Tomohiko Sakai - Academia.edu (original) (raw)

Papers by Tomohiko Sakai

Amount of maximum rise of rSO 2 until 16 minutes 0 10 20 30 40 0.00 0.25 0.50 0.75 1.00 After fir... more Amount of maximum rise of rSO 2 until 16 minutes 0 10 20 30 40 0.00 0.25 0.50 0.75 1.00 After first rhythm check, rhythm check will be performed every 4 minutes. If rhythm changes to a shockable rhythm, defibrillation will be performed and rhythm check will be performed every 2 minutes. Figure 1. Logistic regression analysis for the relation between ROSC and rSO 2 value. These models were adjusted for age, sex, total number of electrical defibrillations and administrations of adrenaline, initial rhythm on EMS arrival, and with or without witness. At 40% of baseline rSO 2 value, 87.5% of patients will achieve ROSC if the rSO 2 value rises above 20% until 16 minutes.

Resuscitation plus, Dec 1, 2021

Background: The hemoglobin index (HbI) represents the amount of hemoglobin, which reflects the re... more Background: The hemoglobin index (HbI) represents the amount of hemoglobin, which reflects the regional tissue blood volume. The HbI is calculated by a regional oxygen saturation monitor. In freshwater drowning, inhaled water is immediately absorbed into the blood causing hemodilution. We hypothesized that this blood dilution could be observed in real time using HbI values in patients with out-of-hospital cardiac arrest (OHCA) due to freshwater drowning. Methods: In this single-center retrospective, observational study, we examined the HbI in patients with OHCA due to freshwater drowning from April 2015 to May 2020. Patients with OHCA due to hanging were selected as a control group. Results: Thirty-two patients in the freshwater drowning group and 21 in the control group were eligible for inclusion. In the freshwater drowning group, the HbI values in the return of spontaneous circulation (ROSC) group were significantly decreased in comparison to the non-ROSC group (À0.28 [IQR À0.55, À0.12] vs. À0.04 [IQR À0.16, 0.025]; p = 0.024). In the control group, the change of HbI during resuscitation in the ROSC and non-ROSC groups was not significantly dierent (0.11 [IQR À0.3525, 0.4225] vs. À0.02 [IQR À0.14, 0.605]; p = 0.8228). In each patient with ROSC in the freshwater drowning group, the HbI value after ROSC was significantly decreased in comparison to before ROSC (1.2±0.5 vs. 0.9 ±0.5]; p = 0.0156). In contrast, this dierence was not observed in patients with an ROSC in the control group (3.7±1.3 vs. 3.8±1.4]; p = 0.7940). Conclusion: Blood dilution induced by freshwater drowning might be detected in real time using the HbI. To prove the validity of this research's result, further prospective large study is needed.

Acute medicine & surgery, Aug 19, 2019

The hemoglobin index (HbI) represents the amount of hemoglobin, which reflects regional tissue bl... more The hemoglobin index (HbI) represents the amount of hemoglobin, which reflects regional tissue blood volume. The HbI is calculated in real time by a regional oxygen saturation (rSO 2) monitor. For the hypothesis of our HbI project, we theorized that HbI could be a new method for the screening of subarachnoid hemorrhage (SAH) in overcrowded emergency departments. As a first step, this study aimed to clarify the effectiveness of HbI in screening SAH in out-of-hospital cardiopulmonary arrest (OHCA) patients using the rSO 2 data of our previous studies. Methods: In this single-center, retrospective, observational study, we examined HbI in patients with OHCA transferred to the Trauma and Acute Critical Care Center at Osaka University Hospital (Osaka, Japan) during the period between April 2013 and December 2015. A sensor attached to the patient's forehead monitored HbI continuously. Results: Among 63 patients (40 men and 23 women; mean age, 76 [interquartile range (IQR), 66-85] years) with OHCA, five were diagnosed as having SAH (SAH group) and 58 were not (non-SAH group). The HbI values were significantly higher in the SAH group than in the non-SAH group (1.35 [IQR: 0.80-2.69] versus 0.41 [IQR: 0.32-0.61]), P = 0.0042). In the SAH group, with an HbI cutoff value of 1.18, the specificity and sensitivity were 96% and 80%, respectively, and the area under the receiver operating characteristic curve of HbI was 0.89. Conclusions: The HbI might be useful for the screening of SAH in patients with OHCA. The application of HbI in the emergency department could be expected in the future.

Journal of the American Heart Association, Jan 8, 2019

Background-Little is known about whether cardiopulmonary resuscitation (CPR) training can increas... more Background-Little is known about whether cardiopulmonary resuscitation (CPR) training can increase bystander CPR in the community or the appropriate target number of CPR trainings. Herein, we aimed to demonstrate community-wide aggressive dissemination of CPR training and evaluate temporal trends in bystander CPR. Methods and Results-We provided CPR training (45-minute chest compression-only CPR plus automated external defibrillator use training or the conventional CPR training), targeting 16% of residents. All emergency medical service-treated out-of-hospital cardiac arrests of medical origin were included. Data on patients experiencing out-of-hospital cardiac arrest and bystander CPR quality were prospectively collected from September 2010 to December 2015. The primary outcome was the proportion of highquality bystander CPR. During the study period, 57 173 residents (14.7%) completed the chest compression-only CPR training and 32 423 (8.3%) completed conventional CPR training. The proportion of bystander CPR performed did not change (from 43.3% in 2010 to 42.0% in 2015; P for trend=0.915), but the proportion of high-quality bystander CPR delivery increased from 11.7% in 2010 to 20.7% in 2015 (P for trend=0.015). The 1-year increment was associated with high-quality bystander CPR (adjusted odds ratio, 1.461; 95% CI, 1.055-2.024). Bystanders who previously experienced CPR training were 3.432 times (95% CI, 1.170-10.071) more likely to perform high-quality CPR than those who did not. Conclusions-We trained 23.0% of the residents in the medium-sized city of Osaka, Japan, and demonstrated that the proportion of high-quality CPR performed on the scene increased gradually, whereas that of bystander CPR delivered overall remained stable.

Clinical Case Reports, Aug 1, 2021

Abstract The regional oxygen saturation (rSO₂) values of brain and muscle tissues can be measured... more Abstract The regional oxygen saturation (rSO₂) values of brain and muscle tissues can be measured simultaneously even if blood pressure cannot be measured due to circulatory failure associated with shock and may continuously reflect the oxygen supply‐demand balance.

Journal of Japanese Society for Emergency Medicine

Acute Medicine & Surgery, 2020

AimThis study aimed to investigate the effect of repeat training and the interval of reattending ... more AimThis study aimed to investigate the effect of repeat training and the interval of reattending a simplified basic life support (BLS) training course.MethodsWe administered a questionnaire on the attitude toward cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use (check for response, chest compression, and using an AED) before and immediately after a 45‐min BLS training program provided for non‐medical staff working at a university hospital from September 2010 to November 2018. The main outcome was positive willingness of the participants toward CPR and AED use. The effect of repeat training was assessed with McNemar’s test and multivariable logistic regression analysis. Differences in the interval of reattending the simplified BLS training course were assessed with Fisher’s exact test.ResultsFifty‐nine training courses were held. Among the total participant count of 1,025, 760 individuals attended, of whom 126 attended the training multiple times. Th...

BMC Research Notes, 2016

Background: In recent years, measurement of cerebral regional oxygen saturation (rSO 2) has attra... more Background: In recent years, measurement of cerebral regional oxygen saturation (rSO 2) has attracted attention during resuscitation. However, serial changes of cerebral rSO 2 in pre-hospital settings are unclear. The objective of this study was to clarify serial changes in cerebral rSO 2 of patients with out-of-hospital cardiac arrest (OHCA) in the prehospital setting. Methods: We recently developed a portable rSO 2 monitor that is small (170 × 100 × 50 mm in size and 600 g in weight) enough to carry in pre-hospital settings. The sensor is attached to the patient's forehead by the ELT (Emergency Life-saving Technician), and it monitors rSO 2 continuously. Results: From June 2013 through August 2014, serial changes in cerebral rSO 2 in seven patients were evaluated. According to the results of the serial changes in rSO 2 , four patterns of rSO 2 change were found, as follows. Type 1: High rSO 2 (around about 60 %) type (n = 1). Initial electrocardiogram was ventricular fibrillation and ROSC (return of spontaneous circulation) could be diagnosed in pre-hospital setting. Her outcome at discharge was Good Recovery (GR). Type 2: Low rSO 2 (around about 45-50 %) type (n = 3). They did not get ROSC even once. Type 3: Gradually decreasing rSO 2 type (n = 2): ROSC could be diagnosed in hospital, but not in pre-hospital setting. Their outcomes at discharge were not GR. Type 4: other type (n = 1). In this patient with ROSC when ELT started cerebral rSO 2 measurement, cerebral rSO 2 was 67.3 % at measurement start, it dropped gradually to 54.5 %, and then rose to 74.3 %. The cerebral oxygenation was impaired due to possible cardiac arrest again, and after that, ROSC led to the recovery of cerebral blood flow. Conclusion: We could measure serial changes in cerebral rSO 2 in seven patients with OHCA in the pre-hospital setting. Our data suggest that pre-hospital monitoring of cerebral rSO 2 might lead to a new resuscitation strategy.

Resuscitation, 2011

Global Positioning System (GPS) is not almighty but supportive tool for improving CPR quality We ... more Global Positioning System (GPS) is not almighty but supportive tool for improving CPR quality We have read the article by Sakai et al. with great interest. 1 We completely agree with their conclusion and would like to comment on their study. Recently, Global Positioning System (GPS) has become one of the most essential and useful tools in the world. But we must not have blind faith in it. Consider, for example, a man who has collapsed in a complex shopping mall, such COEX TM , which is one of the biggest and the most crowded buildings in South Korea. The building comprises 4 stories over-and 4 underground, and is connected directly to two huge hotels, the 55 storied World Trade Centre Seoul, the ASEM tower of 41 stories, the city airport terminal, and one department store. If a lay person witnesses this collapsed man, he (or she) may try to activate the emergency medicine services (EMS) by calling 119, which is the phone number for the national EMS in Korea and serves as a contact point for all kind of emergencies. In this example, the cellular phone used for the EMS activation will also be tracked by the dispatcher to locate the event. However, it is almost impossible to locate the exact place due to a technical limitation. Under current technology, the cellular phone tracking can indicate only the nearest base station (within 1-2 km), not the exact point. Even with GPS technology, which is known to track the signal to within a range of 20 m, it is impossible to locate the place precisely, because GPS cannot receive a signal from satellite in closed places like the inside of a building or a tunnel. Furthermore, the exact floor cannot be recognized (Fig. 1). 2 Sakai et al. revealed that the new mobile automated external defibrillator (AED) map reduced the travel distance to access and retrieve the AED. 1 However, even if the equipment with GPS is used to find an AED, it can show only how to get to the building with an AED, not an exact location within that building. Hence, the layperson may have to wander around for some time before finding the AED, despite the use of GPS. Given this limitation of GPS, the use of a sign giving basic information about the exact location of the AED may be more helpful than new equipment with GPS. New technology such as GPS would be better used as a supportive method for life support rather than a universal tool. The exact location of an AED inside a building should always be indicated with simple signs in case the GPS system becomes inoperable.

Clinical Case Reports

Circulation, 2018

Purpose: Current guidelines recommend rhythm checks every 2 minutes during cardiopulmonary resusc... more Purpose: Current guidelines recommend rhythm checks every 2 minutes during cardiopulmonary resuscitation (CPR), but evidence for this recommendation is insufficient. Recent reports identified regional cerebral oxygen saturation (rSO 2 ) monitoring as useful in detecting return of spontaneous resuscitation (ROSC) and that coronary and cerebral perfusion decreases with the 2-minute rhythm check. On the basis of our previous study, we began the TripleCPR 16 study, which omits 2-minute rhythm checks because stopping chest compression to check rhythm may increase cerebral damage and decrease the ROSC. Methods: The multicenter, prospective TripleCPR 16 study began in January 2017. The inclusion criterion is a cardiopulmonary arrest patient aged ≥16 years with a non-shockable rhythm on hospital arrival. Subjects are divided into 3 groups based on their mean cerebral rSO 2 value in the first minute of arrival: ≥50%, <50% to 40%, and <40%. Continuous mechanical chest compression is per...

Circulation, 2019

Introduction: There are some critical ill patients who cannot measure oxygen saturation (SpO 2 ) ... more Introduction: There are some critical ill patients who cannot measure oxygen saturation (SpO 2 ) by pulse oximeter at the pre-hospital settings. For example, among emergency patients who were treated by emergency medical service (EMS) personnel of Osaka Municipal Fire Department in 2016, there were 3,571 patients who had urgent conditions judged by on-scene EMS personnel but did not have cardiopulmonary arrest (CPA), but the measurement of SpO 2 at the scene could not be measured for 395 patients. On the other hand, the measurement of cerebral regional oxygen saturation (rSO 2 ) during resuscitation has been recently paid to attention. Purpose: To evaluate whether rSO 2 could be measured for these patients.Materials and Methods: We developed portable rSO 2 monitors and equipped them in nine ambulances (There are 63 ambulances in Osaka City). We measured serial changes in cerebral rSO 2 among emergency patients who had urgent conditions judged by on-scene EMS personnel and could not ...

of out-of-hospital cardiac arrest in females of the reproductive age

Circulation, 2019

Purpose: Current guidelines recommend rhythm checks every 2 minutes during CPR, but evidence for ... more Purpose: Current guidelines recommend rhythm checks every 2 minutes during CPR, but evidence for this recommendation is insufficient. Recent reports identified regional cerebral oxygen saturation (rSO 2 ) monitoring as useful in detecting ROSC and that coronary and cerebral perfusion decrease with the 2-minute rhythm check. On the basis of our previous study, we began the TripleCPR 16 study, which omits 2-minute rhythm checks because stopping chest compression to check rhythm may increase cerebral damage and decrease the ROSC. Methods: The multicenter, prospective TripleCPR 16 study began in January 2017. The inclusion criterion is a cardiopulmonary arrest patient aged ≥16 years with a non-shockable rhythm on hospital arrival. Subjects are divided into 3 groups based on their mean cerebral rSO 2 value in the first minute of arrival: ≥50%, <50% to 40%, and <40%. Continuous mechanical chest compression is performed on all subjects for 16 minutes or until their rSO 2 value exceed...

Circulation, 2019

Objective: To clarify the neurological prognosis of post-resuscitation hypoxic encephalopathy pat... more Objective: To clarify the neurological prognosis of post-resuscitation hypoxic encephalopathy patients on the basis of cerebral autoregulation. Methods: We conducted a prospective, observational cohort study of patients admitted to our urban emergency and critical care center in Japan between 2017 and 2019. Cerebral regional oxygen saturation (rSO 2 ) was measured in patients with cardiopulmonary arrest on hospital arrival or return of spontaneous circulation (ROSC) before hospital arrival. Included in the analysis were patients aged ≥16 years who were transported to our hospital. Patients dying within 24 h of hospitalization were excluded. Immediately after arrival, the cerebral rSO 2 sensor was attached to the patient’s forehead and continuous monitoring was started. Continuous monitoring of cerebral rSO 2 and mean arterial pressure (MAP) was conducted until extubation or 96 hours after ROSC. We divided the patients into the good neurological prognosis group (cerebral performance ...

BackgroundIn the field of emergency medical care, we often experience a situation in which we can... more BackgroundIn the field of emergency medical care, we often experience a situation in which we cannot measure pulse oximetric saturation (SpO₂) or blood pressure due to circulatory failure associated with shock. However, as we can measure rSO₂ values of the brain even in patients with shock, we hypothesized that we could evaluate the oxygen supply-demand balance between brain and muscle tissue by simultaneously measuring regional oxygen saturation (rSO₂) values of the brain and muscle tissue of patients with shock.Case presentationWe attached a TOS-OR rSO₂ monitor (TOSTEC CO., Tokyo, Japan) to 10 healthy volunteers and measured the rSO₂ values of their brain and muscle for 3 minutes. The rSO₂ values of their brain cerebral regional oxygen saturation (crSO₂) and muscle regional oxygen saturation (mrSO₂) were 77.6±1.6% and 76.2±1.3% (mean ± SD). There was little difference between crSO₂ and mrSO₂ (cerebro-musculoskeletal difference in regional saturation of oxygen; c-mDrSO₂). However, ...

Resuscitation, 2021

BACKGROUND The proportion of adult patients with return of spontaneous circulation (ROSC) followi... more BACKGROUND The proportion of adult patients with return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) remains unchanged since 2012. A better resuscitation strategy is needed. This study evaluated the effectiveness of a regional cerebral oxygen saturation (rSO2)-guided resuscitation protocol without rhythm check based on our previous study. METHODS Because defibrillation is the definitive therapy that should be performed without delay for shockable rhythm, the study subjects were OHCA patients with non-shockable rhythm on hospital arrival at three emergency departments. They were divided into three groups based on their baseline rSO2 value (%): ≥50, ≥40 to <50, or <40. Continuous chest compression without rhythm checks was performed for 16 minutes or until a maximum increase in rSO2 of 10%, 20%, or 35% was achieved in each group, respectively. This intervention cohort was compared with a historical control cohort regarding the probability of ROSC using inverse probability of treatment weighting (IPTW) with propensity score. RESULTS The control and intervention cohorts respectively included 86 and 225 patients. The rate of ROSC was not significantly different between the groups (adjusted OR 0.91 [95% CI, 0.64-1.29], P=0.60), but no serious adverse events occurred. Sensitivity analyses 1 and 2 showed a significant difference or positive tendency for higher probability of ROSC (adjusted OR 1.63 [95% CI, 1.22-2.17], P<0.001) (adjusted OR 1.25 [95% CI, 0.95-1.63], P=0.11). CONCLUSIONS This trial suggested that a new cardiopulmonary resuscitation protocol with different rhythm check timing could be created using the rSO2 value. Clinical trial number: UMIN000025684.

Resuscitation, 2018

Previous studies have shown that hypothermia reduces the cerebral metabolic rate of oxygen. If ce... more Previous studies have shown that hypothermia reduces the cerebral metabolic rate of oxygen. If cerebral regional saturation of oxygen (rSO 2) accurately reflects the oxygen balance in the cerebrum, the value of rSO 2 would decrease during the rewarming process. The objective of this study was to evaluate the change of rSO 2 during rewarming in patients with accidental hypothermia.

Resuscitation plus, Dec 1, 2021

Acute medicine & surgery, Aug 19, 2019

Journal of the American Heart Association, Jan 8, 2019

Clinical Case Reports, Aug 1, 2021

Journal of Japanese Society for Emergency Medicine

Acute Medicine & Surgery, 2020

BMC Research Notes, 2016

Resuscitation, 2011

Clinical Case Reports

Circulation, 2018

Circulation, 2019

of out-of-hospital cardiac arrest in females of the reproductive age

Circulation, 2019

Resuscitation, 2021

Resuscitation, 2018