{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:40:52Z","timestamp":1790887252104,"version":"4.1.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2013,11,20]],"date-time":"2013-11-20T00:00:00Z","timestamp":1384905600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"},{"start":{"date-parts":[[2013,11,20]],"date-time":"2013-11-20T00:00:00Z","timestamp":1384905600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                        <jats:title>Introduction<\/jats:title>\n                        <jats:p>As emergency medical services (EMS) personnel in Japan are not allowed to perform termination of resuscitation in the field, most patients experiencing an out-of-hospital cardiac arrest (OHCA) are transported to hospitals without a prehospital return of spontaneous circulation (ROSC). As the crucial prehospital factors for outcomes are not clear in patients who had an OHCA without a prehospital ROSC, we aimed to determine the prehospital factors associated with 1-month favorable neurological outcomes (Cerebral Performance Category scale 1 or 2 (CPC 1\u20132)).<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Methods<\/jats:title>\n                        <jats:p>We analyzed the data of 398,121 adult OHCA patients without a prehospital ROSC from a prospectively recorded nationwide Utstein-style Japanese database from 2007 to 2010. The primary endpoint was 1-month CPC 1\u20132.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Results<\/jats:title>\n                        <jats:p>The rate of 1-month CPC 1\u20132 was 0.49%. Multivariate logistic regression analysis indicated that the independent variables associated with CPC 1\u20132 were the following nine prehospital factors: (1) initial non-asystole rhythm (ventricular fibrillation (VF): adjusted odds ratio (aOR), 9.37; 95% confidence interval (CI), 7.71 to 11.4; pulseless ventricular tachycardia (VT): aOR, 8.50; 95% CI, 5.36 to 12.9; pulseless electrical activity (PEA): aOR, 2.75; 95% CI, 2.40 to 3.15), (2) age &lt;65\u00a0years (aOR, 3.90; 95% CI, 3.28 to 4.67), (3) arrest witnessed by EMS personnel (aOR, 2.82; 95% CI, 2.48 to 3.19), (4) call-to-hospital arrival time &lt;24\u00a0minutes (aOR, 2.58; 95% CI, 2.22 to 3.01), (5) arrest witnessed by any layperson, (6) physician-staffed ambulance, (7) call-to-response time &lt;5\u00a0minutes, (8) prehospital shock delivery, and (9) presumed cardiac cause. When four crucial key factors (with an aOR &gt;2.0 in the regression model: initial non-asystole rhythm, age &lt;65\u00a0years, EMS-witnessed arrest, and call-to-hospital arrival time &lt;24\u00a0minutes) were present, the rates of 1-month CPC 1\u20132 and 1-month survival were 16.1% and 23.2% in initial VF, 8.3% and 16.7% in pulseless VT, and 3.8% and 9.4% in PEA, respectively.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Conclusions<\/jats:title>\n                        <jats:p>In OHCA patients transported to hospitals without a prehospital ROSC, nine prehospital factors were significantly associated with 1-month CPC 1\u20132. Of those, four are crucial key factors: initial non-asystole rhythm, age &lt;65\u00a0years, EMS-witnessed arrest, and call-to-hospital arrival time &lt;24\u00a0minutes.<\/jats:p>\n                     <\/jats:sec>","DOI":"10.1186\/cc13121","type":"journal-article","created":{"date-parts":[[2013,11,20]],"date-time":"2013-11-20T10:28:46Z","timestamp":1384943326000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Neurological outcomes in patients transported to hospital without a prehospital return of spontaneous circulation after cardiac arrest"],"prefix":"10.1186","volume":"17","author":[{"given":"Yoshikazu","family":"Goto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuo","family":"Maeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumiko","family":"Nakatsu-Goto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2013,11,20]]},"reference":[{"key":"2163_CR1","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1056\/NEJMoa0906644","volume":"362","author":"T Kitamura","year":"2010","unstructured":"Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Hiraide A: Hiraide A for the Implementation Working Group for All-Japan Utstein Registry of the Fire and Disaster Management Agency: Nationwide public access defibrillation in Japan.\n                           N Engl J Med 2010, 362: 994-1004. 10.1056\/NEJMoa0906644","journal-title":"N Engl J Med"},{"key":"2163_CR2","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.resuscitation.2005.03.021","volume":"67","author":"C Atwood","year":"2005","unstructured":"Atwood C, Eisenberg MS, Herlitz J, Rea TD: Incidence of EMS-treated out-of-hospital cardiac arrest in Europe.\n                           Resuscitation 2005, 67: 75-80. 10.1016\/j.resuscitation.2005.03.021","journal-title":"Resuscitation"},{"key":"2163_CR3","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1161\/CIRCOUTCOMES.109.889576","volume":"3","author":"C Sasson","year":"2010","unstructured":"Sasson C, Rogers MAM, Dahl J, Kellermann AL: Predictors of survival from out-of-hospital cardiac arrest: A systematic review and meta-analysis.\n                           Cir Cardiovasc Qual Outcomes 2010, 3: 63-81. 10.1161\/CIRCOUTCOMES.109.889576","journal-title":"Cir Cardiovasc Qual Outcomes"},{"key":"2163_CR4","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1016\/j.resuscitation.2012.03.015","volume":"83","author":"N Nielsen","year":"2012","unstructured":"Nielsen N: Predictive scores, friend or foe for the cardiac patient.\n                           Resuscitation 2012, 83: 669-670. 10.1016\/j.resuscitation.2012.03.015","journal-title":"Resuscitation"},{"key":"2163_CR5","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1111\/j.1553-2712.2002.tb02144.x","volume":"9","author":"PR Verbeek","year":"2002","unstructured":"Verbeek PR, Vermeulen MJ, Ali FH, Messenger DW, Summers J, Morrison LJ: Derivation of a termination-of-resuscitation guideline for emergency medical technicians using automated external defibrillators.\n                           Acad Emerg Med 2002, 9: 671-678. 10.1111\/j.1553-2712.2002.tb02144.x","journal-title":"Acad Emerg Med"},{"key":"2163_CR6","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1056\/NEJMoa052620","volume":"355","author":"LJ Morrison","year":"2006","unstructured":"Morrison LJ, Visentin LM, Kiss A, Theriault R, Eby D, Vermeulen M, Sherbino J, Verbeek PR, for the TOR investigators: Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest.\n                           N Engl J Med 2006, 355: 478-487. 10.1056\/NEJMoa052620","journal-title":"N Engl J Med"},{"key":"2163_CR7","unstructured":"Ministry of Education Culture, Sports, Science and Technology of Japan\/Ministry of Health, Labor and Welfare of Japan: A guideline for epidemiology studies [in Japanese]. 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