An Outcome Evaluation for Prehospital Cardiopulmonary Arrest Patients Using the Utstein Template: A Japanese Experience

s 12th World Congress on Disaster and Emergency Medicine, Lyon, France S47 An Outcome Evaluation for Prehospital Cardiopulmonary Arrest Patients Using the Utstein Template: A Japanese Experience Kunihiro Mashiko; Toshihumi Otsuka; Shuji Shimazaki; Akitsugu Kohama; Gonbei Kamishima; Kikushi Katsurada; Yusuke Saivada; Izumi Matsubara; Kazunori Yamaguchi Outcome Evaluation Committee for Out of Hospital CPA; Foundation for Ambulance Service Development, JAPAN; Department of Emergency and Critical Care Medicine, Chiba Hokusoh Hospital, Nippon Medical School, Chiba Prefecture, JAPAN Introduction: Publication of Utstein Style Template made it possible to perform a national hospital based evaluation, and compare Emergency Medical Service systems. This research was done as a national investigation to identify present outcome data for prehospital cardiopulmonary arrest (CPA) patients in Japan. Methods: The records of 3,029 CPA patients who were transported to 10 Emergency Critical Care Medical Centers from November 1997 to April 1999, were abstracted according to the Utstein style, and the data for outcomes were analyzed using logistic regression. Results: 109 out of 3,029 cases (3.6%) were found dead. The remaining 2,920 cases (96.4%) underwent CPR by emergency medical technicians (EMT) and were included in this study. Bystander CPR was performed in 28.4% of witnessed cardiogenic CPA. The discharge rate was 4.0% of witnessed cardiogenic CPA, and 18.4% of witnessed ventricular fibrillation or ventricular tachycardia (VF/VT). A comparison of resuscitation rates indicated that a success of 7.9% in prehospital phase and 28.4% in in-hospital phase: this is more than 3 times of former results. Outcome analysis indicated that a discharge rate of witnessed cardiogenic CPA was 49.1% of prehospital resuscitation cases which was 6.6 times higher than for hospital resuscitation cases (7.4%). The latter from an emergency telephone call to defibrillation, the lower one month survival rate, it reached almost 0% in 30 minutes (min). Follow-up evaluation after discharge indicated that the survival rate rapidly decreased from 24 hours to 3 months, then, it reached a plateau in the cardiogenic group; for the noncardiogenic group, the survival rate decreased rapidly from 24 hours to 1 month, then became nearly constant. Conclusion: To improve the resuscitation rate in prehospital phase, we must develop a prehospital medical control system, and then expand management items provided at the scene by Japanese paramedics, such as endotracheal intubation, administration of emergency drugs, and early defibrillation using standing orders. Educating and cultivating a first responder will be needed, and every effort should be concentrated on improving the bystander CPR rate. It may be possible to change the Utstein style statistics in a followup period of one year to 3 months after an onset of CPA.