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
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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.
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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.
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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
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Journal of Japan Society of Neurological Emergencies & Critical Care 31(1) 46-46 2018年6月
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日本臨床高気圧酸素・潜水医学会雑誌 14(1) 16-19 2017年4月症例は51歳女性。小笠原村父島にて2日間で深度約22mの潜水を計6回行った。最終潜水時に急浮上した直後に卒倒し、心停止と判断され船上で心肺蘇生が行われた。数分の心肺蘇生の後に意識改善し診療所に搬送され、肺型減圧症の疑いで高度約6,000m、約4時間の航空機搬送を経て当センターに転送された。来院時、両側肺野にcoarse cracklesを聴取し、CTではびまん性すりガラス陰影がみられた。肺型減圧症と診断し米海軍酸素再圧治療表6にて再圧治療を行った。1回目の治療後に臨床所見は改善し、計3回の治療後にすりガラス陰影は消失したため第14病日に独歩退院した。肺型減圧症は稀ではあるが重症の減圧症である。本症例では高高度・長時間の搬送を余儀なくされたが、航空機内気圧を1.0ATAに保つことで症状の悪化なく搬送できた。遠隔離島で発症した減圧症では搬送にあたり関連各機関との緊密な連携が重要である。(著者抄録)
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日本集中治療医学会雑誌 24(Suppl.) SY24-1 2017年2月
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CHEST 150(3) 756-757 2016年9月 査読有り
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日本救急医学会雑誌 27(9) 332-332 2016年9月
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日本救急医学会雑誌 27(9) 332-332 2016年9月
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日本救急医学会雑誌 27(8) 277-283 2016年8月患者は67歳の女性。約6ヵ月前からの左低音性耳鳴を主訴に近医耳鼻咽喉科を受診し、左滲出性中耳炎と診断され、左鼓膜切開術を施行された。切開時に静脈性出血があり、直後に呼吸困難を訴え、意識が低下し救急要請された。救急隊接触時に室内大気下SpO2が80%であり、当科へ搬送された。当院到着時は意識清明で、高流量酸素投与下でSpO2 99%であった。経胸壁心臓超音波にて両心室内の微小気泡を認めた。頭部CTにて左内頸動脈内の気泡、左鼓室底の形成不全ならびに高位頸静脈球を認め、胸腹部造影CTにて肺動脈主幹部内の気泡、両側肺野に多発するすりガラス影を認めた。12誘導心電図で右心負荷所見を認めた。動静脈空気塞栓症と診断し、緊急で高気圧酸素治療を行い、その後は高濃度酸素投与や輸液療法を中心とした全身管理を行った。治療開始後速やかに呼吸状態は改善した。第3病日に施行した全身CTでは、動脈内空気塞栓像は消失し、第11病日に独歩退院した。高位頸静脈球は耳鼻咽喉科領域において比較的よくみられる解剖学的破格であるが、その損傷による動静脈空気塞栓症の報告はなく、非常に稀な合併症である。救急診療において、この解剖学的破格の認知および稀ではあるが、動静脈空気塞栓症を合併し得ることを認識すべきである。また、空気塞栓症に対し高気圧酸素治療が有効であり、専門施設への早期搬送も念頭において診療にあたる必要がある。(著者抄録)
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日本救急医学会雑誌 27(7) 248-248 2016年7月
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