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1. Physician's presence in pre-hospital setting improves one-month favorable neurological survival after out-of-hospital cardiac arrest: A propensity score matching analysis of the JAAM-OHCA Registry.

Author

Hatakeyama T, Kiguchi T, Sera T, Nachi S, Ochiai K, Kitamura T, Ogura S, Otomo Y, and Iwami T

Subjects
Adolescent, Adult, Cohort Studies, Hospitals, Humans, Japan epidemiology, Propensity Score, Registries, Cardiopulmonary Resuscitation, Emergency Medical Services, Out-of-Hospital Cardiac Arrest therapy, Physicians
Abstract

Background: Using the out-of-hospital cardiac arrest (OHCA) registry in Japan, we evaluated the effectiveness of physicians' presence in pre-hospital settings after adjusting in-hospital treatments., Methods: This was a multicenter cohort study. We registered all consecutive OHCA patients in Japan who, from 1 June 2014 through 31 December 2017, were transported to institutions participating in the Japanese Association for Acute Medicine OHCA registry. We included OHCA patients aged at least 18 years, with medical etiology, and who received resuscitation from emergency medical services (EMS) personnel and medical professionals in hospitals. The primary outcome was one-month favorable neurological survival. We estimated the propensity score by fitting a logistic regression model that was adjusted for several variables before the arrival of EMS personnel and/or pre-hospital physician. A multivariable logistic regression analysis in propensity score-matched patients was used to adjust confounders, including extracorporeal membrane oxygenation, percutaneous coronary intervention, intra-aortic balloon pumping, and targeted temperature management., Results: We analyzed 19,247 patients. Among them, 5.4% (N = 1040) had a neurologically favorable outcome. The adjusted odds ratio (AOR) of the physicians' presence compared with their absence for primary outcome was 1.84 (95% confidence interval (CI): 1.43-2.37). Among first documented non-shockable cardiac rhythm, the AOR was 1.51 (95% CI: 1.04-2.22). Among first documented shockable cardiac rhythm, the AOR of the physicians' presence for primary outcome was 1.15 (95% CI: 0.83-1.59)., Conclusion: The improved one-month favorable neurological survival was significantly associated with the physicians' presence in pre-hospital settings, compared with the physicians' absence., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Published
2021
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2. Cardiopulmonary Resuscitation in Adults Over 80: Outcome and the Perception of Appropriateness by Clinicians

Author

Druwe, Patrick, Benoit, Dominique D., Monsieurs, Koen, Gagg, James, Nakahara, Shinji, Alpert, Evan Avraham, van Schuppen, Hans, Elo, Gabor, Huybrechts, Sofie A., Mpotos, Nicolas, Joly, Luc-Marie, Xanthos, Theodoros, Roessler, Markus, Paal, Peter, Cocchi, Michael N., Bjorshol, Conrad, Nurmi, Jouni, Salmeron, Pascual Pinera, Owczuk, Radoslaw, Svavarsdottir, Hildigunnur, Cimpoesu, Diana, Raffay, Violetta, Pachys, Gal, De Paepe, Peter, Piers, Ruth, Hill, Michael, Spottl, Peter, Gemes, Geza, Grander, Wilhelm, Rugg, Christopher, Likar, Rudolf, von Lutterotti, Theresa, Mitterndorfer, Walter, Baumgartner, Karl, Trimmel, Helmut, Sator, Florian, Pogatschnigg, Michael, Rastner, Verena, Luger, Markus, Schinnerl, Adi, Fleischmann, Wolfgang, Predl, Barbara, Aigner, Patrick, Adler, Rene, Huybrechts, Sofie, Verbeeck, Kris, Van den Broeck, Jan, Vandereyken, Frederik, Leach, Robert, De Kock, Kurt, Raveel, Geert, Van Damme, Erwin, Riahi, Sami, Meuris, David, Engels, Jorge, Fabien, Guerisse, Vranckx, Marc, Kreps, Bernard, Imbo, Filip, Vantroyen, Barbara, Maules, Yves, Sabbe, Marc, Jensen, Peter, Tabrizi, Nima Hosseinpour, Vanelderen, Pascal, Beaune, Sebastien, Ageron, Francois-Xavier, Wargon, Mathias, Roupie, Eric, Gosse, Pierre, Faour, Ali, Duncan, Gregory, Dumas, Florence, Wiel, Eric, Fort, Pierre Arnaud, Jacquin, Laurent, Duval, Arnaud Depil, Boishardy, Fabrice, Freund, Yonathan, Broche, Claire, Giolito, Didier, Herve, Thierry, Rozenberg, Alain, Jardel, Benoit, Flemming, Andreas, Wiegand, Nicolai, Hagemann, Wolfgang, Mueller, Thorsten, Selis, Melanie, Deussen, Marc, Callies, Andreas, Schiffner, Jens, Strickmann, Bernd, Schwille, Ulrich, Christenhusz, Arjan, Weijschede, Frits, Juffermans, Erwin, Nienhuis, Angelique, Breeman, Wim, Landman, Esther, Vrusch, Rob, Wouters, Sven, Winkel, Steven, den Boer, Eugene, Ketelaar, Aart, Hutten, Albert, Fokker, Katinka, van Ree, Karin, Mulder, Peter Jan, Lambregts, Rini, Deasy, Conor, Gilligan, Peadar, Breslin, Tomas, Kennedy, Una, O'Connor, Gabrielle, Doyle, Mark, Fallon, Hilary, McDaid, Fiona, Yeung, Davy, Benger, Jonathan, Stacey, Victoria, Dorrian, Susan, Haig, Stephen, Byers, Sonia, McLauchlan, Chris, Watson, David, Robinson, Maria, Kendall, Jason, Whitfield, Richard, Foster, Theresa, Truhla, Anatolij, Skulec, Roman, Smrzova, Eva, Lejsek, Jan, Gregor, Roman, Sin, Robin, Kubalova, Jana, Kratochvil, Jaroslav, Zika, Jiri, Fiala, Hynek, Koci, Jaromir, Jelen, Stanislav, Galgoczy, Peter, Szabados, Gyorgy, Temesvari, Peter, Kalman, Attila, Zubek, Laszlo, Kovacs, Eniko, Kiss, Domonkos, Valent, Mihaly, Kanizsai, Peter, Wilanowski, Tomasz, Zemojtel, Lukasz, Dubieniecki, Maciej, Ingielewicz, Anna, Wozniak, Piotr, Galazkowski, Robert, Sirbu, Fernando, Milenkovic, Dusan, Trenkler, Stefan, Dobias, Viliam, Ilavsky, Michal, Bajerovska, Lubica, Kubova, Dana, Patras, Juraj, Ioannides, Marios, Georgiou, Marios, Venetsanos, Philipos, Adamos, Georgios, Barouxis, Dimitrios, Karlis, Georgios, Chalkias, Athanasios, Lecinena, Maria Angelez, Suero, Coral, Herrero, Pablo, Sanchez, Miquel, del Castillo, Juan Gonzalez, del Arco, Carmen, Ezponda, Francisco, Llorens, Pere, Boque, Carmen, Millan, Javier, Fernandez, Pablo, Mozota, Julian, Povar, Javier, Juarez, Ricardo, Puiguriguer, Jordi, Navarro, Carmen, Aguero, Clotilde, Gorjon, Esther, Monteagudo, Tania, Saenz, Fernando, Gomez, Ignacio, Picabea, Alberto, Espinosa, Salvador, Palviainen, Jan-Erik, Tavasti, Juhani, Hallikainen, Juhana, Suonpera, Ville, Suonsyrja, Timo, Kaartinen, Johanna, Hoppu, Sanna, Carrasco, Anton Berg, Jonsdottir, Hrafnhildur Lilja, Palsson, Njall, Petursdottir, Sigrun, Palmadottir, Helga, Oskarsson, Jon Palmi, Olafsson, Oddur, Acterberg, Joseph, Blindheim-Rodal, Lillyanne, Hauge, Martin, Ytreland, Sven, Steen-Hansen, Jon Erik, Wilson, Thomas, Naess, Kristoffer, Kurland, Lisa, Malmquist, Pia, Forberg, Jakob Lundager, Djarv, Therese, Fuenzalida, Pablo Aguilera, Lara, Barbara, Zalut, Todd, Weiser, Giora, Strugo, Refael, Jaffe, Eli, Krispil, David, Schwartz, Dagan, Raitter, Ravit, Zimmerman, Deena, Tzadik, Efrat, Markowitz, Samuel, Wacht, Oren, Inagaki, Nobuhiro, Hanada, Hiroyuki, Takahoko, Ken-ichi, Negishi, Masatoshi, Matsushima, Hisao, Kano, Hideki, Koyama, Teppei, Takegami, Tetsuro, Yanagawa, Youichi, Harada, Masahiro, Yasuda, Mitsuhiro, Inaba, Kensuke, Sakamoto, Yuichiro, Yamashita, Hisashi, Honma, Masato, Tanabe, Seizan, Nachi, Sho, Nodagashira, Tatsuya, Matoh, Fumitaka, Takahashi, Tomohiro, Sode, Yoshihisa, Liu, Keibun, Yonekawa, Chikara, Inoue, Teruhiro, Sumi, Tatsunori, Kan'o, Tomomichi, Shoko, Tomohisa, Ishikura, Ken, Suzuki, Shuichi, Kishimoto, Masafumi, Katsuhara, Kazuhiro, Yumoto, Tetsuya, Nishimura, Tetsuro, Yamada, Tomoki, Otani, Takayuki, Yoshida, Kosuke, Nakamura, Motohiro, Uemura, Shuji, Umezawa, Kougaku, Nakamura, Shunsuke, Sugino, Takahiko, Tsunoyama, Taichiro, Endo, Tomoyuki, Nishida, Masamichi, Yagi, Masaharu, Fujita, Motoki, Arends, Jack, Buonadonna, Michael, Narikawa, Kenji, Sakamoto, Tetsuya, Callaway, Clifton, Goldberg, Scott, Wilcox, Susan, Gaieski, David, Sanko, Stephen, Kang, Tarina, HUS Emergency Medicine and Services, Staff Services, Clinicum, Department of Diagnostics and Therapeutics, University of Helsinki, Kimmo Kontula Research Group, Graduate School, ACS - Diabetes & metabolism, APH - Quality of Care, ACS - Heart failure & arrhythmias, ACS - Amsterdam Cardiovascular Sciences, Anesthesiology, and REAPPROPRIATE Study Grp

Subjects
Male, medicine.medical_specialty, Resuscitation, media_common.quotation_subject, medicine.medical_treatment, education, 030204 cardiovascular system & hematology, Out of hospital cardiac arrest, 03 medical and health sciences, 0302 clinical medicine, AGE, Older patients, Japan, Perception, Physicians, Hospital discharge, Medicine, Humans, Cardiopulmonary resuscitation, media_common, Resuscitation Orders, Aged, 80 and over, business.industry, OF-LIFE, HOSPITAL CARDIAC-ARREST, 030208 emergency & critical care medicine, CARE, inappropriate care, Cardiopulmonary Resuscitation, United States, 3. Good health, Nursing Homes, Europe, Cross-Sectional Studies, 3121 General medicine, internal medicine and other clinical medicine, Emergency medicine, SURVIVAL, Female, Human medicine, Geriatrics and Gerontology, adults 80 and older, business, Nursing homes, ETHICS, Out-of-Hospital Cardiac Arrest
Abstract

OBJECTIVES: To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out‐of‐hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN: Subanalysis of an international multicenter cross‐sectional survey (REAPPROPRIATE). SETTING: Out‐of‐hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS: A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS: The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the “appropriate” subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the “uncertain” subgroup, and 2 of 107 (1.9%) in the “inappropriate” subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non‐shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non‐shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION: Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39–45, 2019

Published
2019

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