A newly developed termination of resuscitation rule in the field for refractory out-of-hospital cardiac arrest in Japanese aging society
| Project/Area Number |
18K09999
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Review Section |
Basic Section 58010:Medical management and medical sociology-related
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| Research Institution | Kanazawa University |
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Principal Investigator |
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| Project Period (FY) |
2018-04-01 – 2022-03-31
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| Project Status |
Completed (Fiscal Year 2021)
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| Budget Amount *help |
¥4,030,000 (Direct Cost: ¥3,100,000、Indirect Cost: ¥930,000)
Fiscal Year 2020: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000)
Fiscal Year 2019: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000)
Fiscal Year 2018: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
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| Keywords | 院外心停止 / 蘇生中止 / 疫学 / 医療社会学 / 転帰 / 病院前救護 / 心停止 / 地域医療 / 医療系社会学 / 心肺蘇生 |
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| Outline of Final Research Achievements |
We have developed and validated a novel termination-of-resuscitation rule (TOR) to identify patients eligible for field termination of cardiopulmonary resuscitation (CPR) with the specificity of >99% for predicting 1-month mortality after out-of-hospital cardiac arrest (OHCA), using All-Japan Utstein Registry data. Emergency medical services (EMS) personnel could consider TOR if patients with OHCA met all of the following five criteria: (1) initial asystole, (2) arrest unwitnessed by bystanders, (3) age ≧81 years, (4) no bystander interventions (CPR and public-access defibrillation), and (5) no return of spontaneous circulation after EMS-initiated CPR for 14 minutes. The specificity and positive predictive value for predicting 1-month mortality were 99.2% and 99.7%, respectively, Implementation of this novel rule would reduce patient transports to hospitals by 10.6% in the development group and 10.4% in the validation group.
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| Academic Significance and Societal Importance of the Research Achievements |
本研究は国家レベルの集計データを用いた観察研究であり、臨床的に意義のある成果である。本判断基準の導入は、蘇生に反応しない院外心停止者の不要な搬送を減らすことにより、救急搬送例の減少と救急隊活動の安全確保、医療資源の有効な利用および傷病者への尊厳尊重に役立つことが考えられる。しかし、現行法では救急隊が蘇生処置を現場で中止することは禁止されているため、実際の導入に際しては、病院前救護体制の変革が必要と考えられる。また、本研究は世界から注目されている院外心停止集計データを用いた観察研究であるが、記録の無い病院前および病院内での臨床データが欠如しているため、前向きの研究が今後必要であると考えられる。
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Report
(5 results)
Research Products
(42 results)
