Tag Archives: cardiopulmonary resuscitation

Efficacy of prehospital amiodarone on survival in adult out-of-hospital cardiac arrest: A retrospective observational study

Yuki Kishihara1, Shunsuke Amagasa2, Yosuke Homma3, Takashi Tagami4, Hideto Yasuda1,5-7, Masahiro Kashiura1, Yutaro Shinzato1, Takashi Moriya1, SOS-KANTO 2017 Study Group8

1 Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
2 Department of Emergency and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan
3 Department of Emergency and Critical Care Medicine, Chiba Kaihin Municipal Hospital, Chiba, Japan
4 Department of Emergency and Disaster Medicine, The Jikei University School of Medicine, Tokyo, Japan
5 Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
6 School of Nursing and Midwifery, Alliance for Vascular Access Teaching and Research, Griffith University, Australia
7 School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Australia
8 Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan

DOI: 10.2478/jccm-2026-0035

Aim of the study: This study sought to determine whether prehospital administration of amiodarone improves outcomes among adult patients with out-of-hospital cardiac arrest (OHCA) presenting with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). The analysis accounted for time-dependent confounding and resuscitation time bias using real-world registry data.
Material and methods: We conducted a multicenter, retrospective cohort study using a nationwide Japanese OHCA database, including adult nontraumatic shockable rhythms. The exposure was prehospital amiodarone administration at a given time, and the comparator was no amiodarone at the same time point. The comparison reflects amiodarone administration at that time versus no amiodarone, not ‘amiodarone versus never-amiodarone‘. The primary and secondary endpoints were favorable neurological status and survival at 30 days. Patients were matched 1:3 using time-dependent propensity score matching, followed by generalized estimating equations to address intrahospital clustering. Sensitivity analyses included covariates with standardized mean differences greater than 0.25 after matching. Associations were expressed as risk ratios (RRs) with 95% confidence intervals (CIs).
Results: Among 9,909 eligible patients, 56 (0.6%) remained after matching, including 19 (0.2%) who received amiodarone at the index time point. Median (IQR) age was 65 (52–76) years, and 81.8% were male. The median interval from first medical contact to drug administration was 27 (22–32) minutes. In models adjusted for timing variables and hospital clustering, amiodarone was not significantly related to favorable neurological recovery (RR, 0.45 [95% CI, 0.14–1.47]) or survival (RR, 0.74 [95% CI, 0.31–1.73]). Sensitivity analyses yielded consistent findings, though survival model convergence was limited. 
Conclusions: Prehospital administration of amiodarone in adult OHCA patients with shockable rhythms was not associated with improved neurological or survival outcomes. However, these findings should be interpreted with caution, and further studies are warranted to confirm and extend these observations.

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Latent class analysis for identification of sub-phenotypes predicting prognosis in hospitalized out-of-hospital cardiac arrest

Yuki Kishihara1, Hideto Yasuda1–4, Masahiro Kashiura1, Shunsuke Amagasa5, Hiroyuki Tamura1, Yutaro Shinzato1, Takashi Moriya1

1 Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
2 Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
3 School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Australia
4 School of Nursing and Midwifery; Alliance for Vascular Access Teaching and Research, Griffith University, Australia
5 Department of Emergency and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan

DOI: 10.2478/jccm-2025-0016

Aim of the study: To determine which out-of-hospital cardiac arrest (OHCA) patients should receive advanced treatment is extremely challenging. The objective was to identify sub-phenotypes predicting the prognoses of adult OHCA patients by latent class analysis (LCA) using data up to just after admission.
Material and Methods: We conducted a retrospective observational study using multicentre OHCA registry from 95 Japanese hospitals including adult non-traumatic hospitalized OHCA. The primary outcome was 30-day favourable neurological outcome. Our LCA used clinically relevant variables up to just after admission and the optimal class number was determined from clinical importance and Bayesian information criterion. The associations between sub-phenotypes and outcomes were analysed using univariate logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Our LCA included 2,162 patients and identified four sub-phenotypes. The base excess on hospital arrival had the highest discriminative power. Thirty-day favourable neurological outcomes were observed in 526 patients (24.3%), including 284 (53.8%) in Group 1, 179 (21.2%) in Group 2, 26 (11.4%) in Group 3, and 37 (6.6%) in Group 4. Prehospital return of spontaneous circulation (ROSC) was achieved in 1,009 patients (46.7%), including 379 (81.8%) in Group 1, 340 (40.3%) in Group 2, 115 (50.4%) in Group 3, and 175 (31.1%) in Group 4. Univariate logistic regression analysis for primary outcome using Group 4 as reference revealed ORs (95% CI) of 16.5 (11.4–24.1) in Group 1, 3.83 (2.64–5.56) in Group 2, and 1.83 (1.08–3.10) in Group 3.
Conclusions: Our LCA classified OHCA into four sub-phenotypes showing significant differences for prognosis. In cases who achieved prehospital ROSC, it might be meaningful to continue advanced therapeutic interventions.

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Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction – a Critical Approach for a Critical Condition

Theodora Benedek1*, Monica Marton Popovici2, Dietmar Glogar3

1 University of Medicine and Pharmacy Tirgu Mures, Romania, Clinic of Cardiology
2 Swedish Medical Center, Department of Internal Medicine and Critical Care, Edmonds, Washington, USA
3 Medical University of Vienna, Austria

DOI: 10.1515/jccm-2016-0025

This review summarizes the most recent developments in providing advanced supportive measures for cardiopulmonary resuscitation, and the results obtained using these new therapies in patients with cardiac arrest caused by acute myocardial infarction (AMI). Also detailed are new approaches such as extracorporeal cardiopulmonary resuscitation (ECPR), intra-arrest percutaneous coronary intervention, or the regional models for systems of care aiming to reduce the critical times from cardiac arrest to initiation of ECPR and coronary revascularization.

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Sudden Cardiac Death and Post Cardiac Arrest Syndrome. An Overview

Endre Zima

Semmelweis University, Heart and Vascular Center, Budapest, Hungary

DOI: 10.1515/jccm-2015-0031

A satisfactory neurologic outcome is the key factor for survival in patients with sudden cardiac death (SCD), however this is highly dependent on the haemodynamic status. Short term cardiopulmonary resuscitation and regained consciousness on the return of spontaneous circulation (ROSC) is indicative of a better prognosis. The evaluation and treatment of SCD triggering factors and of underlying acute and chronic diseases will facilitate prevention and lower the risk of cardiac arrest. Long term CPR and a prolonged unconscious status after ROSC, in the Intensive Care Units or Coronary Care Units, indicates the need for specific treatment and supportive therapy including efforts to prevent hyperthermia. The prognosis of these patients is unpredictable within the first seventy two hours, due to unknown responses to therapeutic management and the lack of specific prognostic factors. Patients in these circumstances require the highest level of intensive care and aetiology driven treatment without any delay, independently of their coma state. Current guidelines sugest the use of multiple procedures in arriving at a diagnosis and prognosis of these critical cases.

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