Neurologic outcome and location of cardiac arrest in out-of-hospital cardiac arrest patients who underwent extracorporeal cardiopulmonary resuscitation: A multicentre retrospective cohort in Japan.

Aim: We examined the association between the location of cardiac arrest and outcomes of patients with out-of-hospital cardiac arrest (OHCA) who underwent extracorporeal cardiopulmonary resuscitation (ECPR). Methods: This was a secondary analysis of SAVE-J II, a multicentre retrospective registry with 36 participating institutions across Japan, which enrolled adult patients with OHCA who underwent ECPR. The outcomes of interest were favourable neurologic outcome at discharge. We compared the outcome between OHCA cases that occurred at residential and public locations, using a multilevel logistic regression model allowing for the random effect of each hospital. Results: Among 1,744 enrolled OHCAs, 809 and 935 occurred at residential (house: 603; apartment: 206) and public (street: 260; workplace: 210; others: 465) locations, respectively. The proportion of favourable neurologic outcomes was lower in OHCAs at residential locations than those at public locations (88/781 (11.3%) vs.131/891 (14.7%); adjusted odds ratio, 0.72 [95% confidence interval, 0.53-0.99]). However, subgroup analyses for patients with EMS aged <65 years call to hospital arrival within 30 minutes or during daytime revealed less difference between residential and public locations. Conclusion: When cardiac arrests occurred at residential locations, lower proportions of favourable neurologic outcomes were exhibited among patients with OHCA who underwent ECPR. However, the event's location may not affect the prognosis among appropriate and select cases when transported within a limited timeframe.

Neurologically favourable outcomes of cardiogenic out-of-hospital cardiac arrest with relation to the type of witness in Japan.

AIM: To assess the current situation and neurologically favourable outcomes after out-of-hospital cardiac arrest (OHCA) with respect to the type of witness. METHODS: This retrospective observational study used data from the All-Japan Utstein Registry of the Fire and Disaster Management Agency collected between January 1, 2016, and December 31, 2016. Patients with cardiogenic OHCA aged ≥18 years who were witnessed by bystanders were included. The primary outcome measure was a neurologically favourable outcome 1 month after the OHCA. RESULTS: Among the 123,554 patients with OHCA registered between January 1, 2016, and December 31, 2016, 24,856 patients were included. Of them, 15,139 were witnessed by family, and 9717 were witnessed by non-family (friends, 1306; colleagues, 951; passers-by, 997; others, 6463). When witnessed by family, the rate of neurologically favourable outcomes was significantly lower than that when witnessed by non-family (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.41-0.49, P < 0.001). After adjusting for potential confounders, the rate of neurologically favourable outcomes remained lower when OHCA was witnessed by family (OR = 0.88, 95% CI = 0.79-0.99, P = 0.03). However, in subgroup analysis, adjusted ORs for neurologically favourable outcomes were slightly greater for 65-84-year-old women and ≥85-year-old women with family witnesses than for those with non-family witnesses. For all other groups, non-family witnesses outperformed family witnesses. CONCLUSION: Family-witnessed OHCA events had fewer neurologically favourable outcomes before and after adjusting for confounders. BLS education for family members may lead to improved prognosis of witnessed cardiogenic OHCAs.

Basic life support by citizens in Kawasaki City, Japan - a descriptive epidemiological study of out-of-hospital cardiac arrest patients.

AIM: To better understand the current status and barriers to making basic life support a common practice among the citizens of Kawasaki City, Japan. METHOD: We extracted data according to the Utstein-style guidelines specifically regarding out-of-hospital cardiac arrests (OHCAs) of cardiac etiology. The items were as follows: (i) OHCA witnessed by a citizen, (ii) the victim received bystander cardiopulmonary resuscitation (CPR), (iii) an automatic external defibrillator was used by the witness. We compared the rate of each item and the 1-month survival rates with the national average in Japan. We further divided Kawasaki City into three areas and compared each item. We also examined the rate of bystander CPR in each time period and location. Statistical analysis was carried out using the χ2-test and Fisher's test. RESULTS: The 1-month survival rates did not differ significantly from the national average for cases meeting conditions (i)-(iii): (i) 14.0% versus 13.3%, (ii) 19.1% versus 16.4%, (iii) 71.4% versus 53.3%, respectively. However, the rate of condition (i) was significantly lower (47.5% versus 55. 8%, P = 0.01). The rate of condition (ii) was higher in the northern area of Kawasaki City, as well as in a location other than the home in the daytime. The rate of condition (ii) was low in the home. CONCLUSIONS: Although the 1-month survival rates of OHCAs witnessed by citizens in Kawasaki City did not differ significantly from the national average, the low rate of bystander CPR was notable, especially in the southern and middle areas of the city and when the location was in the home, which implies that basic life support knowledge should be spread to these areas.

Prevalence and risk factors of dry eye disease in Japan: Koumi study.

OBJECTIVE: To estimate the prevalence and risk factors of dry eye disease (DED) in a rural setting in Japan. DESIGN: Cross-sectional study. PARTICIPANTS: We included 3294 subjects, aged ≥ 40 years who were in the residential registry for Koumi town. INTERVENTION: Subjects in a rural mountain area, Koumi town, completed questionnaires designed to detect dry eye diagnosis and risk factors. MAIN OUTCOME MEASURES: Clinically diagnosed DED was defined as the presence of a previous clinical diagnosis of DED by ophthalmologists or severe symptoms of DED (both dryness and irritation constantly or often). Current symptoms of DED and possible risk factors such as age, gender, educational history, smoking history, alcohol drinking history, height and weight, visual display terminal (VDT) use, and contact lens (CL) wear, and past/current history of certain common systemic diseases were the main outcome measures. We used logistic regression analysis to examine associations between DED and other demographic factors. RESULTS: Of the 3294 eligible residents, 2791 residents (85%) completed the questionnaire. The percentage of women with a composite outcome of clinically diagnosed DED or severe symptoms (21.6%; 95% confidence interval [CI], 19.5-23.9) was higher than that of men (12.5%; 95% CI, 10.7-14.5; P<0.001). A low body mass index (BMI; odds ratio [OR], 2.07; 95% CI, 0.98-4.39), CL use (OR, 3.84; 95% CI, 1.46-10.10), and hypertension (HT) (OR, 1.39; 95% CI, 0.94-2.06) were risk factors for DED in men. Use of a VDT (OR, 2.33; 95% CI, 1.12-4.85), CL use (OR, 3.61; 95% CI, 2.13-6.10), and myocardial infarction or angina were the risk factors (OR, 2.64; 95% CI, 1.51-4.62), whereas high BMI was a preventive factor (OR, 0.69; 95% CI, 0.48-1.01) for DED in women. CONCLUSIONS: Among a Japanese cohort, DED leading to a clinical diagnosis or severe symptoms is prevalent. Use of CLs was a common dry eye risk factor in both genders. The condition is more prevalent in men with low BMI, HT, and in women with myocardial infarction or angina and VDT use. Relevant measures directed against the modifiable risks may provide a positive impact on public health and quality of life of Japanese. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.