Miyoshi Takahiro, Endo Hideki, Yamamoto Hiroyuki, Gonmori Satoshi, Miyata Hiroaki, Takuma Kiyotsugu, Sakurai Atsushi, Kitamura Nobuya, Tagami Takashi, Nakada Taka-Aki, Takeda Munekazu
Kawasaki Municipal Hospital, Kanagawa, Japan; Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.
Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Resuscitation. 2022 Dec;181:311-319. doi: 10.1016/j.resuscitation.2022.10.022. Epub 2022 Nov 2.
The aim of this study was to reveal the neurological outcomes of choking-induced out-of-hospital cardiac arrest (OHCA) and evaluate the presence of witnesses, cardiopulmonary resuscitation (CPR) performed by a witness (bystander-witnessed CPR), and the proportion of patients with favourable neurological outcomes by the time from CPR by emergency medical services (EMS) to the return of spontaneous circulation (ROSC) (CPR-ROSC time).
We retrospectively analysed the SOS-KANTO 2012 database, which included data of 16,452 OHCAs in Japan. We selected choking-induced OHCA patients aged ≥ 20 years. We evaluated the neurological outcomes at 1 month with the Cerebral Performance Category (CPC). We defined favourable neurological outcomes (CPCs: 1-2) and present the outcomes with descriptive statistics.
Of 1,045 choking-induced OHCA patients, 18 (1.7%) had a favourable neurological outcome. Of 1,045 OHCAs, 757 (72.6%) were witnessed, and 375 (36.0%) underwent bystander-witnessed CPR. Of the 18 OHCAs with favourable outcomes, 17 (94.4%) were witnessed, and 11 (61.1%) underwent bystander-witnessed CPR. With a CPR-ROSC time of 0-5 minutes, the proportion of patients with favourable neurological outcomes was 29.7%, ranging from 0% to 6% in the following time groups.
The neurological outcome of choking-induced OHCA was poor. The neurological outcomes deteriorated rapidly from 5 minutes after the initiation of CPR by EMS. The presence of witnesses and bystander-witnessed CPR may be factors that contribute to improved outcomes, but the effects were not remarkable. As another approach to reduce deaths due to choking, citizen education for the prevention of choking may be effective.
本研究旨在揭示窒息所致院外心脏骤停（OHCA）的神经学转归，并评估目击者的存在情况、目击者实施的心肺复苏（CPR）（旁观者目击CPR），以及从紧急医疗服务（EMS）开始CPR到自主循环恢复（ROSC）的时间（CPR-ROSC时间）对神经学转归良好患者比例的影响。
我们回顾性分析了SOS-KANTO 2012数据库，该数据库包含日本16452例OHCA的数据。我们选取了年龄≥20岁的窒息所致OHCA患者。我们使用脑功能分类（CPC）评估1个月时的神经学转归。我们定义神经学转归良好（CPC：1-2），并采用描述性统计呈现结果。
在1045例窒息所致OHCA患者中，18例（1.7%）神经学转归良好。在1045例OHCA中，757例（72.6%）有目击者，375例（36.0%）接受了旁观者目击CPR。在18例转归良好的OHCA中，17例（94.4%）有目击者，11例（61.1%）接受了旁观者目击CPR。CPR-ROSC时间为0-5分钟时，神经学转归良好患者的比例为29.7%，在随后的时间组中为0%至6%。
窒息所致OHCA的神经学转归较差。从EMS开始CPR 5分钟后，神经学转归迅速恶化。目击者的存在和旁观者目击CPR可能是有助于改善转归的因素，但效果并不显著。作为减少窒息死亡的另一种方法，对公众进行预防窒息的教育可能是有效的。
