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Nishiuchi T.,Kinki University | Hayashino Y.,Tenri Hospital | Iwami T.,Kyoto University | Kitamura T.,Osaka University | And 5 more authors.
Resuscitation | Year: 2014

Aims: The present study aimed to clarify the incidence and outcomes of sudden cardiac arrests in schools and the clinically relevant characteristics of individuals who experienced sudden cardiac arrests. Methods and results: We obtained data on sudden cardiac arrests that occurred in schools between January 1, 2005 and December 31, 2009 from the database of the Utstein Osaka Project, a population-based observational study on out-of-hospital cardiac arrests in Osaka, Japan. The data were analyzed to show the epidemiological features of sudden cardiac arrests in schools in conjunction with prehospital documentation. In total, 44 cases were registered as sudden cardiac arrests in schools during the study period. Of these, 34 cases had nontraumatic cardiac arrests. Twenty-one cases (62%) had pre-existing cardiac diseases and/or collapsed during physical exercise. Twenty-three cases (68%) presented with ventricular fibrillation or pulseless ventricular tachycardia, with cases of survival 1 month after cardiac arrest and those having favourable neurological outcome (Cerebral Performance Category 1 or 2) being 12 (52%) and 10 (43%), respectively. The incidence of sudden cardiac arrests in students was 0.23 per 100,000 persons per year, ranging from 0.08 in junior high school to 0.64 in high school. The incidence of sudden cardiac arrests in school faculty and staff was 0.51 per 100,000 persons per year, a rate approximately 2 times of that observed in the students. Conclusions: Although sudden cardiac arrests in schools is rare, they majorly occurred in individuals with cardiac diseases and/or during physical exercise and presented as ventricular fibrillation or pulseless ventricular tachycardia observed initially as cardiac arrhythmia. © 2014 Elsevier Ireland Ltd.

Hayashi Y.,Osaka Saiseikai Senri Hospital | Iwami T.,Kyoto University | Kitamura T.,Kyoto University | Nishiuchi T.,Osaka City University | And 6 more authors.
Circulation Journal | Year: 2012

Background: The effectiveness of epinephrine administration for cardiac arrests has been shown in animal models, but the clinical effect is still controversial. Methods and Results: A prospective, population-based, observational study in Osaka involved consecutive outof- hospital cardiac arrest (OHCA) patients from January 2007 through December 2009. We evaluated the outcomes among adult non-traumatic bystander-witnessed OHCA patients for whom the local protocol directed the emergency medical service personnel to administer epinephrine. After stratifying by first documented cardiac rhythm, outcomes were compared among the following groups: non-administration, ≤10, 11-20 and ≥21 min as the time from emergency call to epinephrine administration. A total of 3,161 patients were eligible for our analyses, among whom 1,013 (32.0%) actually received epinephrine. The epinephrine group had a significantly lower rate of neurologically intact 1-month survival than the non-epinephrine group (4.1% vs. 6.1%, P=0.028). In cases of ventricular fibrillation (VF) arrest, patients in the early epinephrine group who received epinephrine administration within 10 min had a significantly higher rate of neurologically intact 1-month survival compared with the non-epinephrine group (66.7% vs. 24.9%), though other epinephrine groups did not. In cases of non-VF arrest, the rate of neurologically intact 1- month survival was low, irrespective of epinephrine administration. Conclusions: The effectiveness of epinephrine after OHCA depends on the time of administration. When epinephrine is administered in the early phase, there is an improvement in neurological outcome from OHCA with VF.

Kitamura T.,Kyoto University | Iwami T.,Kyoto University | Nichol G.,University of Washington | Nishiuchi T.,Osaka Prefectural Senshu Critical Care Center | And 8 more authors.
European Heart Journal | Year: 2010

Aims The aim of this study was to determine relative risk (RR) of incidence and fatality of out-of-hospital cardiac arrest (OHCA) by gender and oestrogen status. Methods and results In a prospective, population-based observational study from 1998 through 2007, incidence and neurologically intact 1-month survival after OHCA were compared by gender after grouping: 0-12 years, 13-49 years, and ≥50 years according to menarche and menopause age. Among 26 940 cardiac arrests, there were 11 179 females and 15 701 males. Age-adjusted RR of females for OHCA incidence compared with males was 0.72 [95 confidence interval (CI), 0.58-0.91] in age 0-12 years, 0.39 (95 CI, 0.37-0.43) in age 13-49 years, and 0.54 (95 CI, 0.52-0.55) in age ≥50 years. Females aged 13-49 years had a significantly higher good neurological outcome than males [adjusted odds ratio (OR), 2.00 (95 CI 1.21-3.32)]. This sex difference was larger than that in the other age groups [adjusted OR, 0.82 (95 CI, 0.06-12.02) in age 0-12 years and 1.23 (95 CI, 0.98-1.54) in age ≥50 years]. Conclusion Reproductive females had a lower incidence and a better outcome of OHCA than females of other ages and males, which might be explained by cardioprotective effects of endogenous oestrogen on OHCA. © The Author 2010.

Hasegawa K.,Brigham and Women's Hospital | Hasegawa K.,Massachusetts General Hospital | Shigemitsu K.,Osaka Saiseikai Senri Hospital | Hagiwara Y.,Tokyo Metropolitan Childrens Medical Center | And 4 more authors.
Annals of Emergency Medicine | Year: 2012

Study objective: Although repeated intubation attempts are believed to contribute to patient morbidity, only limited data characterize the association between the number of emergency department (ED) laryngoscopic attempts and adverse events. We seek to determine whether multiple ED intubation attempts are associated with an increased risk of adverse events. Methods: We conducted an analysis of a multicenter prospective registry of 11 Japanese EDs between April 2010 and September 2011. All patients undergoing emergency intubation with direct laryngoscopy as the initial device were included. The primary exposure was multiple intubation attempts, defined as intubation efforts requiring greater than or equal to 3 laryngoscopies. The primary outcome measure was the occurrence of intubation-related adverse events in the ED, including cardiac arrest, dysrhythmia, hypotension, hypoxemia, unrecognized esophageal intubation, regurgitation, airway trauma, dental or lip trauma, and mainstem bronchus intubation. Results: Of 2,616 patients, 280 (11%) required greater than or equal to 3 intubation attempts. Compared with patients requiring 2 or fewer intubation attempts, patients undergoing multiple attempts exhibited a higher adverse event rate (35% versus 9%). After adjusting for age, sex, principal indication, method, medication, and operator characteristics, intubations requiring multiple attempts were associated with an increased odds of adverse events (odds ratio 4.5; 95% confidence interval 3.4 to 6.1). Conclusion: In this large Japanese multicenter study of ED patients undergoing intubation, we found that multiple intubation attempts were independently associated with increased adverse events. Copyright © 2012 by the American College of Emergency Physicians.

Nitta M.,Osaka Medical College | Kitamura T.,Osaka University | Iwami T.,Kyoto University | Nadkarni V.M.,Children's Hospital of Philadelphia | And 8 more authors.
Resuscitation | Year: 2013

Background: Children have better outcomes after out-of-hospital cardiac arrest (OHCA) than adults. However, little is known about the difference in outcomes between children and adults after OHCA due to drowning. Objectives: The aim of this study is to assess the outcome after OHCA due to drowning between children and adults. Our hypothesis is that outcomes after OHCA due to drowning would be in better among children (<18 years old) compared with adults (≥18 years old). Method: This prospective population-based, observational study included all emergency medical service-treated OHCA due to drowning in Osaka, Japan, between 1999 and 2010 (excluding 2004). Outcomes were evaluated between younger children (0-4 years old), older children (5-17 years old), and adults (≥18 years old). Major outcome measures were one-month survival and neurologically favorable one-month survival defined as cerebral performance category 1 or 2. Multivariate logistic regression analyses were used to account for potential confounders. Results: During the study period, 66,716 OHCAs were documented, and resuscitation was attempted for 62,048 patients (1300 children [2%] and 60,748 adults [98%]). Among these OHCAs, 1737 (3% of OHCAs) were due to drowning (36 younger children [2%], 32 older children [2%], and 1669 adults [96%]). The odds of one-month survival were significantly higher for younger children (28% [10/36]; adjusted odds ratio [AOR], 20.20 [95% confidence interval {CI} 7.45-54.78]) and older children (9% [3/32]; AOR, 4.47 [95% CI 1.04-19.27]) when compared with adults (2% [28/1669]). However, younger children (6% [2/36]; AOR, 5.23 [95% CI 0.52-51.73]) and older children (3% [1/32]; AOR, 2.53 [95% CI 0.19-34.07]) did not have a higher odds of neurologically favorable outcome than adults (1% [11/1669]). Conclusion: In this large OHCA registry, children had better one-month survival rates after OHCA due to drowning compared with adults. Most survivors in all groups had unfavorable neurological outcomes. © 2013 Elsevier Ireland Ltd.

Kitamura T.,Osaka University | Morita S.,Osaka Saiseikai Senri Hospital | Kiyohara K.,Tokyo Women's Medical University | Nishiyama C.,Kyoto University | And 6 more authors.
Resuscitation | Year: 2014

Background: Little is known about the improvement in out-of-hospital cardiac arrest (OHCA) survival among elderly patients. The aim of this study was to evaluate the trends in the survival after bystander-witnessed OHCA of cardiac origin in this age group. Methods: This prospective, population-based, observation of the whole population of Osaka, Japan included consecutive OHCA patients aged ≥65 years with emergency responder resuscitation attempts from January 1999 to December 2011. The primary outcome measure was one-month survival with neurologically favorable outcome, and the trends in the outcome from OHCA were evaluated by location. Multiple logistic regression analysis was used to assess factors that were potentially associated with neurologically favorable outcome. Results: During the study period, a total of 10,876 bystander-witnessed OHCA of cardiac origin were eligible for our analyses. In whole arrests, the proportion of one-month survival with neurologically favorable outcome improved from 1.4% in 1999 to 4.8% in 2011 (. P for trend <0.001). The proportion of neurologically favorable outcome in homes and public places improved from 0.7% in 1999 to 3.2% in 2011 (. P for trend <0.001) and from 4.2% in 1999 to 20.9% in 2011 (. P for trend <0.001), respectively, whereas, in nursing homes, the proportion of neurologically favorable outcome did not improve. In a multivariate analysis, bystander-initiated cardiopulmonary resuscitation and emergency response time were significant predictors for neurologically favorable outcome. Conclusions: In this population, survival from OHCA among elderly patients significantly improved during the study period, but the trends differed by the OHCA location. © 2014 Elsevier Ireland Ltd.

Nishiyama C.,Kyoto University | Iwami T.,Kyoto University | Kawamura T.,Kyoto University | Kitamura T.,Osaka University | And 6 more authors.
Resuscitation | Year: 2013

Objective: Little is known about which symptoms are manifested before out-of-hospital cardiac arrest (OHCA). The objective of this study is to describe the prodromal symptoms of OHCA focusing on the onset of the symptom in relation of etiology of cardiac arrests, and to analyze the association between those symptoms and their outcomes after OHCA. Methods: This prospective, population-based cohort study enrolled all persons aged 18 years or older who had experienced OHCA of presumed cardiac and non-cardiac origin that were witnessed by bystanders or emergency medical system (EMS) personnel in Osaka from 2003 through 2004. Results: There were 1042 were presumed to be of cardiac origin and 424 of non-cardiac. Patients with non-cardiac origin were more likely to have prodromal symptoms than those with cardiac etiology (70.0% vs. 61.8%, p= 0.003). Over 40% of OHCA regardless of etiology had displayed symptoms at least several minutes before their arrest (40.2% [259/644] in those of cardiac origin and 45.5% [135/297] in those of non-cardiac origin). As to cardiac origin, the most frequent prodromal symptom was dyspnea (27.6%), followed by chest pain (20.7%) and syncope (12.7%). For non-cardiac origin, the most frequent symptom was also dyspnea (40.7%), but chest pain was rarely presented (3.4%). Although, prodromal symptoms themselves were not associated with better neurological outcomes (adjusted odds ratio [AOR], 2.03; 95% confidence interval [CI], 1.00-4.13), earlier contact to a patient yielded better neurological outcomes (AOR per every one-minute increase, 0.90; 95% CI, 0.82-0.99). Conclusions: Many of OHCA regardless of etiology have prodromal symptoms before arrest. Prodromal symptoms induced early activation of the EMS system, and may thus improve outcomes after OHCA. © 2012 Elsevier Ireland Ltd.

Ito N.,Osaka Saiseikai Senri Hospital | Nanto S.,Osaka University | Nagao K.,Nihon University | Hatanaka T.,Emergency Life Saving Technique Academy | And 2 more authors.
Resuscitation | Year: 2012

Aim To investigate the association between regional brain oxygen saturation (rSO 2) on hospital arrival and neurological outcomes at hospital discharge in patients with out-of-hospital cardiac arrest (OHCA).Methods A prospective cohort study was conducted, registering 179 patients with OHCA who were referred to Senri Critical Care Medical Centre between April 2009 and June 2010. Of these patients, 92 met the inclusion criteria. The primary end point was " neurological outcomes" at hospital discharge according to the " Utstein style" guidelines.Results The overall rate of good neurological outcome at hospital discharge was 14% (n=13). Sixty-one patients with rSO 2 ≤25% showed poor neurological outcome in the receiver operating curve analysis (optimal cut-off point, 25%; sensitivity, 0.772; specificity, 1.000; positive predictive value, 1.000; area under the curve (AUC), 0.919; p<0.0001). The AUC for rSO 2 was greater than that for base excess (p=0.0461) or lactate (p=0.0128) measured on hospital arrival. Since rSO 2 >40% was previously collated with good neurological outcome after cardiovascular surgery, we categorised our patients into three groups in a post hoc analysis: patients with rSO 2 ≤25% (n=61); patients with rSO 2 26-40% (n=9) and patients with rSO 2 >40% (n=22). Patients with good neurological outcome were as follows: 0 (0%)/61 with rSO 2 ≤25%; two (22.2%)/9 with rSO 2 26-40% and 11 (50.0%)/22 with rSO 2 >40% (p<0.0001).Conclusion rSO 2 on hospital arrival may help predict neurological outcomes at hospital discharge in patients with OHCA. © 2011 Elsevier Ireland Ltd.

Yoshioka S.,Osaka Saiseikai Senri Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

We treated 9 patients diagnosed with brain metastasis from breast cancer. Although 1 patient was initially diagnosed as having Stage IV disease, 5 had Stage I/II early breast cancer. All patients had defined brain metastasis after chemotherapy. Brain metastasis was symptomatic in 7 patients, 4 of whom had brain edema, and asymptomatic in 2 patients. The median survival time from breast cancer metastasis was 23 days for patients who did not receive radiotherapy and 19.6 months for those who received radiotherapy. Among the patients treated with radiotherapy, the median survival time was 4.3 months for patients who did not receive further treatment and 19.7 months for those who received chemotherapy or chemotherapy with trastuzumab. One patient with a solitary brain metastasis underwent stereotactic radiosurgery, and treatment is being continued for 1 of the 2 patients who received systemic therapy after whole-brain radiotherapy and additional stereotactic radiosurgery at recurrence to control brain disease. Systemic treatment after radiotherapy is important for brain metastasis from breast cancer, and early diagnosis of brain metastasis facilitates the use of various available treatments.

Yoshioka S.,Osaka Saiseikai Senri Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011

We investigated 13 cases of axillary-lymph-node recurrence, who received an operation for an early stage breast cancer. They are the first recurrence of only regional without metastatic disease; the 4 patients, who had sentinel-lymph-node by biopsy at first operation, received an axillary lymph adenectomy, and 5 patients received re-lymph-adectomy after axillary lymph node dissection. The other 4 patients received only systemic therapy. Receptor conversion between primary and lymph-node recurrent site was identified for ER in 2 patients; one showed a lower expression of ER and the other showed for HER2. These led to a change in the subsequent treatment plan; 6 patients had systemic chemotherapy after recurrence, 1 patient had endocrine, 2 patients had trastuzumab and 4 patients continued the same treatment prior to surgery. Ten out of 13 patients were alive without recurrence, and 3 patients were with distant metastasis. However, one of the 3 patients who had a distant metastasis died due to brain and lung metastasis. Axillary node recurrence should be treated with axillary dissection, if possible, and receptor measurement in primary and recurrent site is useful for subsequent treatment.

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