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Epidemiology and clinical outcomes of poisoning-induced cardiac arrest in Japan: Retrospective analysis of a nationwide registry

  • Takuyo Chiba
    Correspondence
    Corresponding author at: 852 Hatakeda, Narita, Chiba prefecture, Japan.
    Affiliations
    Department of Emergency Medicine, International University of Health and Welfare, Narita, Chiba, Japan

    Graduate School of Medicine, International University of Health and Welfare, Minatoku, Tokyo, Japan
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  • Shunichi Otaka
    Affiliations
    Department of Emergency Medicine, International University of Health and Welfare, Narita, Chiba, Japan

    Graduate School of Medicine, International University of Health and Welfare, Minatoku, Tokyo, Japan
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  • Ryuhei Igeta
    Affiliations
    Department of Emergency Medicine, International University of Health and Welfare, Narita, Chiba, Japan

    Graduate School of Medicine, International University of Health and Welfare, Minatoku, Tokyo, Japan
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  • Michele M Burns
    Affiliations
    Harvard Medical Toxicology Program, Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, USA
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  • Shunya Ikeda
    Affiliations
    Graduate School of Medicine, International University of Health and Welfare, Minatoku, Tokyo, Japan
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  • Takashi Shiga
    Affiliations
    Department of Emergency Medicine, International University of Health and Welfare, Narita, Chiba, Japan

    Graduate School of Medicine, International University of Health and Welfare, Minatoku, Tokyo, Japan
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      Abstract

      Background

      Poisoning is an important cause of out-of-hospital cardiac arrest which can be challenging to manage. Neurological outcomes after poisoning-induced out-of-hospital cardiac arrest (POHCA) are yet to be fully elucidated. This retrospective cohort study sought to describe the characteristics of POHCA, and identify factors associated with favourable neurologic outcomes.

      Methods

      Cardiac arrests recorded in the “All Japan Utstein Registry” from 1 January 2012 to 31 December 2017 were included. A descriptive analysis of the characteristics of POHCA and non-POHCA patients was performed. Neurological outcomes were compared between the POHCA and non-POHCA groups using logistic regression analysis. Subgroup analysis was performed for patients who underwent prolonged resuscitation.

      Results

      Compared to non-POHCA patients (n = 665,262), POHCA patients (n = 1,868) were younger (median age, 80 vs 51 years) and had a lower likelihood of having a witness, bystander cardiopulmonary resuscitation, and an initial shockable rhythm. Multivariable logistic regression analysis showed that POHCA was associated with favourable neurologic outcomes (odds ratio 1.54, 95 % confidence interval 1.19–2.01, p = 0.001). Among patients who received > 30 min of resuscitation, neurologic outcomes were similar in those with POHCA and non-POHCA (favourable neurologic outcome, 1.03 % vs 0.98 %, p = 0.87).

      Conclusions

      POHCA is associated with favourable neurological outcomes and requires aggressive resuscitation. However, in patients who required prolonged resuscitation, the outcomes of POHCA were not different from those of non-POHCA. The decision to perform prolonged resuscitation should be guided on a case-by-case basis based on a range of factors.

      Keywords

      Abbreviations:

      POHCA (Poisoning-induced out-of-hospital cardiac arrest), OHCA (Out-of-hospital cardiac arrest), ROSC (Return of spontaneous circulation), EMS (Emergency medical service), CPC (Cerebral Performance Category), IQR (Interquartile range), CPR (Cardiopulmonary resuscitation), Vf (Ventricular fibrillation), pVT (Pulseless ventricular tachycardia), PEA (Pulseless electroactivity), PS (Propensity score), ECMO (extracorporeal membrane oxygenation)
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