Takeuchi Ikuto, Nagasawa Hiroki, Hamada Michika, Ota Soichiro, Muramatsu Ken-Ichi, Fujita Wataru, Yanagawa Youichi
Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan.
J Rural Med. 2023 Apr;18(2):119-125. doi: 10.2185/jrm.2022-041. Epub 2023 Apr 5.
To investigate the etiology of cardiac arrest in patients living in depopulated rural areas with a high elderly population in the Kamo region. We investigated patients with cardiac arrest who were transported by the Shimoda Fire Department between January 2019 and December 2021. The following patients' details were collected: circumstance, age, sex, cause of cardiac arrest, witnessed collapse, chest compression performed by bystanders, oral instruction, use of an automated external defibrillator (AED), initial rhythm, advanced cardiac life support provided by emergency medical technicians, and neurological outcomes. The patients were divided into two groups based on the return of consciousness (RC). We compared the variables above between the two groups. A total of 281 patients with cardiac arrest were included in this study. The participants were predominantly men (59.7%), and the average age was 76 years. AED was applied to eight patients at the scene; however, all eight did not have an initial shockable rhythm. RC was achieved in eight (2.8%) patients. The precise cause of cardiac arrest among the participants who achieved RC was cardiogenic, drowning, and suffocation in three, three, and two cases, respectively. The patients were significantly younger, and the ratio of securing a venous route and airway was significantly lower in the RC (+) group than in the RC (-) group. The ratio of helicopter emergency medical services (HEMS) in the RC (+) group was significantly greater than that in the RC (-) group. This study reported the etiology of cardiac arrest in patients living in a depopulated rural area of Japan with a high elderly population. The usefulness of an AED could not be proven; the cardiogenic cardiac arrest was not dominant among patients who achieved RC, and HEMS transport might be useful for obtaining RC.
为调查加茂地区人口稀少、老年人口众多的农村地区心脏骤停患者的病因。我们调查了2019年1月至2021年12月间由下田消防部门运送的心脏骤停患者。收集了以下患者详细信息：情况、年龄、性别、心脏骤停原因、目睹的倒地情况、旁观者进行的胸外按压、口头指示、自动体外除颤器（AED）的使用、初始心律、急救医疗技术人员提供的高级心脏生命支持以及神经学转归。根据意识恢复情况（RC）将患者分为两组。我们比较了两组之间上述变量。本研究共纳入281例心脏骤停患者。参与者以男性为主（59.7%），平均年龄为76岁。现场有8例患者使用了AED；然而，所有8例患者均无初始可除颤心律。8例（2.8%）患者实现了意识恢复。意识恢复的参与者中，心脏骤停的确切原因分别为心源 性、溺水和窒息，各有3例、3例和2例。意识恢复（+）组患者明显更年轻，建立静脉通路和气道的比例明显低于意识恢复（-）组。意识恢复（+）组直升机紧急医疗服务（HEMS）的比例明显高于意识恢复（-）组。本研究报告了日本人口稀少农村地区老年人口众多的心脏骤停患者的病因。AED的有效性无法得到证实；在意识恢复的患者中，心源 性心脏骤停并非主要原因，HEMS转运可能有助于实现意识恢复。
