今月発行の医学新聞Medical Tribuneに当教室の舟田講師（救急部）の論文が大きく取り上げられています。記事ではCirculation Journal誌4月号に掲載された論文「Improved Survival With Favorable Neurological Outcome in Elderly Individuals With Out-of-Hospital Cardiac Arrest in Japan- A Nationwide Observational Cohort Study.」について、Circ J誌編集長の東北大学下川教授により詳細に解説され、注目度の高さを表しています。
総務省消防庁の2008～2012年の全国前向きウツタイン登録の解析から、75歳以上の院外心肺停止患者の転帰が経年的に改善したこと、また心停止が心原性で目撃あり、最初に記録されたリズムが除細動の適応の3条件を満たす患者群では、神経学的予後良好を伴った生存率が8～26％と良好で、心肺蘇生の有用性が高いことを報告しています。
Improved Survival With Favorable Neurological Outcome in Elderly Individuals With Out-of-Hospital Cardiac Arrest in Japan - A Nationwide Observational Cohort Study. Funada A, Goto Y, Maeda T, Teramoto R, Hayashi K, Yamagishi M. Circ J. 2016 Apr 25;80(5):1153-62. doi: http://doi.org/10.1253/circj.CJ-15-1285
BACKGROUND: There is sparse data regarding the survival and neurological outcome of elderly patients with out-of-hospital cardiac arrest (OHCA).
Methods and Results: OHCA patients (334,730) aged >/=75 years were analyzed using a nationwide, prospective, population-based Japanese OHCA database from 2008 to 2012. The overall 1-month survival with favorable neurological outcome (Cerebral Performance Category Scale, category 1 or 2; CPC 1-2) rate was 0.88%. During the study period, the annual 1-month CPC 1-2 rate in whole OHCA significantly improved (0.73% to 0.96%, P for trend <0.001). In particular, outcomes of OHCA patients aged 75 to 84 years and those aged 85 to 94 years significantly improved (0.98% to 1.28%, P for trend=0.01; 0.46% to 0.70%, P for trend <0.001, respectively). However, in OHCA patients aged >/=95 years, the outcomes did not improve. Multivariate logistic regression analysis indicated that younger age, shockable first documented rhythm, witnessed arrest, earlier emergency medical service (EMS) response time, and cardiac etiology were significantly associated with the 1-month CPC 1-2. Under these conditions, elderly OHCA patients who had cardiac etiology, shockable rhythm and had a witnessed arrest had acceptable 1-month CPC1-2 rate; 7.98% in cases where OHCA was witnessed by family, 15.2% by non-family, and 25.6% by EMS.
CONCLUSIONS: The annual 1-month CPC 1-2 rate after OHCA among elderly patients significantly improved, and the resuscitation of elderly patients in a selected population is not futile.
