Background: Last year, we have reported extracorporeal cardiopulmonary resuscitation (ECPR) improves the outcome of out-of hospital cardiac arrest. (SAVE-J study) Objectives: The aim is to determine the most effective indication criteria of ECPR. Method: The registered cases of SAVE-J from December 2008 to September 2011 were evaluated for cost effective analysis. The age, time to arrival, 6months outcome and the hospitalization costs were evaluated. The Quality Adjusted Life Years (QALY) and costs were evaluated for accumulation of Incremental Cost-Effectiveness Ratios (ICER). Different age groups and time to hospital arrival were sorted to extract data, and cost effectiveness of each group was compared. Result: The ICER of overall SAVE-J inclusion criteria was $85,800. By restricting to below the age of 50, the ICER was $54,800 and below the age of 40 was $38,300. With the sortation by arrival time, ICER was $64,100 within 25 minutes, and was $43,800 within 20 minutes. Conclusion: In Japan, implementation of new treatment is said to be about $50,000~60,000 per QALY. From cost-effectiveness point of view, the inclusion criteria for ECPR are below the age of 50, or arrival time to hospital within 20 minutes seems reasonable.
Rapid Response System (RRS)は病態変化を早期に察知し,迅速に対応することで,院内心停止などを軽減する医療安全管理システムである。「Rapid Response System 運用指針」はRRS の効果的な運用により,病状増悪時の対応を標準化することを目指して作成された。本指針は組織体制とRRS の運用から構成されている。組織体制に関しては,病院管理者が責任者となって運営委員会を設置し,システムの計画・監督・質改善を行うことが推奨される。各施設に最適化された運営マニュアルの作成を推奨し,主治医チームと対応チームが連携することを提案する。一方,RRS の運用面では,システムの維持運営とスタッフ教育を推奨し,起動基準の周知とバイタルサインの適切な測定を推奨する。また,迅速な対応を提案し,起動事例のデータ収集と分析を推奨する。また,各事例を検討し、その結果を関連各所にフィードバックすることも提案する。
Abstract Out‐of‐hospital cardiac arrest (OHCA) is a major health concern in Japan and other developed countries with aging populations. Improvements in OHCA outcomes require streamlining the chain of survival. Deployment of public‐access automated external defibrillators (PADs) and defibrillation by bystanders is one strategy that may streamline the chain by reducing the time to defibrillation in individuals with shockable rhythms. Although the effectiveness of PAD programs in increasing survival to discharge has been reported, there have been criticisms and concerns about the small population impact, cost‐effectiveness, and potential negative impact on those with nonshockable rhythms. This article reviews relevant literature regarding the effectiveness and concerns regarding PAD for OHCA.
Background: In Japan, fatalities among patients who experienced an acute reaction following self-administration of novel psychoactive substances (NPS) have been more frequently reported since June 2014. Objective: This survey aimed to document and analyze trends in NPS consumption in emergency patients. Methods: We conducted a multicenter retrospective survey of patients who were transported to emergency facilities after consuming NPS-containing products between January 2013 and December 2014. Letters requesting participation were sent to 467 emergency facilities, and questionnaires were mailed to facilities that agreed to participate. Results: We surveyed 589 patients from 85 (18.2%) facilities. Most patients were male (89.6%) and young (median age, 30 years), and inhaled (88%) NPS contained in herbal products (80.5%). Harmful behavior was observed at the scene of acute reaction, including violence (6.9%), traffic accidents (4.9%), and self-injury or suicidal attempts (1.1%). Other than neuropsychiatric and physical symptoms, many patients also had physical complications such as rhabdomyolysis (17.5%), liver injury (12.4%), acute kidney injury (9%), and physical injury (1.9%). Of the 256 patients (43.5%) admitted to hospitals, 35 (5.9%) were hospitalized for seven or more days. Most patients (93.2%) completely recovered, although a few (1.4%) died. However, synthetic cannabinoids and synthetic cathinones were only detected in the blood of five patients. Conclusion: Consumption of NPS-containing products have been associated with harmful behaviors such as violence and traffic accidents, physical complications (e.g., rhabdomyolysis, liver injury), death, or physical and neuropsychiatric symptoms. Compared to a previous survey (2006–2012), the present survey revealed more severe toxicity.
Backgrounds: There have been few suggestions for communities how to train people in cardiopulmonary resuscitation (CPR) and to increase bystander CPR in a community. We developed a simplified 45-min training program of chest compression-only CPR (CCCPR) and have been promoting this short CPR training program in addition to conventional CPR training program. Objective: The objective of this study is to assess temporal trends in the proportion of bystander CPR and good quality CPR in the target area where we try to disseminate CPR more by use of simplified CPR training program with CCCPR. Method Design: A community-based intervention trial based on a population-based registry. Main outcome measure: Bystander CPR (chest compression-only and conventional) and good quality CPR among the bystander CPR. Participants: Citizens in Toyonaka City (population: approximately 380,000). Since Apr. 2010, we have trained for 14.9% of the population CPR (9.2% with CCCPR and 5.7% conventional CPR). Proportion of bystander C...
Neuromuscular blocking agents are used to control shivering in cardiac arrest patients treated with target temperature management. However, their effect on outcomes in patients treated with extracorporeal cardiopulmonary resuscitation is unclear.This study was a secondary analysis of the SAVE-J II study, a retrospective multicenter study of 2175 out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation in Japan. We classified patients into those who received neuromuscular blocking agents and those who did not and compared in-hospital mortality and incidence rates of favorable neurological outcome and in-hospital pneumonia between the groups using multivariable regression models and stabilized inverse probability weighting with propensity scores.Six hundred sixty patients from the SAVE-J II registry were analyzed. Neuromuscular blocking agents were used in 451 patients (68.3%). After adjusting for potential confounders, neuromuscular blocking agents use was not significantly associated with in-hospital mortality (aHR 0.88; 95% CI, 0.67-1.14), favorable neurological outcome (aOR 0.85; 95% CI, 0.60-1.11), or pneumonia (aOR 1.52; 95% CI, 0.85-2.71). The results for in-hospital mortality (aHR 0.89; 95% CI, 0.64-1.25), favorable neurological outcome (aOR 0.94; 95% CI, 0.59-1.48) and pneumonia (aOR 1.59; 95% CI, 0.74-3.41) were similar after weighting was performed.Although data on the rationale for using neuromuscular blocking agents were unavailable, their use was not significantly associated with outcomes in out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation and targeted temperature management. Neuromuscular blocking agents should be used based on individual clinical indications.
We presented a 65-year-old man with the right occipital dural arteriovenous malformation (AVM) who first experienced photopsia in his left inferior quadrantanopic field and then developed formed hallucinations 8 days later. His visual hallucinations disappeared with saccadic eye movements. EEG showed no epileptic discharge. MRI revealed hyperintensity in the right medial occipital lobe on proton density image. 123I-IMP SPECT during the hallucinations revealed decrease of regional cerebral blood flow (r-CBF) not only in the right medial occipital lobe but also in the right lateral occipital and in the right medial temporal lobe. Both left inferior quadrantanopia and visual hallucinations disappeared following the treatment of the dural AVM by transarterial embolizations. Because the lesion on MRI improved after the treatment, we considered that the lesion was brain edema, not infarction. Additionally decreased r-CBF in the temporo-occipital lesion on SPECT improved after the treatment, we emphasized the role of the temporo-occipital lesion as the cause of visual hallucinations in the hemianopic field.
