Current situation regarding out-of-hospital cardiopulmonary arrest.
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概要
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In this paper we describe the current situation regarding out-of-hospital cardiopulmonary arrest (OHCPA) based on 2 years of experience with doctor-car operation and will clarify differences from conventional DOA reports. The subject of this study was 463 cases of OHCPA encountered during operation of the doctor car over the two-year period begining April 1, 1993. We assessed incidence, age, sex, type, premorbid profile of the patients, the time and place of the OHCPA, presence of bystanders, and circumstances at the time of arrival at the scene. 1) Incidence: The incidence of OHCPA was 50.6-59.8 persons/year per 100, 000 population. 2) Age: The aged accounted for a very large proportion of the cases, with 43.7% being 71 years of age or older. 3) Type: Endogenous CPA accounted for 65.0% of the cases, exogenous CPA for 21.4%, and in 13.6% the cause was unknown. 4) Premorbid profile: In 11.4% of the cases the patient was already confined to bed for chronic diseases or terminal cancer. 5)Time of occurrence: The most common times of occurrence, in decreasing order, were evening, daytime working hours and the middle of the night. 6) Place: Almost all of the endogenous and etiology-unknown cases of CPA occured at home, and 16.8% of the patients were found in the bathtab. 7) Witnessed cases: Witnessed cases accounted for only 38.9% of the total incidence. 8) Circumstances at the time of arrival at the scene: In 26.3% of the cases postmortem changes were already evident. The ECG findings showed standstill in 78.3%, ventricullar fibrillation in 12.8%, electromechanical dissociation in 3.1%, and bradycardia in 5.8%. The patients with OHCPA differed from the DOA cases reported earlier in the following ways: 1) There was a higher proportion of aged and a lower percentage of young persons, and postmortem changes observed in many more cases. 2) There were fewer witnessed cases. 3) There were fewer cases of exogenous CPA. 4) DOA included cases in which CPA had occurred in the ambulance. As there is a clear disparity between the actual circumstances regarding OHCPA and DOA, it is difficult to compare the outcome in each group. Further comparison of the results of each pre-hospital care system should be made using uniform terms and definitions regarding OHCPA in Japan.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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