a b s t r a c tPurpose of study: To determine the effects of ageing and training experience on attitude towards performing basic life support (BLS). Methods: We gave a questionnaire to attendants of the courses for BLS or safe driving in authorised driving schools. The questionnaire included questions about participants' backgrounds. The questionnaire explored the participant's willingness to perform BLS in four hypothetical scenarios related to early emergency call, cardiopulmonary resuscitation (CPR) under their own initiative, telephone-assisted compression-only CPR and use of an automated external defibrillator (AED), respectively. Results: There were significant differences in gender, occupation, residential area, experience of BLS training, and knowledge of AED use among the young (17-29 y, N = 6122), middle-aged (30-59 y, N = 827) and elderly (>59 y, N = 15,743) groups. In all four scenarios, the proportion of respondents willing to perform BLS was lowest in the elderly group. More respondents in the elderly group were willing to follow the telephone-assisted instruction rather than performing CPR under their own initiative. Multiple logistic regression analysis confirmed ageing as an independent factor related to negative attitude in all scenarios. Gender, occupation, resident area, experience with BLS training and knowledge about AED use were other independent factors. Prior BLS training did not increase willingness to make an emergency call. Conclusion:The aged population has a more negative attitude towards performing BLS. BLS training should be modified to help the elderly gain confidence with the essential elements of BLS, including making early emergency calls.

factors associated with delay. The ratio of correctable causes (human factors) was high at care facilities and home, compared with other places. Calling others was a major reason for delay in all places. Performing CPR and other treatments was another major reason at care facilities. Large delay, defined as an interval exceeding 5 min (upper quartile value) was an independent factor associated with a low 1-year survival rate. Conclusion: The incidence of correctable causes of delay is high in the community. Correction of emergency call manuals in care facilities and public relations efforts to facilitate early emergency call may be necessary. The BLS education should be modified to minimize the interval related to making an emergency call.

excluded from the analysis. The incidence of sustained return of spontaneous circulation (ROSC) was significantly higher in cases of AAM with ET (30%) than in AAM with other devices (20.2%) and in the standard procedure with BVMD (21.3%). The AAM with ET did not significantly affect 1-year survival. Multiple regression analysis indicated that tracheal intubation but not patient management by the certified paramedics is an independent factor associated with sustained ROSC (odds ratio = 1.503, 95% confidence interval 1.081 -2078). Conclusion: Tracheal intubation according to limited indication criteria and well-organised protocol in Japan may improve the short-term outcome of OHCA with non-cardiac origin. The large prospective study is needed to determine universal effects of tracheal intubation on the long-term outcome of OHCA with disturbed ventilation. INTRODUCTIONAdvanced cardiac life support (ACLS), including advanced airway management (AAM) and intravenous drug therapy, may have some benefits on the outcome of out-of-hospital cardiac arrest (OHCA) [1]. It is not clear whether AAM with an endotracheal tube (ET) in the emergency medical service (EMS) provides a better outcome on OHCA than other airway management devices [2,3]. One controlled study in children showed that tracheal intubation does not improve clinical outcome [4]. Outcome was reported to be worsened when AAM with ET was performed in cases of OHCA with shockable rhythms [5,6]. Recently, Garza et al. reported that avoidance of tracheal intubation as an early airway management and an increase in the ratio of chest compression to ventilation improved survival rate in OHCA of cardiac origin [6].In Japan, certified paramedics who have completed training programs for tracheal intubation have used ET in patients with OHCA since July 2004. The program includes 180 hours of lectures and exercises in schools as well as experience with 30 cases in hospital operating rooms. When ET is indicated as an AAM device, the paramedics obtain instruction regarding tracheal intubation from an emergency physician in accordance with a protocol defined by the regional medical control council (MCC).The present population-based cohort study was performed to determine whether airway management with ET according to the indication criteria may affect the outcome of OHCA in comparison with other AAM devices or BVMD and whether patient management by paramedics certified for ET may affect the prognosis in comparison with uncertified paramedics. Furthermore, we investigated whether the origin of OHCA (cardiac or non-cardiac in the Utstein style) modifies the effects. MATERIALS AND METHODSData were collected in accordance to the national guideline of ethics for the epidemiological survey (The Ministry of Health, Labor and Welfare in Japan : http://www.mhlw.go.jp/general/seido/kousei/i-kenkyu/index.html). The study was approved by an institutional review board (#843). Populations and settingIshikawa prefecture encompasses an area of 4,185 km 2 on the Sea of Japan coast, and has a r...

IntroductionWe previously showed that erythropoietin (EPO) attenuates the morphological signs of spinal cord ischemia/reperfusion (I/R) injury in swine [1] without, however, improving neurological function. The clinical use of EPO has been cautioned most recently due to serious safety concerns arising from an increased mortality in acute stroke patients treated with EPO and simultaneously receiving systemic thrombolysis [2]. Carbamylated EPO (cEPO) is an EPO derivative without erythropoietic activity and devoid of the EPO side eff ects, but with apparently well maintained cytoprotective qualities [3]. We therefore tested the hypothesis whether cEPO may be equally effi cient as EPO in reducing morphological as well as functional aortic occlusion-induced spinal cord I/R injury. Methods In a randomized and blinded trial pigs received either vehicle (control, n = 9), EPO or cEPO, respectively (n = 9 each; 5,000 IU/kg over 30 minutes before and during the fi rst 4 hours of reperfusion). Animals underwent 30 minutes of thoracic aortic balloon occlusion with catheters placed immediately downstream of the A. subclavia and upstream of the aortic trifurcation. Spinal cord function was assessed by motor evoked potentials (MEP as percentage of the amplitude before aortic occlusion) and lower limb refl exes (assessed as the subjective strength of response) for a period of 10 hours after reperfusion. Tissue damage was evaluated using Nissl staining. Results Both EPO-treated and cEPO-treated animals presented with attenuated spinal cord injury in the Nissl staining (median (quartile) percentage of damaged neurons in the thoracic segments: control 27 (25,44), cEPO 8 (4,10), and EPO 5 (5,7), P <0.001 vs control group; in the lumbar segments: control 26 (19,32), cEPO 7 (5,13), EPO 8 (5,10), P <0.001 vs control group). However, while only cEPO treatment was associated with recovery of the MEP amplitude to pre-occlusion values when compared with the control group (P <0.05), lower limb refl ex response was comparably restored stronger in both treatment groups (P <0.05 vs control). Conclusions In a clinically relevant porcine model mimicking aortic crossclamping during vascular surgery repair of thoracic aortic aneurysm, cEPO protected spinal cord function and integrity as eff ective as EPO when applied at equipotent doses. Acknowledgements Supported by the Deutsche Forschungs gemeinschaft (SCHE 899/2-2). References Introduction Unfolded protein response (UPR)-mediated apoptosis plays a pivotal role in ischemia-reperfusion injury. Sodium 4-phenylbutyrate (PBA) has been reported to act as a chemical chaperone inhibiting UPR-mediated apoptosis triggered by ischemia in various organs other than the heart. Therefore we investigated whether PBA reduces UPR-mediated apoptosis and protects against myocardial ischemia-reperfusion injury in mice. Methods C57BL/6 mice were subjected to 30 minutes LAD ischemia followed by reperfusion. PBA (100 mg/kg) or PBS (control) was administrated intraperitoneally just before ischemia. Apoptosis, infarct ...

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