Current termination of resuscitation (TOR) guidelines predict neurologically favorable outcome in Japan
Current termination of resuscitation (TOR) guidelines predict neurologically favorable outcome in Japan
复制标题
DOI：
10.1016/j.resuscitation.2012.05.027
复制
发表时间：
2013-01-01
期刊：
影响因子：
6.5
通讯作者：
Yamayoshi, Shigeru
中科院分区：
文献类型：
--
作者：
Kajino, Kentaro;Kitamura, Tetsuhisa;Yamayoshi, Shigeru
背景资料：目前尚不清楚北美制定的基本生命支持（BLS）和高级生命支持（ALS）院前终止复苏（TOR）规则是否可以成功应用于其他国家的院外心脏骤停（OHCA）患者。目的：评估日本的BLS和ALS TOR的性能。一项回顾性全国性、基于人群、观察性队列研究，研究对象为2005年1月1日至2009年12月31日期间在日本进行紧急响应者复苏尝试的连续OHCA患者。BLS TOR规则有3个标准，而ALS TOR规则包括2个额外的标准。我们提取OHCA患者满足所有标准的每一个TOR规则，并计算的特异性和阳性预测值（PPV）的每一个TOR规则识别OHCA患者谁没有神经学上有利的一个月survival.Results：在研究期间，151,152例可用于评估BLS TOR规则，和137,986例评估ALS TOR规则。在113，140例满足BLS TOR规则所有三个标准的患者中，193例（0.2%）具有神经学上有利的一个月生存期。BLS TOR规则预测1个月生存率的特异性为0.968（95%CI：0.963-0.972），PPV为0.998（95%CI：0.998-0.999）。在41,030名符合ALS TOR规则所有五项标准的患者中，只有37名（0.1%）具有神经学上有利的一个月生存率。ALS TOR规则的特异性为0.981（95% CI：0.973-0.986），PPV为0.999（95%CI：0.998-0.999）预测缺乏神经学上有利的1个月生存率。院前BLS和ALS TOR规则在日本表现良好，具有高特异性和PPV，可预测缺乏神经学上有利的规则。在日本生存一个月然而，特异性和PPV不是1000，我们必须制定更具体的TOR规则。(C)2012爱思唯尔爱尔兰有限公司保留所有权利。
Background: It is unclear whether the basic life support (BLS) and advanced life support (ALS) pre-hospital termination of resuscitation (TOR) rules developed in North America can be applied successfully to patients with out-of-hospital cardiac arrest (OHCA) in other countries.Objectives: To assess the performance of the BLS and ALS TOR in Japan.Methods: Retrospective nationwide, population-based, observational cohort study of consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2009 in Japan. The BLS TOR rule has 3 criteria whereas the ALS TOR rule includes 2 additional criteria. We extracted OHCA patients meeting all criteria for each TOR rule, and calculated the specificity and positive predictive value (PPV) of each TOR rule for identifying OHCA patients who did not have neurologically favorable one-month survival.Results: During the study-period, 151,152 cases were available to evaluate the BLS TOR rule, and 137,986 cases to evaluate the ALS TOR rule. Of 113,140 patients that satisfied all three criteria for the BLS TOR rule, 193 (0.2%) had a neurologically favorable one-month survival. The specificity of BLS TOR rule was 0.968 (95% CI: 0.963-0.972), and the PPV was 0.998 (95% CI: 0.998-0.999) for predicting lack of neurologically favorable one-month survival. Of 41,030 patients that satisfied all five criteria for the ALS TOR rule, just 37 (0.1%) had a neurologically favorable one-month survival. The specificity of ALS TOR rule was 0.981 (95% CI: 0.973-0.986), and the PPV was 0.999 (95% CI: 0.998-0.999) for predicting lack of neurologically favorable one-month survival.Conclusions: The prehospital BLS and ALS TOR rules performed well in Japan with high specificity and PPV for predicting lack of neurologically favorable one-month survival in Japan. However, the specificity and PPV were not 1000 and we have to develop more specific TOR rules. (C) 2012 Elsevier Ireland Ltd. All rights reserved.