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Soga T.,Nihon University | Nagao K.,Nihon University | Sawano H.,Saiseikai Senri Hospital | Yokoyama H.,National Cerebral and Cardiovascular Center | And 12 more authors.
Circulation Journal | Year: 2012

Background: Although therapeutic hypothermia is an effective therapy for comatose adults experiencing out-ofhospital shockable cardiac arrest, there is insufficient evidence that is also applicable for those with out-of-hospital non-shockable cardiac arrest. Methods and Results: Of 452 comatose adults treated with therapeutic hypothermia after return of spontaneous circulation (ROSC) subsequent to an out-of-hospital cardiac arrest of cardiac etiology, 372 who had a bystanderwitnessed cardiac arrest, target core temperature of 32-34°C and cooling duration of 12-72 h were eligible for this study (75 cases of non-shockable cardiac arrest, 297 cases of shockable cardiac arrest). The median collapse-to- ROSC interval was significantly longer in the non-shockable group than in the shockable group (30 min vs. 22 min, P=0.008), resulting in a significantly lower frequency of 30-day favorable neurological outcome in the non-shockable group compared with the shockable group (32% vs. 66%, P<0.001). However, an analysis of data in quartiles assigned to varying lengths of collapse-to-ROSC interval revealed a similar frequency of 30-day favorable neurological outcome among both groups when the collapse-to-ROSC interval was ≤16 min (90% non-shockable group vs. 92% shockable group; odds ratio 0.80, 95% confidence interval 0.09-7.24, P=0.84). Conclusions: Post-ROSC cooling is an effective treatment for patients with non-shockable cardiac arrest when the time interval from collapse to ROSC is short.


Nagao K.,Nihon University | Hase M.,Sapporo City University | Tahara Y.,Yokohama City University | Hazui H.,Osaka Mishima Emergency and Critical Care Center | And 7 more authors.
Circulation Journal | Year: 2011

Background: Mild hypothermia is an effective therapy for patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest. However, evidence of the effectiveness of therapeutic hypothermia (TH) remains unclear. Methods and Results: A multicenter registry in Japan (J-PULSE-HYPO study registry) was conducted to investigate the effectiveness of TH for post-resuscitation neurological dysfunction developing after out-of-hospital cardiac arrest from 14 institutions, between January 2005 and December 2009. The committee entrusted each hospital with the timing of cooling, cooling methods, target temperature, duration, and rewarming. There were 452 patients (375 men) enrolled into the registry. The mean age was 58.6±13.5 years. Initial electrocardiogram rhythm at the time of occurrence of the cardiac arrest showed 68.9% had ventricular fibrillation or pulseless ventricular tachycardia, 13.7% had pulseless electrical activity, and 9.1% had asystole. The median interval from the occurrence of cardiac arrest to ROSC was 26 min. The target core temperature during TH was 33.90.4°C and the mean duration of cooling was 31.513.9 h. Intra-aortic balloon pumping was used in 40.1% and percutaneous cardiopulmonary support in 22.6% of patients. At 30 days after cardiac arrest, the proportion of survival was 80.1% and the proportion of patients with favorable neurological functions, with a cerebral performance category score of 1 or 2, was 55.3%. Conclusions: The J-PULSE-HYPO study registry showed a clinical aspect of TH.


Hifumi T.,Kagawa University | Kuroda Y.,Kagawa University | Kawakita K.,Kagawa University | Sawano H.,Saiseikai Senri Hospital | And 11 more authors.
Circulation Journal | Year: 2015

Background: Because the initial (on admission) Glasgow Coma Scale (GCS) examination has not been fully evaluated in comatose survivors of cardiac arrest (CA) who receive therapeutic hypothermia (TH), the aim of the present study was to determine any association between the admission GCS motor score and neurologic outcomes in patients with out-of-hospital CA who receive TH. Methods and Results: In the J-PULSE-HYPO study registry, patients with bystander-witnessed CA were eligible for inclusion. Patients were divided into 3 groups based on GCS motor score (1, 2–3, and 4–5) to assess various effects on neurologic outcome. Univariate and multivariate analyses were performed to identify independent predictors of good neurologic outcome at 90 days. Of 452 patients, 302 were enrolled. There was a significant difference among the 3 patient groups with regard to neurologic outcome at 90 days in the univariate analysis. Multiple logistic regression analyses showed that the GCS motor score on admission, age >65 years, bystander cardiopulmonary resuscitation, the time from collapse to return of spontaneous circulation, and pupil size <4 mm were independent predictors of a good neurologic outcome at 90 days in cases of CA (GCS motor score, 4–5: odds ratio, 8.18; 95% confidence interval: 1.90–60.28; P<0.01). Conclusions: GCS motor score is an independent predictor of good neurologic outcome at 90 days in patients sustaining out-of-hospital CA who receive TH. © 2015, Japanese Circulation Society. All rights reserved.


PubMed | Sumitomo Hospital, Saiseikai Senri Hospital, Nihon University, Sapporo Medical University and 10 more.
Type: Journal Article | Journal: Journal of intensive care | Year: 2015

Therapeutic hypothermia (TH) is a standard strategy to reduce brain damage in post-cardiac arrest syndrome (PCAS) patients. However, it is unknown whether the target temperature should be adjusted for PCAS patients in different states.Participants in the J-PULSE-Hypo study database were divided into lower (32.0-33.5C; Group L) or moderate (34.0-35.0C; Group M) temperature groups. Primary outcome was a favourable neurological outcome (proportion of patients with a Glasgow-Pittsburgh Cerebral Performance Category [CPC] of 1-2 on day 30). We compared between the two groups and in subgroups of patients divided by age and resuscitation interval (interval from collapse to return of spontaneous circulation) by propensity score (PS) analysis.Overall, 467 participants were analysed. The proportions of patients with favourable neurological outcomes were as follows (Group L vs. Group M) (OR; Odds ratio): all patients, 64% (n=42) vs. 55% ((n=424) (PS; OR 1.381 (0.596-3.197)), P=0.452) and resuscitation interval30min, 88% (n=24) vs. 64% ((n=281) (PS; OR 7.438 (1.769-31.272)), P=0.007).PCAS patients with a resuscitation interval of <30min may be candidates for TH with a target temperature of <34C.University Hospital Medical Information Network (UMIN) Clinical Trials Registry UMIN000001935; available at: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000002348&language=J.


Yasuda S.,National Cerebral and Cardiovascular Center | Yasuda S.,Tohoku University | Sawano H.,Saiseikai Senri Hospital | Hazui H.,Osaka Mishima Emergency and Critical Care Center | And 7 more authors.
Circulation Journal | Year: 2010

Background: Nifekalant hydrochloride (NIF) is an intravenous class-III antiarrhythmic agent that purely blocks the K+-channel without inhibiting β-adrenergic receptors. The present study was designed to investigate the feasibility of NIF as a life-saving therapy for out-of-hospital ventricular fibrillation (VF). Methods and Results: The Japanese Population-based Utstein-style study with basic and advanced Life Support Education study was a multi-center registry study with 4 participating institutes located at the northern urban area of Osaka, Japan. Eligible patients were those treated with NIF because of out-of-hospital VF refractory to 3 or more precordial shocks and intravenous epinephrine. Between February 2006 and February 2007, 17 patients were enrolled for the study. The time from a call for emergency medical service to the first shock was 12 (6-26) min. The time from the first shock to the NIF administration was 25.5 (9-264) min and the usage dose of NIF was 25 (15-210) mg. When excluding 3 patients in whom percutaneous extracorporeal membrane oxygenation was applied before NIF administration, the rate of return of spontaneous circulation was 86% and the rate of admission alive to the hospital was 79%. One patient developed torsade de pointes. Conclusions: Intravenous administration of NIF seems to be feasible as a potential therapy for advanced cardiac life-support in patients with out-of-hospital VF, and therefore further study is warranted.


Takahashi C.,University of Toyama | Okudera H.,University of Toyama | Origasa H.,University of Toyama | Takeuchi E.,Kyoto Fushimishimizu Hospital | And 8 more authors.
American Journal of Emergency Medicine | Year: 2011

Objectives: The Emergency Coma Scale (ECS) was developed in Japan in 2003. We planned a multicenter study to evaluate the utility of the ECS by comparison of the ECS and the Glasgow Coma Scale (GCS). Methods: Ten medical facilities, including 4 university hospitals in Japan, participated in this study. We evaluated and recorded the level of consciousness, using the ECS and GCS, of all patients transported to these medical facilities by ambulance. We then performed a statistical analysis of the level of rater agreement of each scale using the average weighted κ coefficient according to the types of diagnosis at time of discharge and the occupations of the raters. We then evaluated the relationship between outcome of patients and their scores on the ECS and GCS by logistic regression analysis. Results: The ECS showed the greater agreement among raters in patient scoring (0.802). In patients with traumatic brain injury and cerebrovascular disease, the ECS also yielded the higher agreement (0.846 and 0.779, respectively). The ECS score appears to be more strongly related than the GCS to patient outcome as measured by the Glasgow Outcome Scale (GOS). Conclusions: Our results showed that the ECS is a simple and readily understandable coma scale for a wide range of professionals in the field of neurologic emergencies. Furthermore, ECS appears to be suitable for evaluating patients in neurologic emergency settings. © 2011 Elsevier Inc. All rights reserved.


Zushi R.,Osaka Mishima Emergency and Critical Care Center | Hazui H.,Osaka Mishima Emergency and Critical Care Center | Hoshiga M.,Osaka Medical College | Yagi Y.,Osaka Mishima Emergency and Critical Care Center | And 7 more authors.
Journal of Cardiology Cases | Year: 2010

A 31-year-old man suddenly collapsed at work. His colleagues witnessed the event, applied basic life support, and called for an ambulance. After the ambulance arrived, the initial rhythm was confirmed as ventricular fibrillation (VF) and he was defibrillated with an automated external defibrillator. Spontaneous circulation was regained at 8 min after collapse. He was thought to be a good candidate for therapeutic hypothermia because he was comatose and had survived outside hospital VF cardiac arrest due to cardiac etiology. However, he was taking immunosuppressive drugs after undergoing a kidney transplant. We obtained written, informed consent from the patient's family to start therapeutic hypothermia at 33.5-34.5 °C for 48 h, although he was at high risk for such induction. Serious complications and neurological deficits did not develop and the patient was referred to another hospital on day 42 for implantation with a cardioverter defibrillator. © 2009 Japanese College of Cardiology.


Majima N.,Osaka Medical College | Nishihara I.,Osaka Mishima Emergency and Critical Care Center | Yamaguchi K.,Kagoshima University | Kawakami M.,Osaka Mishima Emergency and Critical Care Center
Japanese Journal of Anesthesiology | Year: 2013

Background : It is known that patients with severe head injury experience marked hypercoagulability and excessive hyperfibrinolysis due to the release of tissue factors from injured cerebral parenchyma. Methods : We retrospectively evaluated the usefulness of tranexamic acid (TA) in patients with single, severe head trauma, who showed a Glasgow coma scale (GCS) ≦8 or D-dimer ≧20 μg·ml-1. Twenty-five patients receiving TA [TA (+)] were given the agent 2 g taking 30 minutes soon after their visit. Those not receiving TA [TA (-)] were 25 consecutive patients who met the criteria before the initiation of treatment with TA. Results : The mortality rate was 4% in TA (+) and 24% in TA (-), significantly lower than in the former. The prognosis showed a tendency to improve in TA (+), but without significant differences between the groups. D-dimer was compared between the groups with a favorable prognosis in TA (+) and those in TA (-), its value was significantly higher in the former (60±56 μg·ml-1) than the latter (28±27 μg·ml-1) group. In addition, no thrombotic complications occurred in the former. Conclusions : Patients with severe head injury receiving TA showed a significantly better mortality rate without complications suggesting its usefulness.


Takeshita H.,Osaka Mishima Emergency and Critical Care Center
Rinsho byori. The Japanese journal of clinical pathology | Year: 2011

Disaster medicine is a special field of medicine which is required at unexpected times under poor medical circumstances, such as the transport of several patients at once, complex information and lack of medical staff. In order to provide accurate diagnostic information under such poor medical conditions, it is necessary to establish a well-considered and functional system to prevent malpractice in a serial process from the identification of each patient to blood sampling, its analysis and reporting, and in the process of blood transfusion, as a typical example. We have established a diagnostic system based on a manual focusing on rapidity of procedures and prevention of malpractice consisting of a distinction between priority analysis (for blood gas and blood type) and secondary analysis, the development of a blood typing method, adoption of blood sampling with heparin and so on. On the basis of the characteristics of disaster medicine, we stressed the minimization of analytical items and simplification of analytical procedures as much as possible. In order to utilize this system effectively in a disaster, it is essential to implement periodic training and revision.


Ohno K.,Osaka Medical College | Yokota A.,Osaka Medical College | Hirofuji S.,Osaka Medical College | Kanbara K.,Osaka Medical College | And 2 more authors.
Journal of Orthopaedic Research | Year: 2010

To elucidate the pathophysiological mechanisms underlying chronic nerve-stretch injury, we gradually lengthened rat femurs by 15mmat the rate of 0.5mm/day(group L, n = 13). Thecontrol groups comprised sham-operated (group S, n = 10) and naive (group N,n = 8) rats. Immediately after the lengthening, we performed a conduction study on their sciatic nerves and harvested samples. Electrophysiological and histological analyses showed mild conduction slowing and axonal degeneration of unmyelinated fibers in group L rats. AlteredmRNAexpression of the voltage-gated sodium channels in the dorsal root ganglion was also observed. Tetrodotoxin-resistant (TTXR) sodium-channel Nav1.8 mRNA expression was significantly decreased and TTX-R sodium-channel Nav1.9 mRNA expression showed a tendency to decrease when compared with the mRNA expressions in the control groups. However, tetrodotoxin-sensitive (TTX-S) sodiumchannel Nav1.3 mRNA expression remained unaltered. The immunohistochemical alteration of Nav1.8 protein expression was parallel to the results of the mRNA expression. Previous studies involving neuropathic states have suggested that pain/paresthesia is modulated by a subset of sodium channels, including downregulation and/or upregulation of TTX-R and TTX-S sodium channels, respectively. Our findings indicate that Nav1.8 downregulation may be one of the pathophysiological mechanisms involved in limb lengthening-induced neuropathy. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

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