Rationale, design, and profile of Comprehensive Registry of In-Hospital Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan

Abstract

BackgroundWe established a multi-center, prospective cohort that could provide appropriate therapeutic strategies such as criteria for the introduction and the effectiveness of in-hospital advanced treatments, including percutaneous coronary intervention (PCI), target temperature management, and extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) patients.MethodsIn Osaka Prefecture, Japan, we registered all consecutive patients who were suffering from an OHCA for whom resuscitation was attempted and who were then transported to institutions participating in this registry since July 1, 2012. A total of 11 critical care medical centers and one hospital with an emergency care department participated in this registry. The primary outcome was neurological status after OHCA, defined as cerebral performance category (CPC) scale.ResultsA total of 688 OHCA patients were documented between July 2012 and December 2012. Of them, 657 were eligible for our analysis. Patients’ average age was 66.2 years old, and male patients accounted for 66.2 %. The proportion of OHCAs having a cardiac origin was 50.4 %. The proportion as first documented rhythm of ventricular fibrillation/pulseless ventricular tachycardia was 11.6 %, pulseless electrical activity 23.4 %, and asystole 54.5 %. After hospital arrival, 10.5 % received defibrillation, 90.8 % tracheal intubation, 3.0 % ECPR, 3.5 % PCI, and 83.1 % adrenaline administration. The proportions of 90-day survival and CPC 1/2 at 90 days after OHCAs were 5.9 and 3.0 %, respectively.ConclusionsThe Comprehensive Registry of In-hospital Intensive Care for OHCA Survival (CRITICAL) study will enroll over 2000 OHCA patients every year. It is still ongoing without a set termination date in order to provide valuable information regarding appropriate therapeutic strategies for OHCA patients (UMIN000007528).

Impact of age on survival of patients with out‐of‐hospital cardiac arrest transported to tertiary emergency medical institutions in Osaka, Japan

“…We analyzed data from the CRITICAL study, which is a multicenter prospective observational data registry, designed to obtain comprehensive data for both out‐ and in‐hospital OHCA managed by tertiary care institutions in Osaka, Japan. The methods and data elements collected by the CRITICAL study have been previously described . Briefly, the CRITICAL study was initiated in 2010 in Osaka Prefecture, Japan, which has an area of 1897 km 2 and a residential population of 8 865 245 inhabitants (2010 census data).…”

“…Unlike Europe and the USA, there is no formal system for prehospital “termination of resuscitation” in the field in Japan, and emergency transportation of all OHCA patients continues despite very low survival rates. Furthermore, the proportion of older people aged ≥65 years in the population will reach 30% in 2025, and the proportion of older people aged ≥75 years will reach 18% . Therefore, the evaluation of characteristics and outcomes for OHCA stratified by age and a better understanding of the prognostic factors associated with survival are required to optimize the management of older OHCA patients in Japan.…”

“…Furthermore, the proportion of older people aged ≥65 years in the population will reach 30% in 2025, and the proportion of older people aged ≥75 years will reach 18%. [7][8][9][10] Therefore, the evaluation of characteristics and outcomes for OHCA stratified by age and a better understanding of the prognostic factors associated with survival are required to optimize the management of older OHCA patients in Japan.…”

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

“…This survey also indicated that most of the centers do not have a well-defined list of inclusion/ex- [43] OHCA 55 30% Survival to discharge Beurtheret et al [56] Refractory CS 104 36.8% Survival to discharge Yamada et al [54] OHCA 688 5.9% 90-days survival rate Kagawa et al Intra-arrest PCI and ECPR 86 36% Survival to discharge. Yannopoulos et al [67] OHCA 27 55% Survival to discharge Sharma et al [66] OHCA 195 46.2% Survival to discharge Le Guen et al [7] OHCA and refractory CA 51 4% 30-days survival *OHCA = out-of-hospital cardiac arrest, IHCA = in-hospital cardiac arrest, CA = cardiac arrest, CSA = cardiogenic shock…”

“…This study aimed to provide the most appropriate therapeutic strategy, based on a mixed approach including PCI, cooling and ECPR for out-of-hospital cardiac arrest patients with presumed ischemic origin, preliminary data indicating very low rates of survival at 90-day and neurological performance (5.9% and 3.0% respectively) [54].…”