基本情報
- 所属
- 自治医科大学 附属さいたま医療センター内科系診療部救急科 講師
- J-GLOBAL ID
- 201701001479141743
- Researcher ID
- E-5987-2016
- researchmap会員ID
- B000275391
- 外部リンク
研究分野
1論文
74-
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2024年4月8日OBJECTIVE: The objective was to investigate whether early advanced airway management during the entire resuscitation period is associated with favorable neurological outcomes and survival in patients with out-of-hospital cardiac arrest (OHCA). METHODS: We performed a retrospective cohort study of patients with OHCA aged ≥18 years enrolled in OHCA registry in Japan who received advanced airway management during cardiac arrest between June 2014 and December 2020. To address resuscitation time bias, we performed risk set matching analyses in which patients who did and did not receive advanced airway management were matched at the same time point (min) using the time-dependent propensity score; further, we compared early (≤10 min) and late (>10 min) advanced airway management. The primary and secondary outcome measures were favorable neurological outcomes using Cerebral Performance Category scores and survival at 1 month after cardiac arrest. RESULTS: Of the 41,101 eligible patients, 21,446 patients received early advanced airway management. Thus, risk set matching was performed with a total of 42,866 patients. In the main analysis, early advanced airway management was significantly associated with favorable neurological outcomes (risk ratio [RR] 0.997, 95% confidence interval [CI] 0.995-0.999) and survival (RR 0.990, 95% CI 0.986-0.994) at 1 month after cardiac arrest. In the sensitivity analysis with early advanced airway management defined as ≤5 min and ≤20 min, the results were comparable. CONCLUSIONS: Although early advanced airway management was statistically significant for improved neurological outcomes and survival at 1 month after cardiac arrest, the RR was very close to 1, indicating that the timing of advanced airway management has minimal impact on clinical outcomes, and decisions should be made based on the individual needs of the patient.
-
Annals of emergency medicine 2023年11月22日STUDY OBJECTIVE: To determine the association between early versus late advanced airway management and improved outcomes in pediatric out-of-hospital cardiac arrest. METHODS: We performed a retrospective cohort study using data from the out-of-hospital cardiac arrest registry in Japan. We included pediatric patients (<18 years) with out-of-hospital cardiac arrest who had received advanced airway management (tracheal intubation, supraglottic airway, and esophageal obturator). The main exposure was early (≤20 minutes) versus late (>20 minutes) advanced airway management. The primary and secondary outcome measurements were survival and favorable neurologic outcomes at 1 month, respectively. To address resuscitation time bias, we performed risk-set matching analyses using time-dependent propensity scores. RESULTS: Out of the 864 pediatric patients with both out-of-hospital cardiac arrest and advanced airway management over 67 months (2014 to 2019), we included 667 patients with adequate data (77%). Of these 667 patients, advanced airway management was early for 354 (53%) and late for 313 (47%) patients. In the risk-set matching analysis, the risk of both survival (risk ratio 0.98 for early versus late [95% confidence interval 0.95 to 1.02]) and favorable 1-month neurologic outcomes (risk ratio 0.99 [95% confidence interval 0.97 to 1.00]) was similar between early and late advanced airway management groups. In sensitivity analyses, with time to early advanced airway management defined as ≤10 minutes and ≤30 minutes, both outcomes were again similar. CONCLUSION: In pediatric out-of-hospital cardiac arrest, the timing of advanced airway management may not affect patient outcomes, but randomized controlled trials are needed to address this question further.
-
The American journal of emergency medicine 75 65-71 2023年10月21日BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a serious condition. The volume-outcome relationship and various post-cardiac arrest care elements are believed to be associated with improved neurological outcomes. Although previous studies have investigated the volume-outcome relationship, adjusting for post-cardiac arrest care, intra-class correlation for each institution, and other covariates may have been insufficient. OBJECTIVE: To investigate the volume-outcome relationships and favorable neurological outcomes among OHCA cases in each institution. METHODS: We conducted a prospective observational study of adult patients with non-traumatic OHCA using the OHCA registry in Japan. The primary outcome was 30-day favorable neurological outcomes, and the secondary outcome was 30-day survival. We set the cutoff values to trisect the number of patients as equally as possible and classified institutions into high-, middle-, and low-volume. Generalized estimating equations (GEE) were performed to adjust for covariates and within-hospital clustering. RESULTS: Among the 9909 registry patients, 7857 were included. These patients were transported to either low- (2679), middle- (2657), or high- (2521) volume institutions. The median number of eligible patients per institution in 19 months of study periods was 82 (range, 1-207), 252 (range, 210-353), and 463 (range, 390-701), respectively. After multivariable GEE using the low-volume institution as a reference, no significant difference in odds ratios and 95% confidence intervals were noted for 30-day favorable neurological outcomes for middle volume [1.22 (0.69-2.17)] and high volume [0.80 (0.47-1.37)] institutions. Moreover, there was no significant difference for 30-day survival for middle volume [1.02 (0.51-2.02)] and high volume [1.09 (0.53-2.23)] institutions. CONCLUSION: The patient volume of each institution was not associated with 30-day favorable neurological outcomes. Although this result needs to be evaluated more comprehensively, there may be no need to set strict requirements for the type of institution when selecting a destination for OHCA cases.
MISC
241-
日本救急医学会雑誌 24(9) 767-773 2013年9月【目的】精神科領域、特に統合失調症患者において病的多飲を誘因とする水中毒がしばしばみられる。また水中毒の経過中に横紋筋融解症(rhabdomyolysis、RML)を併発することがある。しかし、その発症機序やリスクについては解明されているとは言い難い。水中毒患者におけるRML発症要因と予後について検討した。【対象・方法】2006年1月から2012年8月までに東京都立墨東病院救命救急センターに搬送され、水中毒と診断した症例を対象として診療録を後方視的に検討した。RML非発症例を対照群としてRML発症例の患者背景、入院時の検査値、検査値の推移、救命救急センター在室日数、入院日数、合併症、予後を比較した。【結果】水中毒と診断された患者は33例で、そのうちRML発症例は18例(55%)であった。最大血清creatin kinase(CK)値の中央値は22,640 IU/l(四分位範囲6,652-55,020 IU/l)だった。RMLの合併例と非合併例において入院時血清Na値や血漿浸透圧値では有意差を認めなかった(p=0.354、p=0.491)が、血清Na値の補正速度に有意差を認めた(p=0.001)。経過中に急性腎傷害(acute kidney injury:AKI)の合併は5例あったが、腎代替療法を要した症例や腎障害が遷延した症例はなかった。橋中心性髄鞘崩壊症候群(central pontine myelinolysis:CPM)を合併した症例や死亡例はなかった。【結語】水中毒においてRMLの合併は少なくない。RML合併には急速な血清Na値の補正が関連している可能性があり、CPMと併せて注意すべき合併症である。(著者抄録)
-
日本臨床救急医学会雑誌 16(3) 286-286 2013年6月
-
日本臨床救急医学会雑誌 16(3) 296-296 2013年6月
-
日本集中治療医学会雑誌 20(2) 273-274 2013年4月Extracorporeal cardiopulmonary resuscitationが行われた院外心肺停止症例を対象に、エコーガイド下でカニュレーションした群6例(US群)と非エコーガイド群8例(non-US群)に分け、来院から経皮的心肺補助法(PCPS)開始までの時間を比較検討した。その結果、来院からPCPS開始までの時間は、US群で11(8.8〜13)min、non-US群で26(21〜34)minと、US群で有意な短縮が示された。non-US群の1例で送血管の誤挿入が認められた。穿刺部からの出血の頻度はUS群で低い傾向にあった。以上より、エコーガイド下のカニュレーションは院外心肺停止症例に対してより迅速なPCPSの導入を可能とし、またカニュレーションに伴う合併症の軽減につながる可能性が示唆された。
共同研究・競争的資金等の研究課題
2-
日本学術振興会 科学研究費助成事業 2021年4月 - 2026年3月
-
日本学術振興会 科学研究費助成事業 若手研究 2020年4月 - 2023年3月