Study regarding the effects of biomarkers and advanced intensive cares on the survival among patients with out-of-hospital cardiac arrest

2018 Fiscal Year Final Research Report

• Project/Area Number: 16K09034
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Epidemiology and preventive medicine
• Research Institution: Osaka University
• Principal Investigator: Kitamura Tetsuhisa 大阪大学, 医学系研究科, 助教 (30639810)
• Project Period (FY): 2016-04-01 – 2019-03-31
• Keywords: 救急医学 / 蘇生科学 / 院外心停止 / 臨床疫学

Outline of Final Research Achievements

This study aimed to assess the effects of biomarkers and advanced intensive cares on the survival among patients with OHCA, and has been collected 8,721 OHCA patients from critical care medical centers in Osaka Prefecture between 2012 and 2016. In 1,516 adult patients with OHCA of cardiac origin who achieved return of spontaneous circulation (ROSC), the proportion of favorable neurological outcome (defined as cerebral performance category scale 1 or 2) decreased as the serum potassium level increased in the multivariable analysis (adjusted p for trend<0.001). In 2,894 adult patients with OHCA of non-traumatic origin who achieved ROSC, the proportions of 1-month survival with favorable neurological outcome were almost consistent, and there were no significant differences between the intra-aortic balloon pumping (IABP) use group and the non-IABP use group (adjusted odds ratio, 0.97; 95% confidence interval, 0.55-1.74) by using the propensity-score matched analysis.

Free Research Field

臨床疫学

Academic Significance and Societal Importance of the Research Achievements

院外心停止患者に対するバイオマーカーと高度集中治療に関する先行研究では、ガイドライン上で確立されるようなエビデンスは十分でなかった。本多施設共同前向きにおいて、高カリウム血症と院外心停止患者の予後との関係を明らかにした本解析は、院外心停止後転帰改善のための予後予測をつながり、病院搬送後の高度集中治療実施の可否などの基準を提案することができる。また、病院搬送後にIABPという循環補助デバイス導入が院外心停止患者の予後改善と明らかな関係は認められなかったことは、院外心停止患者への循環補助デバイスあり方に一石を投じ、心肺蘇生ガイドラインに貢献できるエビデンスと思われる。