Satoshi Yoshimura1, Atsushi Hirayama2, Takeyuki Kiguchi1,3, Taro Irisawa4, Tomoki Yamada5, Kazuhisa Yoshiya6, Changhwi Park7, Tetsuro Nishimura8, Takuya Ishibe9, Yoshiki Yagi10, Masafumi Kishimoto11, Toshiya Inoue12, Yasuyuki Hayashi13, Taku Sogabe14, Takaya Morooka15, Haruko Sakamoto16, Keitaro Suzuki17, Fumiko Nakamura18, Tasuku Matsuyama19, Yohei Okada1, Norihiro Nishioka1, Daisuke Kobayashi20, Satoshi Matsui21, Shunsuke Kimata1, Takeshi Shimazu4, Tetsuhisa Kitamura21, Taku Iwami1. 1. Department of Preventive Services, Kyoto University School of Public Health. 2. Public Health, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine. 3. Critical Care and Trauma Center, Osaka General Medical Center. 4. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine. 5. Emergency and Critical Care Medical Center, Osaka Police Hospital. 6. Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital. 7. Department of Emergency Medicine, Tane General Hospital. 8. Department of Critical Care Medicine, Osaka City University. 9. Department of Emergency and Critical Care Medicine, Kindai University School of Medicine. 10. Osaka Mishima Emergency Critical Care Center. 11. Osaka Prefectural Nakakawachi Medical Center of Acute Medicine. 12. Senshu Trauma and Critical Care Center. 13. Senri Critical Care Medical Center, Saiseikai Senri Hospital. 14. Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital. 15. Emergency and Critical Care Medical Center, Osaka City General Hospital. 16. Department of Pediatrics, Osaka Red Cross Hospital. 17. Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital. 18. Department of Emergency and Critical Care Medicine, Kansai Medical University. 19. Department of Emergency Medicine, Kyoto Prefectural University of Medicine. 20. Kyoto University Health Services. 21. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine.
Abstract
BACKGROUND: The aim of our study was to investigate in detail the temporal trends in in-hospital characteristics, actual management, and survival, including neurological status, among adult out-of-hospital cardiac arrest (OHCA) patients in recent years.Methods and Results: From the prospective database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan, we enrolled all OHCA patients aged ≥18 years for whom resuscitation was attempted, and who were transported to participating hospitals between the years 2013 and 2017. The primary outcome measure was 1-month survival with favorable neurological outcome after OHCA. Temporal trends in in-hospital management and favorable neurological outcome among adult OHCA patients were assessed. Of the 11,924 patients in the database, we included a total of 10,228 adult patients from 16 hospitals. As for in-hospital advanced treatments, extracorporeal cardiopulmonary resuscitation (ECPR) use increased from 2.4% in 2013 to 4.3% in 2017 (P for trend <0.001). However, the proportion of adult OHCA patients with favorable neurological outcome did not change during the study period (from 5.7% in 2013 to 4.4% in 2017, adjusted odds ratio (OR) for 1-year increment: 0.98 (95% confidence interval: 0.94-1.23)). CONCLUSIONS: In this target population, in-hospital management such as ECPR increased slightly between 2013 and 2017, but 1-month survival with favorable neurological outcome after adult OHCA did not improve significantly.
BACKGROUND: The aim of our study was to investigate in detail the temporal trends in in-hospital characteristics, actual management, and survival, including neurological status, among adult out-of-hospital cardiac arrest (OHCA) patients in recent years.Methods and Results: From the prospective database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan, we enrolled all OHCA patients aged ≥18 years for whom resuscitation was attempted, and who were transported to participating hospitals between the years 2013 and 2017. The primary outcome measure was 1-month survival with favorable neurological outcome after OHCA. Temporal trends in in-hospital management and favorable neurological outcome among adult OHCA patients were assessed. Of the 11,924 patients in the database, we included a total of 10,228 adult patients from 16 hospitals. As for in-hospital advanced treatments, extracorporeal cardiopulmonary resuscitation (ECPR) use increased from 2.4% in 2013 to 4.3% in 2017 (P for trend <0.001). However, the proportion of adult OHCA patients with favorable neurological outcome did not change during the study period (from 5.7% in 2013 to 4.4% in 2017, adjusted odds ratio (OR) for 1-year increment: 0.98 (95% confidence interval: 0.94-1.23)). CONCLUSIONS: In this target population, in-hospital management such as ECPR increased slightly between 2013 and 2017, but 1-month survival with favorable neurological outcome after adult OHCA did not improve significantly.