• Takashi Tagami, Kazuhiko Hirata, Toshiyuki Takeshige, Junichiroh Matsui, Makoto Takinami, Masataka Satake, Shuichi Satake, Tokuo Yui, Kunihiro Itabashi, Toshio Sakata, Ryoichi Tosa, Shigeki Kushimoto, Hiroyuki Yokota, and Hisao Hirama.
• Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan. t-tagami@nms.ac.jp
• Circulation. 2012 Jul 31;126(5):589-97.

BackgroundThe American Heart Association 2010 resuscitation guidelines recommended adding a fifth link (multidisciplinary postresuscitation care in a regional center) to the previous 4 in the chain of survival concept for out-of-hospital cardiac arrest. Our study aimed to determine the effectiveness of this fifth link.Methods And ResultsThis multicenter prospective cohort study involved all eligible out-of-hospital cardiac arrest patients in the Aizu region (n=1482, suburban/rural, Fukushima, Japan). Proportions of favorable neurological outcomes were evaluated before (January 2006-April 2008) and after (January 2009-December 2010) the implementation of the fifth link. After implementation, all patients were transported directly from the field to the tertiary-level hospital or secondarily from an outlying hospital to the tertiary-level hospital after restoration of circulation. The tertiary hospital provided intensive postresuscitation care, including appropriate hemodynamic and respiratory management, therapeutic hypothermia, and percutaneous coronary intervention. One-month survival with a favorable neurological outcome among all patients treated by emergency medical services providers improved significantly after implementation (4 of 770 [0.5%] versus 21 of 712 [3.0%]; P<0.001). The adjusted odds ratios of favorable neurological outcome were 0.9 (95% confidence interval, 0.7-1.1) for early access to emergency medical care, 3.1 (95% confidence interval, 0.7-14.2) for bystander resuscitation, 14.7 (95% confidence interval, 3.2-67.0) for early defibrillation, 1.0 (95% confidence interval, 1.0-1.1) for early advanced life support, and 7.8 (95% confidence interval, 1.6-39.0) for the fifth link.ConclusionThe proportion of out-of-hospital cardiac arrest patients with a favorable neurological outcome improved significantly after the implementation of the fifth link, which may be an independent predictor of outcome.Clinical Trial RegistrationURL: http://www.apps.who.int/trialsearch. Unique identifier: UMIN000001607.

29 keywords...

hide…