{"id":4628,"date":"2019-03-02T10:34:36","date_gmt":"2019-03-02T01:34:36","guid":{"rendered":"http:\/\/www.med.osaka-u.ac.jp\/eng\/?page_id=4628"},"modified":"2022-08-26T14:58:35","modified_gmt":"2022-08-26T05:58:35","slug":"kitamura2019-03","status":"publish","type":"page","link":"https:\/\/www.med.osaka-u.ac.jp\/eng\/activities\/results\/2019year\/kitamura2019-03","title":{"rendered":"Sho Komukai\u226aBiomedical Statistics\u226b, Tetsuhisa Kitamura \u226aEnvironmental Medicine and Population Sciences\u226b <span>ECG rhythm and Airway Management Make All the Difference During A Heart Attack<\/span>"},"content":{"rendered":"<ul class=\"linkBar clearfix\">\n<li><a href=\"http:\/\/www.med.osaka-u.ac.jp\/activities\/results\/2019year\/komukai-kitamura\">Text in Japanese<\/a><\/li>\n<\/ul>\n<p>2019-03-01<br \/><em><em><\/p>\n<p><span class=\"lineFrame\">Publish\u00a0<\/span> <em>The BMJ<\/em><\/p>\n<p><em>Japan-based study involving Osaka University finds valuable correlation between use of advanced airway management and ECG rhythms indicating need\/non-need for defibrillation during out-of-hospital cardiac arrest<\/em><\/p>\n<p class=\"figure\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-4629 size-medium\" src=\"http:\/\/www.med.osaka-u.ac.jp\/eng\/wp-content\/uploads\/2019\/03\/4c91d76fc4075d5b09d799ccb1e3fc4d-400x211.png?_t=1552005235\" alt=\"\" width=\"400\" height=\"211\" srcset=\"https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-content\/uploads\/2019\/03\/4c91d76fc4075d5b09d799ccb1e3fc4d-400x211.png 400w, https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-content\/uploads\/2019\/03\/4c91d76fc4075d5b09d799ccb1e3fc4d-768x405.png 768w, https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-content\/uploads\/2019\/03\/4c91d76fc4075d5b09d799ccb1e3fc4d-1024x540.png 1024w, https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-content\/uploads\/2019\/03\/4c91d76fc4075d5b09d799ccb1e3fc4d.png 1956w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><a href=\"http:\/\/www.med.osaka-u.ac.jp\/eng\/wp-content\/uploads\/2019\/03\/4c91d76fc4075d5b09d799ccb1e3fc4d.png\"> <span class=\"caption\">One-month survival following adult out-of-hospital cardiac arrest with or without advanced airway management, <br \/>in non-shockable patients <\/span> <\/a><\/p>\n<p>&nbsp;<\/p>\n<p>In cardiac arrest, the speed and type of treatment can literally mean life or death in the immediate term, but can also affect health outcomes after successful resuscitation.<\/p>\n<p>During out-of-hospital cardiac arrest (OHCA), effective treatment starts with cardiopulmonary resuscitation (CPR) and, if necessary, electric shock by a defibrillator. In performing the process, emergency medical service (EMS) personnel also provide oxygen and ventilation either by the bag\u2013valve\u2013mask method or via more invasive advanced airway management (AAM) techniques, such as tube insertion, to keep the airway open. The ventilation methods have pros and cons in the immediate and longer term.<\/p>\n<p>A team including researchers from Osaka University sought to identify patterns in the ventilation method and 1-month outcome after survival. To do so, they used data from more than 300,000 OHCA cases in the large-scale All-Japan Utstein Registry of the Fire and Disaster Management Agency (of Japan). Key in their work was tracing the correlation of electrocardiographic (ECG) rhythm and ventilation method, and the outcomes these combinations yielded. They reported their findings in <em>The BMJ<\/em>.<\/p>\n<p>While AAM has been proven effective at protecting the airway during cardiac arrest treatment, many studies found it led to worse outcomes after survival. Its use compared with bag\u2013valve\u2013mask is controversial. The researchers sought to shed light on the debate.<\/p>\n<p>\u201cWe noted that outcomes differed based on patients\u2019 first-documented ECG rhythm,\u201d says study co-author Sho Komukai.\u201cWe found shockable patients did not have improved 1-month outcomes after AAM. However, non-shockable patients treated with AAM showed better outcomes.\u201d<\/p>\n<p>A shockable rhythm indicates receptivity to defibrillation, while a non-shockable rhythm is treated with only CPR, often accompanied by intravenous adrenaline. Favorable outcomes include recovering the<\/p>\n<p>The findings were made possible by the researchers\u2019 use of an advanced statistical technique called time-dependent propensity-score sequential-matching analysis. This method accounts for the timing of AAM administration, and offsets bias from patients undergoing longer resuscitation and receiving more interventions. The result was a more accurate portrait of AAM\u2019s outcomes, and the positive connection with AAM in non-shockable patients.<\/p>\n<p>\u201cInternational guidelines do account for treatment based on ECG rhythms, yet we found that different airway management strategies based on these rhythms deserve greater attention,\u201d explains Tetsuhisa Kitamura. \u201cShockable rhythm should receive immediate defibrillation and continuous chest-compression, rather than ventilatory support. However, non-shockable rhythm could benefit from oxygen delivery with AAM.\u201d<\/p>\n<p>***<br \/>The article, \u201cPrehospital Advanced Airway Management for Adult Patients with Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study,\u201d was published in <em>The BMJ <\/em>at DOI: <a href=\"https:\/\/doi.org\/10.1136\/bmj.l430\">https:\/\/doi.org\/10.1136\/bmj.l430<\/a>.<\/p>\n<p>***<\/p>\n<p><strong>Article: <\/strong>Prehospital Advanced Airway Management for Adult Patients with Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study<br \/><strong>Journal: <\/strong><em>The BMJ<br \/><\/em><strong>DOI: <\/strong>10.1136\/bmj.l430<br \/><strong>Authors: <\/strong>Junichi Izawa, Sho Komukai, Koichiro Gibo, Masashi Okubo, Kosuke Kiyohara, Chika Nishiyama, Takeyuki Kiguchi, Tasuku Matsuyama, Takashi Kawamura, Taku Iwami, Clifton W Callaway, Tetsuhisa Kitamura<br \/><strong>Funding: <\/strong>Clinical Investigator\u2019s Research Project at Osaka University Graduate School of Medicine; Ministry of Education, Culture, Sports, Science and Technology of Japan<br \/><strong>Summary:\u00a0<\/strong>Japan-based research examined a large-scale national registry of cardiac arrest cases to measure the effects of advanced airway management (AAM) on 1-month outcomes after patients survived. The deep statistical analysis found that patients not needing electrical defibrillation (based on ECG rhythm) and receiving AAM had better outcomes, such as hospital discharge. The results suggest ECG rhythm is a valuable indicator for deciding on whether to use AAM during cardiac arrest.<\/p>\n<p><strong>Primary Keyword: <\/strong>Medicine\/Health<br \/><strong>Additional Keywords:<\/strong> Cardiology, Critical Care\/Emergency Medicine, Health Care Systems\/Services, Pulmonary\/Respiratory Medicine<br \/><strong>Categories: <\/strong>Life Sciences, Medical<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Text in Japanese 2019-03-01 Publish\u00a0 The BMJ Japan-based study involving Osaka University finds valuable corre [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":4629,"parent":4390,"menu_order":103,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-json\/wp\/v2\/pages\/4628"}],"collection":[{"href":"https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-json\/wp\/v2\/comments?post=4628"}],"version-history":[{"count":12,"href":"https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-json\/wp\/v2\/pages\/4628\/revisions"}],"predecessor-version":[{"id":7613,"href":"https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-json\/wp\/v2\/pages\/4628\/revisions\/7613"}],"up":[{"embeddable":true,"href":"https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-json\/wp\/v2\/pages\/4390"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-json\/wp\/v2\/media\/4629"}],"wp:attachment":[{"href":"https:\/\/www.med.osaka-u.ac.jp\/eng\/wp-json\/wp\/v2\/media?parent=4628"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}