OBJECTIVES:To evaluate the cost-effectiveness of implementing an extracorporeal cardiopulmonary resuscitation (ECPR) strategy for refractory out-of-hospital cardiac arrest (OHCA) compared with current practice in Singapore, where it is not routinely used. DESIGN:We performed a simulation-based cost-effectiveness analysis using a decision tree to model acute phase and a Markov model for long-term outcomes over a lifetime horizon, from a healthcare provider perspective. SETTING:Singapore healthcare system. PATIENTS:Nontraumatic adult OHCA patients from Singapore with initial shockable rhythm and no prehospital return of spontaneous circulation were analyzed. INTERVENTIONS:We modeled the implementation of an ECPR strategy and compared it with current practice using only conventional cardiopulmonary resuscitation. Transition probabilities of existing practice were derived from the nationwide Singapore OHCA registry (Pan-Asian Resuscitation Outcomes Study: PAROS), (2010-2016), while ECPR outcomes were based on the Comprehensive Registry of Intensive Care for OHCA Survival in Osaka (Osaka CRITICAL study) (2012-2019). Costs and quality-adjusted life-years (QALYs) were compared between strategies, with scenario analyses conducted to assess the impact of lower age eligibility thresholds and increased transport time to extracorporeal membrane oxygenation-capable hospitals. Incremental cost-effectiveness ratios (ICERs) were estimated using a willingness-to-pay threshold of S$45,000 per QALY. MEASUREMENTS AND MAIN RESULTS:A total of 1462 OHCA cases from Singapore were analyzed; the mean age of patients was 57 years (sd, 11 yr), and 87% were male. In base-case analysis, ICER was estimated at $34,320/QALY, with a positive net monetary benefit of $8,532. Scenario analyses demonstrated that an age-restricted ECPR strategy (< 65 yr) yielded a similar ICER ($33,469/QALY) to the base case. In contrast, incorporating a 10-minute transport extension slightly exceeded the willingness-to-pay threshold ($47,158/QALY). CONCLUSIONS:In this modeling study, adopting an ECPR strategy for OHCA in Singapore was likely to be cost-effective across different age-based eligibility thresholds; however, it was sensitive to delays in transport time. Further implementation research is important to guide scale-up and policy decisions.

Abstract Background A lower serum lactate/albumin ratio has been linked to favorable outcomes in critically ill patients. Objective We investigated whether the serum lactate/albumin ratio could predict the likelihood of benefiting from targeted temperature management (TTM) after out‐of‐hospital cardiac arrest (OHCA). Methods Using a nationwide Japanese registry, we reviewed patients aged ≥18 years with OHCA of medical cause who received TTM during the study period. The patients were grouped by serum lactate/albumin ratio quartile at hospital arrival (first quartile, ≤1.77, n = 219; second quartile, 1.77 to ≤2.59, n = 211; third quartile, 2.59 to ≤3.62, n = 212; fourth quartile, >3.62, n = 191) for targeted temperatures of ≤34°C and ≥35°C. The primary outcome was 30‐day survival with favorable neurological outcomes, defined as Cerebral Performance Category scores of 1 or 2. Results The targeted temperature was ≤34°C in 833 patients and ≥35°C in 437 patients. Multivariable logistic regression analysis in the ≤34°C subgroup illustrated that patients in the second [adjusted odds ratio (AOR) = 0.60, 95% confidence interval (CI) = 0.36–0.99], third (AOR = 0.24, 95% CI = 0.14–0.39), and fourth quartiles (AOR = 0.12, 95% CI = 0.06–0.22) had lower odds of favorable neurological outcomes than those in the first quartile. Similar results were obtained in the ≥35°C subgroup (p for interaction = 0.86). Conclusions Among patients who received TTM after OHCA, those in the lowest serum lactate/albumin ratio quartile at hospital admission experienced significantly better neurological outcomes.

Transcatheter arterial embolization is an essential treatment for lower gastrointestinal bleeding; however, embolization of multiple vasa recta carries a substantial risk of bowel infarction. This study aimed to evaluate the safety of quick-soluble gelatin sponge particles (QS) compared with conventional gelatin sponge particles (GS) in a canine model of superior mesenteric artery branch embolization. This study planned to include 10 Beagle dogs. The entire ileocolic artery and its vasa recta were non-selectively embolized to create a stringent ischemic environment. DSA was performed at 15, 30, and 60 min after embolization and on days 1 and 7 post-embolization. Dogs were randomly assigned to receive QS (n = 5) or GS (n = 5). The primary outcome was 7-day survival. Secondary outcomes included angiographic recanalization, as well as macroscopic and histopathological evaluation of intestinal necrosis. Given the first two mortality cases in the GS group, further enrollment in the GS group was halted. All five dogs in the QS group survived the 7-day observation period, demonstrating a significantly higher survival rate than the GS group (100

Aim: We aimed to assess the association between base excess (BE) levels and neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA), accounting for the time from cardiac arrest onset to blood sampling. Methods: This multicentre study was conducted in Osaka, Japan, and enrolled consecutive patients with OHCA who were transported to 16 medical centres between 2012 and 2021. Patients aged ≥ 18 years with witnessed OHCA and available BE measurements upon hospital arrival were examined. Patients were stratified into Q1 (BE ≤ −21.1 mmol/L), Q2 (−21.1 < BE ≤ −15.7 mmol/L), Q3 (−15.7 < BE ≤ −10.4 mmol/L) and Q4 (BE > −10.4 mmol/L) groups based on BE levels. The primary outcome was 1-month survival with a favourable neurological outcome (Cerebral Performance Category scale score: 1 or 2). Results: Among the 23,854 patients with OHCA, only 6066 were included in the final analysis. Approximately 3.2 %, 4.7 %, 9.9 % and 23.7 % of patients in the Q1, Q2, Q3 and Q4 groups, respectively, achieved favourable neurological outcomes at 1 month. Compared with Q4, the adjusted odds ratio for a favourable neurological outcome in Q1 was 0.13. Subgroup analysis revealed a significant interaction between prehospital return of spontaneous circulation (ROSC) and neurological outcomes; neurological outcomes worsened as BE decreased in patients with ROSC but not in those without ROSC. Conclusion: Lower BE levels upon hospital arrival are associated with poorer neurological outcomes and may serve as prognostic indicators in patients with OHCA who achieved prehospital ROSC.

Background The causes underlying out‐of‐hospital cardiac arrest (OHCA) are rarely investigated. This study aimed to investigate causes of OHCA in CRITICAL (Comprehensive Registry of In‐Hospital Intensive Care for OHCA Survival), a multicenter OHCA registry in Osaka, Japan. Methods Nontraumatic patients with OHCA (by CARES [Cardiac Arrest Registry to Enhance Survival] criteria) aged 18 to 90 years between July 1, 2012 and December 31, 2020 were included. By Japanese law, all patients with OHCA (resuscitated or not) must be transported to the emergency department where death is declared if resuscitation is unsuccessful; this latter group was considered presumed sudden cardiac deaths whereas those surviving to hospitalization were considered resuscitated OHCA. We compared underlying causes of OHCA in presumed sudden cardiac deaths, survivors of OHCA (alive 30 days after the event), and nonsurvivors of OHCA (died during hospitalization). Causes were confirmed when autopsy or postresuscitation hospital workup was performed and probable when determined by attending physician impression (partial workup). Results Of 12 252 total OHCAs, 8005 (65.3%) were. presumed sudden cardiac deaths, 4247 (34.7%) were resuscitated, and 1293 (10.6%) were survivors. Resuscitated OHCA cardiac causes comprised 73.2% (n=3110) and noncardiac causes 26.8% (n=1137). Cardiac cause, most commonly acute coronary syndrome, was more prevalent in survivors of OHCA than nonsurvivors (85.7% [n=1137] versus 67.8% [n=2002]; P<0.001). Although 40.4% of the survived at 30 days cases were acute coronary syndrome, cerebrovascular disease accounted for 9.8% of nonsurvivors of OHCA and nearly one fifth (n=144, 17.8%) of middle‐aged cases. Conclusions Cardiac cause was more common in survivors than cases dying in the emergency room (sudden deaths) or in hospital after initial resuscitation (nonsurvivors of OHCA). Causes in nonsurvivors of OHCA who died in hospital were more heterogeneous than those of survivors of OHCA, especially cerebrovascular emergencies.

Extracorporeal cardiopulmonary resuscitation (ECPR) requires advanced skills for induction and management. This study evaluated whether the outcomes of ECPR differ by institutional volume. Using the Japanese Association for Acute Medicine–Out-of-Hospital Cardiac Arrest (JAAM-OHCA) registry, we analyzed adult patients (aged ≥18 years) who received ECPR between 2014 and 2020, focusing on 30 day in-hospital survival and favorable neurologic prognosis at 30 days defined as Cerebral Performance Category (CPC) 1–2. Facilities were categorized into tertiles by annual ECPR volume. Multivariable logistic regression examined outcomes across low (≤4.7 cases/year), medium (4.8–7.8 cases/year), and high (≥7.9 cases/year) volume groups. A total of 1,759 patients from 83 centers were included, with an overall 30 day survival of 21.1% and CPC 1–2 rate of 10.1%. We observed no statistically significant differences in the respective rates of 30 day survival and neurologic outcomes in the medium ECPR volume group (adjusted odds ratios 1.09 [95% confidence interval {CI}, 0.82–1.47] and 0.85 [0.56–1.26]) and higher ECPR volume group (adjusted odds ratios 1.27 [95% CI, 0.95–1.70] and 1.11 [0.75–1.63]) compared with the lower ECPR volume group. These findings suggest that ECPR outcomes for out-of-hospital cardiac arrest are not significantly affected by institutional ECPR volume.

OBJECTIVE:Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a serious complication in patients with severe COVID-19. This study investigated the incidence and risk factors for CAPA in patients with severe COVID-19 at Osaka Public University Hospital from April 2020 to November 2021. METHODS:This retrospective study involved patients with CAPA patients requiring invasive ventilation who were diagnosed according to the European Confederation of Medical Mycology and the International Society of Human and Animal Mycology criteria. Patients were classified into the CAPA and non-CAPA groups. Data collected included age, sex, body mass index, smoking history, underlying disease, length of hospital stay, steroid and other drug use, extracorporeal membrane oxygenation use, and outcome. Univariate analysis was used to identify risk factors associated with CAPA. RESULTS:Of the 256 COVID-19 patients, 187 required invasive ventilation, and eight were diagnosed with CAPA. The incidence of CAPA among COVID-19 patients requiring ventilator management was 4.28 %. Tracheostomy was performed in seven patients, and Aspergillus spp. was detected in six, of whom four were confirmed to have A. fumigatus. CAPA mortality was high, with six of eight patients dying. Univariate analysis showed COPD (P = 0.04) and chronic liver disease (P = 0.04) as common comorbidities. β-D-glucan positivity, tracheostomy, prolonged hospitalization, prolonged steroid use, and death (P < 0.01) were more prevalent in the CAPA group. CONCLUSIONS:When bronchoscopy is unfeasible, early diagnosis using serum Aspergillus antigen measurement and imaging is essential, particularly for patients with COPD, liver disease, or risk factors like prolonged hospitalization or steroid use post-COVID-19 treatment.

Background: The patients most likely to benefit from targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) are unknown. We investigated whether a lower serum lactate/albumin ratio (SLAR) at hospital arrival was associated with favorable neurological outcomes in patients receiving TTM after OHCA. Methods: Using the nationwide registry led by the Japanese Association for Acute Medicine, we reviewed the records of adults aged ≥18 years with OHCA who received TTM after the return of spontaneous circulation between June 1, 2014, and December 31, 2022. SLAR was recorded at hospital arrival. Patients with OHCA caused by trauma such as falls, hanging, drowning, poisoning, burns, or asphyxia were excluded, as were patients with missing data, those who received extracorporeal membrane oxygenation, and those for whom the time the emergency call to the measurement of laboratory data exceeded 120 min. The primary outcome was 30-day survival with favorable neurological outcome, defined as cerebral performance category scale 1 or 2. The enrolled patients were categorized according to the quartiles of SLAR for targeted temperatures of ≤34°C (n = 833; first quartile: SLAR ≤ 1.73, n = 209; second quartile: 1.73 < SLAR ≤ 2.54, n = 208; third quartile: 2.54 < SLAR ≤ 3.53, n = 209; fourth quartile: SLAR > 3.53, n = 207) and ≥35°C (n = 437; first quartile: SLAR ≤ 1.85, n = 111; second quartile: 1.85< SLAR ≤ 2.68, n = 108; third quartile: 2.68< SLAR ≤ 3.75, n = 109; fourth quartile: SLAR > 3.75, n = 109). Multivariable logistic regression analysis was performed to adjust for critical factors. Results: In patients with targeted temperature ≤ 34°C, the likelihood of favorable neurological outcomes was lower in the second (adjusted odds ratio [AOR] = 0.59, 95% confidence interval [CI] = 0.35–0.98), third (AOR = 0.25, 95% CI = 0.15–0.42), and fourth quartiles (AOR = 0.10, 95% CI = 0.05–0.18) than in the first quartile. In the group with target temperature ≥ 35°C, the likelihood of favorable neurological outcomes was similarly lower in the second (AOR = 0.38, 95% CI = 0.19–0.74), third (AOR = 0.19, 95% CI = 0.09–0.40), and fourth quartiles (AOR = 0.07, 95% CI = 0.03–0.17) than in the first quartile. Conclusions: A lower SLAR at hospital arrival was significantly associated with better neurological outcomes in patients receiving TTM after OHCA regardless of the targeted temperature.

Background Cardiac arrest leads to an abrupt cessation of blood flow, resulting in severe metabolic acidosis. Base excess (BE) is a widely used marker of metabolic acidosis. However, its prognostic value in cardiac arrest patients remains unclear, as previous studies have not adjusted for the time from arrest to blood testing. This study aimed to assess the association between BE levels and neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA) by adjusting the time from the onset of cardiac arrest to blood tests. Methods This study in Osaka, Japan, enrolled consecutive patients with OHCA transported to 16 centres between 2012 and 2021. We included adult patients (age ≥ 18 years) with witnessed OHCA and available BE levels upon hospital arrival. The patients were grouped based on BE quartiles: Q1 (BE ≤ − 21.1 mmol/L), Q2 (− 21.1 < BE ≤ − 15.7 mmol/L), Q3 (− 15.7 < BE ≤ − 10.4 mmol/L), and Q4 (BE > − 10.4 mmol/L). The primary outcome was 1-month survival with favourable neurological outcomes, defined as a Cerebral Performance Category scale score of 1 or 2. Results Of the 23,854 patients with OHCA, 7,591 met the inclusion criteria, and 6,066 were eligible for analysis. The 1-month favourable neurological outcomes based on BE quartile were 23.5%, 9.8%, 4.7%, and 3.2% Q4, Q3, Q2, and Q1, respectively (p for trend < 0.001). The adjusted odds ratio for Q1 compared with Q4 was 0.13 (95%CI: 0.090–0.19). Subgroup analysis showed an interaction between prehospital return of spontaneous circulation (ROSC) and outcome (p for interaction < 0.001); neurological outcomes worsened as BE decreased in those with ROSC (p for trend < 0.001), but not in those without ROSC (p for trend = 0.12). Conclusions Lower BE levels upon hospital arrival are associated with worse neurological outcomes and may serve as prognostic indicators, especially in patients with OHCA and prehospital ROSC.

Background Few prediction models for individuals with early‐stage out‐of‐hospital cardiac arrest (OHCA) have undergone external validation. This study aimed to externally validate updated prediction models for OHCA outcomes using a large nationwide dataset. Methods and Results We performed a secondary analysis of the JAAM‐OHCA (Comprehensive Registry of In‐Hospital Intensive Care for Out‐of‐Hospital Cardiac Arrest Survival and the Japanese Association for Acute Medicine Out‐of‐Hospital Cardiac Arrest) registry. Previously developed prediction models for patients with cardiac arrest who achieved the return of spontaneous circulation were updated. External validation was conducted using data from 56 institutions from the JAAM–OHCA registry. The primary outcome was a dichotomized 90‐day cerebral performance category score. Two models were updated using the derivation set (n=3337). Model 1 included patient demographics, prehospital information, and the initial rhythm upon hospital admission; Model 2 included information obtained in the hospital immediately after the return of spontaneous circulation. In the validation set (n=4250), Models 1 and 2 exhibited a C‐statistic of 0.945 (95% CI, 0.935–0.955) and 0.958 (95% CI, 0.951–0.960), respectively. Both models were well‐calibrated to the observed outcomes. The decision curve analysis showed that Model 2 demonstrated higher net benefits at all risk thresholds than Model 1. A web‐based calculator was developed to estimate the probability of poor outcomes ( https://pcas‐prediction.shinyapps.io/90d_lasso/ ). Conclusions The updated models offer valuable information to medical professionals in the prediction of long‐term neurological outcomes for patients with OHCA, potentially playing a vital role in clinical decision‐making processes.

Background Poor communication contributes to adverse events (AEs). In our hospital, following an experience of a fatal incident in 2014, we developed an educational programme aimed at improving communication for better teamwork that led to a reduction in AEs.Methods We developed and implemented an intervention bundle comprising external investigation committee reviews, the establishment of a working group (WG), standards and emergency response guidelines, as well as educational programmes and tools. To determine the effectiveness of the educational programmes, we measured communication abilities among doctors and nurses by administering psychological scales focused on their confidence in speaking up. Furthermore, we applied the trigger tool methodology in a retrospective study to determine if our interventions had reduced AEs.Results The nurses’ scores for ‘perceived barriers to speaking up’ and ‘negative attitude toward voicing opinions in the healthcare team’ decreased significantly after the training from 3.20 to 3.00 and from 2.47 to 2.29 points, respectively. The junior doctors’ scores for the same items also decreased significantly after the training from 3.34 to 2.51 and from 2.42 to 2.11 points, respectively. The number of AEs was 32.1 (median) before the WG, 39.9 (median) before the general training, 22.2 (median) after the general training and 18.4 (median) after implementing the leadership educational programmes. During the intervention period the hospital’s incident reports per employee kept increasing.Conclusion Our new educational programmes improved junior doctors and nurses’ perceptions of speaking up. We speculated that our intervention may have improved staff communication, which in turn may have led to a reduction in AEs and a sustained increase in incident reports per employee.

Aim: Life-threatening electrocardiographic (ECG) findings aid in the diagnosis of acute coronary syndrome (ACS), which has not been well -evaluated in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the diagnostic test accuracy (DTA) of ST-elevation myocardial infarction (STEMI) equivalents following the return of spontaneous circulation (ROSC) in patients with OHCA to identify patients with ACS.Methods: Using the database of the Comprehensive Registry of In-Hospital Intensive Care for OHCA Survival study from 2012 to 2017, patients aged >= 18 years with non-traumatic OHCA and ventricular fibrillation or pulseless ventricular tachycardia on the arrival of emergency medical service personnel or arrival at the emergency department, who achieved ROSC, were included. Patients without ST-segment elevation or complete left bun-dle branch block on ECG and those who did not undergo ECG or coronary angiography, were excluded from the study. We evaluated the DTA of STEMI equivalents for the diagnosis of ACS: isolated T-wave inversion, ST-segment depression, Wellens' signs, and ST-segment elevation in lead aVR.Results: Isolated T-wave inversion and Wellens' signs had high specificity for ACS with 0.95 (95% confidence interval [CI], 0.87-0.99) and 0.92 (95% CI, 0.82-0.97), respectively, but their positive likelihood ratios were low, with a wide range of 95% CI: 1.89 (95% CI, 0.51-7.02) and 0.81 (95% CI, 0.25-2.68), respectively.Conclusion: The DTA of STEMI equivalents for the diagnosis of ACS was low among patients with OHCA. Further investigation considering the measurement timing of the ECG after ROSC is required.

Aim Studies have not fully examined whether the medical care system would be able to manage the high number of casualties due to a Nankai Trough earthquake, whose probability of recurrence in the next 30 years is ~70%. This study assessed the demand–supply balance of the disaster medical care system in Osaka city by integrating the data on damage estimation and disaster coping hospitals using a geographic information system. Methods We obtained data on the distribution of casualties in two cases, high and low rates of evacuation from the tsunami, and available beds in Osaka city calculated from operating data of each disaster coping hospital. We expanded these data on a geographic information system and investigated the balance of medical care. Results The total number of available beds in the disaster medical care facilities was 5,559, and the shortage with evacuation rates being either low or high, would be 47,631 and 1,487, respectively. With a low evacuation rate, bed shortage is a common occurrence in coastal areas. With a high evacuation rate, bed shortage decreases, and problems with medical care arise in the eastern area of Osaka city. Discussion In the case of a low evacuation rate, greater bed shortage was found along the coast of Osaka Bay where the probabilities of flooding are high. In the case of a high evacuation rate, however, the number of casualties was much lower. A shortage of medical care did not occur along the coast, but in the eastern part of Osaka city.

IntroductionThe telephone triage service is an emergency medical system through which citizens consult telephone triage nurses regarding illness, and the nurses determine the urgency and need for an ambulance. Despite being introduced in several countries, its impact on emergency patients has not been reported. We aimed to determine the effect of the telephone triage service on the outcomes of hospitalized patients diagnosed with cerebrovascular disease upon arrival after being transported by an ambulance.MethodsThis retrospective study included patients with cerebrovascular disease who were transported by ambulance between January 2016 and December 2019. The primary outcome was discharge to home by day 21 of hospitalization. A total of 344 patients who used the telephone triage service were propensity score-matched to 344 patients who directly called for an ambulance.ResultsTelephone triage service use was associated with discharge to home by hospital day 21 (crude odd ratio: 1.8; 95% confidence interval: 1.3–2.4) and was not significantly associated with survival on hospital day 21 in multivariate regression analysis.ConclusionThe prognoses of cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage depend on the time from symptom onset to treatment. Telephone triage services may allow patients to receive treatment more rapidly than traditional ambulance requests, resulting in improved patient outcomes. The findings of this study suggest that the use of telephone triage services is associated with improved outcomes in patients with cerebrovascular disease and indicate that the costs for medical expenses and disability may be greatly reduced in an aging society.

Background: We aimed to investigate the association between blood urea nitrogen to creatinine ratio (BCR) and survival with favourable neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA). Methods: This prospective, multicentre, observational study conducted in Osaka, Japan enrolled consecutive OHCA patients transported to 16 participating institutions from 2012 through 2019. We included adult patients with non-traumatic OHCA who achieved a return of spontaneous circulation and whose blood urea nitrogen and creatinine levels on hospital arrival were available. Based on BCR values, they were divided into: 'low BCR' (BCR <10), 'normal BCR' (10 <= BCR < 20), 'high BCR' (20 <= BCR < 30), and 'very high BCR' (BCR >= 30). We evaluated the association between BCR values and neurologically favourable outcomes, defined as cerebral performance cate-gory score of 1 or 2 at one month after OHCA. Results: Among 4415 eligible patients, the 'normal BCR' group had the highest favourable neurological outcome [19.4 % (461/2372)], followed by 'high BCR' [12.5 % (141/1127)], 'low BCR' [11.2 % (50/445)], and 'very high BCR' groups [6.6% (31/471)]. In the multivariable analysis, adjusted odds ratios for 'low BCR', 'high BCR', and 'very high BCR' compared with 'normal BCR' for favourable neurological outcomes were 0.58 [95 % confidence interval (CI 0.37-0.91)], 0.70 (95 % CI 0.49-0.99), and 0.40 (95 % CI 0.21-0.76), respectively. Cubic spline analysis indicated that the association between BCR and favourable neurological outcomes was non-linear (p for non-linearity = 0.003). In subgroup analysis, there was an interaction between the aetiology of arrest and BCR in neurological outcome (p for interaction <0.001); favourable neurological outcome of cardiogenic OHCA patients was lower when the BCR was higher or lower, but not in non-cardiogenic OHCA patients. Conclusions: Both higher and lower BCR were associated with poor neurological outcomes compared to normal BCR, especially in cardiogenic OHCA patients. (c) 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Background: The effectiveness of IABP for shockable out-of-hospital cardiac arrest (OHCA) has not been extensively investigated. This study aimed to investigate whether the use of an intra-aortic balloon pump (IABP) for non-traumatic shockable OHCA patients was associated with favorable neurological outcomes. Methods: From the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest registry, a nationwide multicenter prospective registry, we enrolled adult patients with non-traumatic and shockable OHCA for whom resuscitation was attempted, and who were transported to participating hospitals between 2014 and 2019. The primary outcome was 1-month survival with favorable neurological outcomes after OHCA. After adopting the propensity score (PS) inverse probability of weighting (IPW), we evaluated the association between IABP and favorable neurological outcomes. Results: Of 57,754 patients in the database, we included a total of 2738 adult non-traumatic shockable patients. In the original cohort, the primary outcome was lower in the IABP group (OR with 95% confidence intervals (CIs)), 0.57 (0.48–0.68), whereas, in the IPW cohort, it was not different between patients with and without IABP (OR, 1.18; 95% CI, 0.91–1.53). Conclusion: In adult patients with non-traumatic shockable OHCA, IABP use was not associated with 1-month survival with favorable neurological outcomes.

Aim: Coronavirus disease (COVID-19) spread worldwide, and was declared as a pandemic by the World Health Organization. Despite numerous studies in the last few years, the factors associated with the outcomes of patients with COVID-19 requiring mechanical ventilation remain unclear. The prediction of ventilator weaning and mortality using the data obtained at the time of intubation could be beneficial for establishing appropriate treatment strategies and obtaining informed consent. In this study, we aimed to clarify the association between patient information at the time of intubation and the outcomes of intubated COVID-19 patients.Methods: This retrospective observational study used single-center data from patients with COVID-19. Patients with COVID-19 who were admitted to Osaka Metropolitan University Hospital from April 1, 2020, to March 31, 2022, and under mechanical ventilation were included. The main outcome was defined as the factors related to ventilator weaning; a multivariate analysis was carried out to evaluate the association between patient information at the time of intubation and the outcome.Results: In total, 146 patients were included in this study. The factors significantly associated with ventilator weaning were age (65-74 years old, adjusted odds ratio [OR], 0.168; 75 years and older, adjusted OR, 0.121), vaccination history (adjusted OR, 5.655), and Sequential Organ Failure Assessment (SOFA) respiration score (adjusted OR, 0.007) at the time of intubation.Conclusion: Age, SOFA respiration score, and COVID-19 vaccination history at the time of intubation could be associated with outcomes in patients with COVID-19 requiring mechanical ventilation.

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has been focused as a rescue therapy for the refractory cardiac arrest patients; however, little is known about the effect of ECPR on survival. The aim of this study is to evaluate the association between ECPR and the survival among the out-of-hospital cardiac arrest patients. Method: This was the secondary analysis of JAAM-OHCA registry which is a nationwide multicenter prospective study collecting the data of out-of-hospital cardiac arrest patients from July 2012 to December 2019. The study participant were adult (≥18 years) cardiac arrest patients due to internal medical cause. Initial cardiac rhythm was stratified as initial shockable and non-shockable rhythm. Patients received ECPR were sequentially matched with the patients who had not yet received within the same minutes (control) based on the time-dependent propensity scores calculated from the patient characteristics to eliminate the resuscitation time bias. Odds ratio with 95% confidence interval (CI) of ECPR for the 30-day survival were calculated by conditional logistic model. Results: Of 57,754 patients in the JAAM-OHCA registry, 1,826 matched cohort with initial shockable rhythm (913 treated with ECPR and 913 control) and 740 matched cohort with initial non-shockable rhythm (370 treated with ECPR and 370 control) were eligible for analysis. Their characteristics between with ECPR and control were well balanced. In the matched cohort with initial shockable rhythm, 30-day survival was 24.6% (225/913) in the patients with ECPR and 16.3% (149/913) in the control. In the matched cohort with initial non-shockable rhythm, 30-day survival was 11.9% (44/370) in the patients with ECPR and 2.4% (9/370) in the control. Odds ratio of with ECPR for 30-day survival was 1.76 [95%CI: 1.38-2.25] in shockable rhythm and 5.37 [95%CI: 2.53- 11.43] in non-shockable rhythm, referred to the control. Conclusion: This time-dependent propensity score sequential matching analysis suggested that ECPR was associated with the 30-day survival outcomes among the out-of-hospital cardiac arrest patients with both initial shockable and non-shockable rhythms.