with out-of-hospital cardiac arrest

被引：5

作者：

Sakurai, Atsushi ^{[1
]}

Kinoshita, Kosaku ^{[1
,56
]}

Maeda, Yukihiro ^{[2
]}

Homma, Yosuke ^{[3
]}

Tahara, Yoshio ^{[4
]}

Yonemoto, Naohiro ^{[5
]}

Nagao, Ken ^{[6
,29
]}

Yaguchi, Arino ^{[7
,19
]}

Morimura, Naoto ^{[8
,25
]}

Inokuchi, Sadaki ^{[9
]}

Masui, Yoshihiro ^{[10
]}

Miura, Kunihisa ^{[11
]}

Tsutsumi, Haruhiko ^{[12
]}

Takuma, Kiyotsugu ^{[13
]}

Atsushi, Ishihara ^{[14
]}

Nakano, Minoru ^{[15
]}

Tanaka, Hiroshi ^{[16
]}

Ikegami, Keiichi ^{[17
]}

Arai, Takao ^{[18
]}

Yaguchi, Arino ^{[7
,19
]}

Kitamura, Nobuya ^{[20
]}

Oda, Shigeto ^{[21
]}

Kobayashi, Kenji ^{[22
]}

Suda, Takayuki ^{[23
]}

Ono, Kazuyuki ^{[24
]}

Morimura, Naoto ^{[8
,25
]}

Furuya, Ryosuke ^{[26
]}

Koido, Yuichi ^{[27
]}

Iwase, Fumiaki ^{[28
]}

Nagao, Ken ^{[6
,29
]}

Kanesaka, Shigeru ^{[30
]}

Okada, Yasusei ^{[31
]}

Unemoto, Kyoko ^{[32
]}

Sadahiro, Tomohito ^{[33
]}

Iyanaga, Masayuki ^{[34
]}

Muraoka, Asaki ^{[35
]}

Hayashi, Munehiro ^{[36
]}

Ishimatsu, Shinichi ^{[37
]}

Miyake, Yasufumi ^{[38
]}

Yokokawa, Hideo ^{[39
]}

Koyama, Yasuaki ^{[40
]}

Tsuchiya, Asuka ^{[41
]}

Kashiyama, Tetsuya ^{[42
]}

Hayashi, Munetaka ^{[43
]}

Oshima, Kiyohiro ^{[44
]}

Kiyota, Kazuya ^{[45
]}

Hamabe, Yuichi ^{[46
]}

Yokota, Hiroyuki ^{[47
]}

Hori, Shingo ^{[48
]}

Inaba, Shin ^{[49
]}

机构：

[1] Nihon Univ, Sch Med, Dept Acute Med, Div Emergency & Crit Care Med,Itabashi Ku, Tokyo, Japan

[2] Nihon Univ, Sch Med, Dept Hlth Care Serv Management, Itabashi Ku, Tokyo, Japan

[3] Tokyo Bay Urayasu Ichikawa Med Ctr, Emergency Med, Urayasu, Japan

[4] Natl Cerebral & Cardiovasc Ctr Hosp, Suita, Osaka, Japan

[5] Kyoto Univ, Dept Publ Hlth, Grad Sch Med, Kyoto, Japan

[6] Nihon Univ Hosp, Cardiovasc Ctr, Chiyoda Ku, Tokyo, Japan

[7] Tokyo Womens Med Univ, Dept Crit Care & Emergency Med, Shinjuku Ku, Tokyo, Japan

[8] Univ Tokyo, Dept Acute Med, Grad Sch Med, Bunkyo Ku, Tokyo, Japan

[9] Tokai Univ, Sch Med, Hiratsuka, Kanagawa, Japan

[10] St Marianna Univ, Sch Med, Yokohama Seibu Hosp, Yokohama, Kanagawa, Japan

[11] Koto Hosp, Tokyo, Japan

[12] Saitama Med Ctr, Adv Tertiary Med Ctr, Saitama, Japan

[13] Kawasaki Municipal Hosp Emergency & Crit Care Ctr, Kawasaki, Kanagawa, Japan

[14] Yokohama Municipal Citizens Hosp, Yokohama, Kanagawa, Japan

[15] Japanese Red Cross Maebashi Hosp, Maebashi, Gunma, Japan

[16] Juntendo Univ, Urayasu Hosp, Urayasu, Japan

[17] Dokkyo Med Univ, Koshigaya Hosp, Mibu, Tochigi, Japan

[18] Tokyo Med Univ, Hachioji Med Ctr, Tokyo, Japan

[19] Tokyo Womens Med Univ Hosp, Tokyo, Japan

[20] Kimitsu Chuo Hosp, Chiba, Japan

[21] Chiba Univ, Grad Sch Med, Chiba, Japan

[22] Saiseikai Utsunomiya Hosp, Utsunomiya, Tochigi, Japan

[23] Mito Saiseikai Gen Hosp, Mito, Ibaraki, Japan

[24] Dokkyo Med Univ, Mibu, Tochigi, Japan

[25] Yokohama City Univ, Med Ctr, Yokohama, Kanagawa, Japan

[26] Natl Hosp Org Yokohama Med Ctr, Yokohama, Kanagawa, Japan

[27] Natl Disaster Med Ctr, Tachikawa, Tokyo, Japan

[28] Yamanashi Prefectural Cent Hosp, Yamanashi, Japan

[29] Surugadai Nihon Univ Hosp, Tokyo, Japan

[30] Yokohama Rosai Hosp, Yokohama, Kanagawa, Japan

[31] Showa Gen Hosp, Tokyo, Japan

[32] Nippon Med Sch, Tamanagayama Hosp, Tokyo, Japan

[33] Tokyo Womens Med Univ, Yachiyo Med Ctr, Tokyo, Japan

[34] Awa Reg Med Ctr, Chiba, Japan

[35] Todachuo Gen Hosp, Toda, Saitama, Japan

[36] Japanese Red Cross Med Ctr, Tokyo, Japan

[37] St Lukes Int Hosp, Tokyo, Japan

[38] Showa Univ, Sch Med, Tokyo, Japan

[39] Totsuka Kyoritsu Hosp 1, Yokohama, Kanagawa, Japan

[40] St Marianna Univ, Sch Med, Kawasaki, Kanagawa, Japan

[41] Natl Hosp Org Mito Med Ctr, Mito, Ibaraki, Japan

[42] Tokyo Metropolitan Tama Med Ctr, Tokyo, Japan

[43] Showa Univ, Fujigaoka Hosp, Tokyo, Japan

[44] Gunma Univ, Grad Sch Med, Maebashi, Gunma, Japan

[45] Saitama Red Cross Hosp, Saitama, Japan

[46] Tokyo Metropolitan Bokutoh Hosp, Tokyo, Japan

[47] Nippon Med Coll Hosp, Tokyo, Japan

[48] Keio Univ Hosp, Tokyo, Japan

[49] Chiba Emergency Med Ctr, Chiba, Japan

[50] Teikyo Univ, Sch Med, Tokyo, Japan

来源：

EMERGENCY MEDICINE JOURNAL | 2019年 / 36卷 / 07期

关键词：

cardiac arrest; emergency care systems; efficiency; prehospital care; clinical management; resuscitation; effectiveness; SPONTANEOUS CIRCULATION; ASSOCIATION; OUTCOMES; RETURN;

D O I：

10.1136/emermed-2018-208107

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objectives Many registry studies on patients with out-of-hospital cardiac arrest (OHCA) have reported that conventional bag-valve-mask (BVM) ventilation is independently associated with favourable outcomes. This study aimed to compare the data of patients with OCHA with confirmed cardiac output on emergency medical services (EMS) arrival and consider the confounding factors in prehospital airway management studies. Methods This was a cohort study using the registry data for survivors after out-of hospital cardiac arrest in the Kanto region at 2012 in Japan (SOS-KANTO 2012). Survivors who received advanced airway management (AAM) group and a BVM group were compared for confirmed cardiac output on EMS arrival and neurolgical outcome at 1 month. Favourable neurological outcome was defined as a score of one or two on the Cerebral Performance Categories Scale. Multivariable logistic regression was used to adjust the neurological outcome by age, gender, cardiac aetiology, witnessed arrest, shockable rhythm, cardiopulmonary resuscitation performed by a bystander, BVM at prehospital ventilation and presence of confirmed cardiac output on EMS arrival. Results A total of 16 452 patients were enrolled in the SOS-KANTO 2012 study, and of those data 12 867 were analysed; 5893 patients comprised the AAM group and 6974 comprised the BVM group. Of the study participants, 386 (2.9%) had confirmed cardiac output on EMS arrival; 340 (2.6%) of the entire study group had a favourable neurological outcome. The proportion of patients with confirmed cardiac output on EMS arrival was significantly higher in the BVM group (272: 3.9%) than in the AAM group (114: 1.9%) (95% CI: 1.65 to 2.25). The proportion of patients with favourable neurological outcomes was 30% (117/386) in those with cardiac output on EMS arrival compared with 1.8% (223/12481) in those without. The OR for a good neurological outcome with BVM decreased from 3.24 (2.49 to 4.20) to 2.60 (1.97 to 3.44) when confirmed cardiac output on EMS arrival was added to the multivariable model analysis. Conclusion Confirmed cardiac output on EMS arrival should be considered as confounding by indication in observational studies of prehospital airway management.

引用

页码：410 / +

页数：6

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