Changes Over 7 Years in Temperature Control Treatment and Outcomes After Out-of-Hospital Cardiac Arrest: A Japanese,Multicenter Cohort Study

Abstract

Temperature control is the only neuroprotective intervention suggested in current international guidelines for patients with return of spontaneous circulation after cardiac arrest, but the prevalence of temperature control therapy, temperature settings, and outcomes have not been clearly reported. We aimed to investigate changes over 7 years in provision of temperature control treatment among out-of-hospital cardiac arrest (OHCA) patients in Kanto region, Japan. Data of all adult OHCA patients who survived for more than 24 hours in the prospective cohort studies, SOS-KANTO 2012 (conducted from 2012 to 2013) and SOS-KANTO 2017 (conducted from 2019 to 2021), in Japan were included. We compared the prevalence of temperature control and the proportion of mild (≥35°C) and moderate (from 32°C to 34.9°C) hypothermia between the two study groups. We also performed a Cox regression analysis to evaluate 30-day mortality adjusted by temperature control therapy (none, moderate hypothermia, or mild hypothermia), age, sex, past medical history, witnessed status, bystander cardiopulmonary resuscitation, initial rhythm, location of arrest, and dataset (SOS-KANTO 2012 or 2017). We analyzed data from 2936 patients (n = 1710, SOS-KANTO 2012; n = 1226, SOS-KANTO 2017). Use of temperature control was lower (45.3% vs. 41.4%, p = 0.04), moderate hypothermia was lower (p < 0.01), and mild hypothermia was higher (p < 0.01) in SOS-KANTO 2017 compared with SOS-KANTO 2012. The survival rate was significantly higher for patients with mild (p < 0.01) and moderate (p < 0.01) hypothermia compared with those who did not receive temperature control therapy. Overall, the incidence of moderate hypothermia decreased and that of mild hypothermia increased and the use of temperature control decreased between the two studies conducted 7 years apart in the Kanto area, Japan. Temperature control management might improve survival of patients with OHCA.

Introduction

Among patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA), postanoxic brain damage is one of the most serious complications (Lemiale et al., 2013). Temperature control is the only neuroprotective intervention suggested in the current international guidelines (Sandroni et al., 2022).

The concept of temperature control therapy after CA has changed drastically over the decades. Hypothermia was first used after CA in 1958, and guidelines published by the International Committee on Resuscitation (ILCOR) in 2005 suggested that therapeutic hypothermia after CA was effective (Bonaventura et al., 2016).

The 2010 American Heart Association (AHA) guidelines and the 2013 European Resuscitation Council (ERC) guidelines recommend that the temperature of patients with ROSC after out-of-hospital CA (OHCA) caused by ventricular fibrillation should be controlled at 32–34°C. The targeted temperature management trials published in 2013 and other studies reported that targeted hypothermia might not be more effective than targeted normothermia (Bonaventura et al., 2016; Nielsen et al., 2013).

In the 2020 AHA guidelines and 2021 ERC guidelines, temperature control targeting a temperature from 32°C to 36°C was recommended for all post-CA patients, regardless of initial rhythm, and the 2020 Japan Resuscitation Council (JRC) guidelines include a similar recommendation (Japan Resuscitation Council, 2020; Nolan et al., 2021; Panchal et al., 2020).

These changes likely influenced patient management after CA in the real world (Tagami et al., 2016), but the prevalence of temperature control therapy, temperature settings used, and outcomes have not been consistently reported. The aim of the current study was to compare the provision of temperature control treatment among OHCA patients using data from two multicenter prospective studies conducted over 7 years in the same region of Japan.

Methods

Ethical considerations

The present study adhered to the principles of the Declaration of Helsinki and was approved by the ethics committee at the Nippon Medical School Tama Nagayama Hospital (reference number 597). Our analysis did not include personal identifying information of patients, so the requirement for informed consent was waived.

Study design and population

This study was one of the predefined themes of SOS-KANTO 2017, a multicenter prospective study performed in the Kanto region of Japan. The SOS-KANTO study was supported by the Kanto Regional Group of the Japanese Association for Acute Medicine.

The previous studies were conducted to collect prehospitalization records of all-cause CA patients who were transported to participating hospitals by trained emergency medical service (EMS) providers and who were admitted to participating hospitals. The Kanto region is situated in the middle part of Japan, and the area is about 32,000 square kilometers. The population in this area is about 41 million, that is, over 30% of the population in Japan.

The database includes information about patients' on-scene vital signs, patients' background, initial rhythm documented by EMS, the cause of OHCA, hospital arrival time, vital signs upon arrival at the hospital, treatments in the hospital, onset time of OHCA, neurological outcome, and mortality (SOS-KANTO Study Group, 2015; SOS-KANTO Study Group, 2015; Tanaka et al., 2016).

All adult OHCA patients who were enrolled in SOS-KANTO 2012 and 2017 were included. Patients <18 years old, patients who died within 24 hours of CA, and patients with missing discharge date information were excluded. The studies were conducted from January 2012 to March 2013 for the SOS-KANTO 2012 study and from September 2019 to March 2021 for the SOS-KANTO 2017 study.

Definitions and data collection

CA was defined as the absence of a pulse and normal breathing (Jacobs et al., 2004). We used the term “temperature control,” aiming for targeted hypothermia and targeted temperature management, because the ILCOR Advanced Life Support Task Force recently adopted the term (Sandroni et al., 2022).

Neurological outcomes at discharge from hospital were defined using the cerebral performance category (CPC) score, as follows: (1) good performance; (2) moderate disability; (3) severe disability; (4) vegetative state; and (5) death (Jacobs et al., 2004; Tagami et al., 2012). We grouped CPCs 1 and 2 as favorable outcomes and CPCs 3, 4, and 5 as poor outcomes in accordance with previous studies (Jacobs et al., 2004; SOS-KANTO 2012 Study Group, 2015; SOS-KANTO Study Group, 2015; Tagami et al., 2012).

The temperature control targets in the SOS-KANTO 2012 study were “hypothermia” and “avoid hyperthermia” and the numeric target temperature range was from 32.0°C to 38.5°C. In contrast, the SOS-KANTO 2017 study used only “temperature control” and the numeric target temperature range was from 32°C to 36°C.

Therefore, on the basis of previous studies, we defined the targeted temperature for moderate hypothermia as being from 32°C to 34.9°C and that for mild hypothermia as being ≥35°C for the current study (Düggelin et al., 2021; Granfeldt et al., 2021; Nolan et al., 2021; Sanfilippo et al., 2021).

Outcome measures

The main outcome measures were the prevalence of temperature control treatment and the proportion of mild and moderate hypothermia. Secondary outcome measures were 30-day mortality and the proportion of favorable outcomes at 1 month.

Statistical analysis

We compared patients' background and covariates between the SOS-KANTO 2012 and SOS-KANTO 2017 study groups. Results are expressed as median (interquartile range [IQR]) for non-normally distributed data. Continuous variables were analyzed using Student's t-test or the Mann–Whitney U test, and categorical variables were analyzed using the chi-square test or Fisher's test, as appropriate. We then compared outcomes between the two groups based on initial rhythm.

Moreover, we performed multiple imputation to decrease the bias caused by incomplete data: each missing value was replaced with a set of five plausible substitute values, and one model was created by statistical inference with the results of the five imputed datasets (Janssen et al., 2010; Little et al., 2012).

Finally, we conducted a survival analysis using Cox proportional hazards regression analysis. We chose covariates that were independently associated with mortality, according to previous studies, as follows: temperature control therapy (none, moderate hypothermia, or mild hypothermia), age, sex, past medical history, witnessed status, bystander cardiopulmonary resuscitation (CPR), initial rhythm, location of arrest, and database (SOS-KANTO 2012 or 2017) (Al-Dury et al., 2020; Kim et al., 2023; Mathew et al., 2021).

A p-value of ≤0.05 was considered to indicate statistical significance. All data were analyzed using SPSS software (version 28; IBM Corp., Armonk, NY).

Results

Among 16,452 patients in the SOS-KANTO 2012 study and 9909 patients in the SOS-KANTO 2017 study, 2936 adult patients who survived at least 24 hours after admission were included in our analysis (n = 1710, SOS-KANTO 2012; n = 1226, SOS-KANTO 2017) (Fig. 1).

FIG. 1.

Patient selection.

Patients' demographic information is presented in Table 1 and Supplementary Table S1. There were no statistically significant differences in age (68 years [IQR: 57–79] vs. 70 years [IQR: 56–79]; p = 0.14), sex (p = 0.59), or the cause of CA (p = 0.29). However, the proportion of patients with ischemic heart disease was higher (6.6% vs. 10.6%; p < 0.01) and baseline activities of daily living in patients with disability were higher (p < 0.01) in the SOS-KANTO 2017 group compared with the SOS-KANTO 2012 group.

Table 1.

Patient Demographics and Clinical Characteristics upon Hospital Admission

Variable	SOS-KANTO 2012 (n = 1710)	SOS-KANTO 2017 (n = 1226)	p
Age, years	68 (57 to 79)	70 (56 to 79)	0.14
Male sex	1171/1710 (68.5)	851/1226 (69.4)	0.59
Body–mass index, kg/m²	22.0 (19.5 to 24.2)	22.2 (19.6 to 25.7)	<0.01
Body temperature on arrival, °C	35.5 (34.7 to 36.2)	35.9 (35.2 to 36.4)	0.05
GCS 3 on hospital arrival	1350/1686 (80.1)	1001/1226 (81.6)	<0.01
GCS 3 on hospital admission	1048/1499 (69.9)	971/1226 (79.2)	<0.01
Lactate (mmol)^a	1.3 (0.8 to 7.0)	11.1 (8.2 to 14.5)	<0.01
WBC (10³/μL)	10.3 (7.9 to 13.2)	10.5 (8.2 to 13.5)	0.02
Hb (g/dL)	12.6 (11.1 to 14.3)	12.6 (10.9 to 14.3)	0.26
K (mmol/L)	4.3 (3.7 to 5.1)	4.1 (3.6 to 4.9)	0.01
pH^b	7.06 (6.91 to 7.27)	6.94 (6.83 to 7.06)	<0.01
PaCO₂ (mmHg)^b	60.4 (39.8 to 91.9)	75.1 (52.1 to 95.6)	<0.01
PaO₂ (mmHg)^b	110.0 (55.9 to 273.8)	64.5 (33.4 to 136.4)	<0.01
HCO₃ (mEq/L)^b	18.1 (14.3 to 21.9)	16.4 (12.6 to 19.3)	<0.01
BE (mEq/L)^b	−12.1 (−17.1 to −6.4)	−16.1 (−21.2 to −11.2)	<0.01
Pupil right/left (mm)	4 (3 to 4)	4 (3 to 4)	0.22
Medical history	1159/1710 (67.8)	762/1226 (62.2)	<0.01
Baseline ADL			<0.01
Good ability	1135/1431 (79.3)	614/990 (62.0)
Mild disability	218/1431 (15.2)	269/990 (27.2)
Severe disability	76/1431 (5.3)	88/990 (8.9)
Vegetative state	2/1431 (0.1)	19/990 (1.9)
ECG on hospital arrival			<0.01
VF	143/1692 (8.5)	114/1226 (9.3)
Pulseless VT	10/1692 (0.6)	17/1226 (1.4)
PEA	331/1692 (19.6)	256/1226 (20.9)
Asystole	360/1692 (21.3)	197/1226 (16.1)
Others^c	848/1692 (50.1)	642/1226 (52.4)
Cause of CA			0.29
Cardiac etiology	959/1682 (57.0)	723/1226 (59.0)
Noncardiac etiology	723/1682 (43.0)	503/1226 (41.0)
Trauma	55/705 (7.8)	22/223 (9.9)
Asphyxia	211/705 (211)	156/223 (70.0)

Data are provided as the number of positive observations/total number of observations (%) or as median (IQR). For each variable, the number of missing observations can be obtained as the difference between the total number of patients in each phase and the total number of observations.

Lactate was measured in 1344 patients in the SOS-KANTO 2012 study and in 459 patients in the SOS-KANTO 2017 study.

Arterial blood gas was measured in 1607 patients in the SOS-KANTO 2012 study and in 463 patients in the SOS-KANTO 2017 study.

Others included any ECGs of the patients with return of spontaneous circulation after cardiac arrest.

ACS, acute coronary syndrome; ADL, activities of daily living; BE, base excess; CA, cardiac arrest; ECG, electrocardiogram; GCS, Glasgow Coma Scale; Hb, hemoglobin; HCO₃, bicarbonate; IQR, interquartile range; K, potassium; PaCO₂, partial pressure of carbon dioxide; PaO, partial pressure of oxygen; PEA, pulseless electrical activity; VF, ventricular fibrillation; VT, ventricular tachycardia; WBC, white blood cells.

Table 2 shows the patients' prehospital information and EMS procedures. Defibrillation by a citizen and bystander CPR were more often performed in SOS-KANTO 2017 than in SOS-KANTO 2012 (34.4% vs. 44.2%; p < 0.01; 48.6% vs. 54.7%; p < 0.01, respectively). For prehospital treatments by EMS, intravenous access, epinephrine administration, and airway management were more successful in SOS-KANTO 2017 than in SOS-KANTO 2012 (27.1% vs. 42.1%, p < 0.01; 21.3% vs. 31.4%, p < 0.01; and p < 0.01, respectively).

Table 2.

Prehospital Patient Demographics and Clinical Characteristics

Variable	SOS-KANTO 2012 (n = 1710)	SOS-KANTO 2017 (n = 1226)	p
Witnessed by layperson	1311/1708 (76.8)	897/1188 (75.5)	0.44
Defibrillation performed by a citizen	287/834 (34.4)	111/251 (44.2)	<0.01
Bystander CPR	829/1707 (48.6)	650/1189 (54.7)	<0.01
Location			<0.01
Home	824/1679 (49.1)	662/1208 (54.8)
Public place (indoor)	249/1679 (14.8)	40/1208 (3.3)
Public place (outdoor)	104/1679 (6.2)	259/1208 (21.4)
Medical institutions	161/1679 (9.6)	29/1208 (2.4)
Initial rhythm confirmed by EMS			<0.01
VF	434/1690 (25.7)	304/1178 (25.8)
Pulseless VT	13/1690 (0.8)	14/1178 (1.2)
PEA	445/1690 (26.3)	381/1178 (32.3)
Asystole	361/1690 (21.4)	237/1178 (20.1)
Others^a	437/1690 (25.9)	242/1178 (20.5)
ROSC during transportation	694/1555 (44.6)	563/1157 (48.7)	0.04
Prehospital treatment by EMS
Defibrillation	589/1678 (35.1)	392/1198 (32.7)	0.18
Intravenous access	449/1657 (27.1)	501/1191 (42.1)	<0.01
Epinephrine	341/1602 (21.3)	370/1180 (31.4)	<0.01
Airway management by EMS			<0.01
Supraglottic airway device	581/1689 (34.4)	866/1149 (75.4)
Tracheal intubation	77/1689 (4.6)	88/1149 (7.7)

Others included any ECGs of the patients with return of spontaneous circulation after cardiac arrest.

CPR, cardiopulmonary resuscitation; EMS, emergency medical service; IQR, interquartile range; PEA, pulseless electrical activity; ROSC, return of spontaneous circulation; VF, ventricular fibrillation; VT, ventricular tachycardia.

The percentage of patients undergoing temperature control was lower in the SOS-KANTO 2017 group compared with SOS-KANTO 2012 group (45.3% vs. 41.4%; p = 0.04) (Table 3). Focusing on initial rhythm, the proportion of patients undergoing temperature control in the SOS-KANTO 2012 group did not differ from that in the SOS-KANTO 2017 group among patients with a shockable rhythm on scene (68.9% vs. 66.4%; p = 0.46).

Table 3.

In-Hospital Treatments

Variable	SOS-KANTO 2012 (n = 1710)	SOS-KANTO 2017 (n = 1226)	p
Temperature control
All	775/1710 (45.3)	508/1226 (41.4)	0.04
Shockable rhythm	308/447 (68.9)	211/318 (66.4)	0.46
Nonshockable rhythm	318/806 (39.5)	198/618 (32.0)	<0.01
Target temperature, °C			<0.01
32.0–32.9	6/775 (0.8)	5/508 (0.4)
33.0–33.9	59/775 (7.6)	7/508 (1.0)
34.0–34.9	508/775 (65.5)	219/508 (43.1)
35.0–35.9	78/775 (10.1)	89/508 (17.5)
36.0+	124/775 (16.0)	186/508 (36.6)
Cooling method
Surface cooling	525/639 (82.2)	336/488 (68.9)	<0.01
Intravascular cooling device	22/639 (3.4)	40/479 (8.4)	<0.01
ECMO	90/639 (14.1)	111/478 (23.2)	<0.01
Defibrillation	314/1598 (19.6)	237/1223 (19.4)	0.86
ECMO	209/1584 (13.2)	192/1226 (15.7)	0.06
Emergency coronary angiography	623/1622 (38.4)	456/1226 (37.2)	0.51
PCI	282/475 (59.4)	233/475 (49.1)	<0.01
Medications
Epinephrine	846/1579 (53.6)	560/1226 (45.7)	<0.01
Vasopressin	6/1581 (0.4)	3/1226 (0.2)	0.53
Atropine	82/1581 (5.2)	8/1226 (0.7)	<0.01
Lidocaine	94/1575 (6.0)	26/1226 (2.1)	<0.01
Nifekalant	45/1579 (2.8)	18/1226 (1.5)	0.01
Amiodarone	207/1576 (13.1)	202/1226 (16.5)	0.01
Magnesium sulfate	100/1564 (6.4)	37/1226 (3.0)	<0.01

Data are provided as the number of positive observations/total number of observations (%).

For each variable, the number of missing observations can be obtained as the difference between the total number of patients in each phase and the total number of observations.

ECMO, extracorporeal membrane oxygenation; PCI, percutaneous coronary intervention.

Conversely, temperature control was performed less often in the SOS-KANTO 2017 group than in the SOS-KANTO 2012 group among patients with a nonshockable rhythm (39.5% vs. 32.0%; p < 0.01).

Similar trends for temperature control target range were observed in all groups, including those with a shockable or nonshockable rhythm (Fig. 2). The proportion of moderate hypothermia was lower and that of mild hypothermia was higher in the SOS-KANTO 2017 group compared with that in the SOS-KANTO 2012 group (p < 0.01 and p < 0.01, respectively).

FIG. 2.

Prevalence of moderate and mild hypothermia, 30-day mortality, and favorable outcomes at 1 month, focusing on initial rhythms.

In addition, 30-day mortality in the SOS-KANTO 2012 group was not different from that in the SOS-KANTO 2017 group for all patients, patients with a shockable rhythm, and patients with a nonshockable rhythm (47.5% vs. 50.0%, p = 0.19; 29.1% vs. 34.8%, p = 0.11; and 67.4% vs. 66.3%, p = 0.67, respectively).

The results of the survival analysis using a Cox proportional hazards model to evaluate mortality, adjusted by temperature control therapy (none, moderate hypothermia, or mild hypothermia), age, sex, past medical history, witnessed status, bystander CPR, initial rhythm, location of arrest, and dataset (SOS-KANTO 2012 or 2017), are shown in Figure 3 and Table 4.

FIG. 3.

Survival analysis using Cox regression among patients with OHCA. OHCA, out-of-hospital cardiac arrest.

Table 4.

Cox Regression Analysis of the Risk of 30-Day Mortality Among Out-of-Hospital Cardiac Arrest Patients After Multiple Imputation

	Hazard ratio	95% CI	p
Mild hypothermia	0.73	0.62–0.86	<0.01
Moderate hypothermia	0.66	0.57–0.76	<0.01
No temperature control treatment (reference)	1
SOS-KANTO 2017	1.03	0.92–1.16	0.60
SOS-KANTO 2012 (reference)	1
Female	1.17	1.03–1.33	0.01
Male (reference)	1
Age	1.00	1.00–1.01	0.12
Medical history +	1.04	0.93–1.18	0.47
Medical history − (reference)	1
Witness +	0.91	0.81–1.03	0.14
Witness − (reference)	1
Bystander CPR +	0.81	0.72–0.91	<0.01
Bystander CPR − (reference)	1
Shockable rhythm	0.58	0.49–0.70	<0.01
Nonshockable rhythm (reference)	1
Public space: outside	0.79	0.63–0.99	0.04
Public space: inside	0.86	0.71–1.04	0.11
Nursing home and medical facilities	0.94	0.74–1.18	0.58
Other places	0.79	0.68–0.92	<0.01
Home (reference)	1

CI, confidence interval; CPR, cardiopulmonary resuscitation.

After adjusting for the dataset (SOS-KANTO 2012 or 2017), the survival rate was significantly higher for patients with mild hypothermia than for those who did not receive temperature control therapy (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.62–0.86; p < 0.01). Similarly, the survival rate was significantly higher for patients with moderate hypothermia than for those who did not receive temperature control therapy (HR, 0.66; 95% CI, 0.57–0.76; p < 0.01).

Discussion

The results of the current study indicated the following changes in neuroprotective treatment for post-CA patients: the proportion of moderate hypothermia was lower and that of mild hypothermia higher in the SOS-KANTO 2017 group compared with the SOS-KANTO 2012 group.

This significant change might reflect the revised guidelines for CA patients. Previous reports demonstrate that adherence to resuscitation guidelines improves outcomes (Hessulf et al., 2020; Honarmand et al., 2018; McEvoy et al., 2014). The ERC, AHA, and JRC guidelines published in 2020 and 2021 were revised to further emphasize post-CA care and to accept normothermia and hypothermia (Japan Resuscitation Council, 2020; Nolan et al., 2021; Panchal et al., 2020).

Technically, in the real world, maintaining normothermia is easier than adhering to a hypothermia protocol (Düggelin et al., 2021). This means that the temperature control target after CA tends to be higher and closer to normal body temperature. The results of our study suggest that resuscitation guideline revisions likely changed doctors' prescribing behavior in Japan and the guidelines had a substantial effect on clinical treatment.

Survival analysis showed that survival rates of patients who received mild or moderate hypothermia were significantly higher than those who did not receive temperature control treatment after adjusting for the data source (SOS-KANTO 2012 or 2017) and other variables that were independently associated with mortality. This result supports the efficacy of temperature control therapy compared with no temperature management.

Recent studies on temperature control therapy emphasize not only the comparison of targeted temperatures (33°C vs. 36°C) but also comparison between hypothermia and normothermia (Dankiewicz et al., 2021; Düggelin et al., 2021; Nielsen et al., 2013; Sanfilippo et al., 2021). However, our study classified the target temperature into moderate or mild hypothermia, and we did not assess normothermia; therefore, we cannot determine the ideal targeted temperature. Further studies are required to evaluate the optimal temperature to target for OHCA patients.

We also examined the effects of different prehospital treatments administered by EMS personnel, who have an important role in a chain of survival for patients with OHCA (Ong et al., 2018). Among our adult patients who survived at least 24 hours after ROSC, successful intravenous access, epinephrine administration, and airway management by EMS employees before arrival at the hospital occurred more often in the SOS-KANTO 2017 group than in the SOS-KANTO 2012 group.

The medical control protocol for OHCA patient management in the Kanto region did not change much during each study period; therefore, these results indicate that EMS provider skills have improved.

Limitations

There are some limitations in this study. First, the current study was a cohort design with a post hoc analysis using a multicenter database survey. However, sampling at the participating hospitals was not randomized or population based.

Second, the mild hypothermia group defined in our study must have included patients with normothermia. Besides, there is no standard definition of moderate hypothermia and mild hypothermia, and the definitions of the terms in the current study were its own, so we could not directly compare the results of this study with others.

Finally, the databases did not include information about do-not-resuscitate orders, indications for temperature control, or the reasons why doctors decided upon a targeted temperature.

Conclusions

The current study shows a clear trend for implementing temperature control after CA in Japan. Moderate hypothermia was lower, mild hypothermia was higher, and the proportion of temperature control was lower in the SOS-KANTO 2017 trial (2019–2021) compared with the SOS-KANTO 2012 trial (2012–2013). Our results support the efficacy of temperature control therapy for OHCA patients.

Footnotes

Authors' Contributions

C.T. was involved in conceptualization, methodology, analysis, and writing—original draft preparation. T.T., F.N., M.K., N.K., H.Y., S.A., M.T., and K.U. were involved in supervision and writing—reviewing.

Ethical Approval and Consent to Participate

The ethics committee at the Nippon Medical School Tama Nagayama Hospital approved the present study (reference number 597). Because we analyzed anonymous data, the requirement for written informed consent was waived.

Availability of Data and Materials

The data used in this study are available from the SOS-KANTO 2017 study group. However, restrictions apply to the availability of these data, which were used under the license for the current study, and thus, they are not publicly available. Data are available from the authors upon reasonable request and with the permission of the SOS-KANTO 2017 study group.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

Supplementary Material

References

Al-Dury

, Ravn-Fischer

, Hollenberg

, et al. Identifying the relative importance of predictors of survival in out of hospital cardiac arrest: A machine learning study. Scand J Trauma Resusc Emerg Med, 2020; 28(1):60; doi: 10.1186/s13049-020-00742-9

Bonaventura

, Alan

, Vejvoda

, et al. History and current use of mild therapeutic hypothermia after cardiac arrest. Arch Med Sci, 2016; 12(5):1135–1141; doi: 10.5114/aoms.2016.61917

Dankiewicz

, Cronberg

, Lilja

, et al.; TTM2 Trial Investigators. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med, 2021; 384(24):2283–2294; doi: 10.1056/NEJMoa2100591

Düggelin

, Maggiorini

, Voigtsberger

, et al. Increased protocol adherence and safety during controlled normothermia as compared to hypothermia after cardiac arrest. J Crit Care, 2021; 63:146–153; doi: 10.1016/j.jcrc.2020.09.019

Granfeldt

, Holmberg

, Nolan

, et al.; International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support Task Force. Targeted temperature management in adult cardiac arrest: Systematic review and meta-analysis. Resuscitation, 2021; 167:160–172; doi: 10.1016/j.resuscitation.2021.08.040

Hessulf

, Herlitz

, Rawshani

, et al. Adherence to guidelines is associated with improved survival following in-hospital cardiac arrest. Resuscitation, 2020; 155:13–21; doi: 10.1016/j.resuscitation.2020.07.009

Honarmand

, Mepham

, Ainsworth

, et al. Adherence to advanced cardiovascular life support (ACLS) guidelines during in-hospital cardiac arrest is associated with improved outcomes. Resuscitation, 2018; 129:76–81; doi: 10.1016/j.resuscitation.2018.06.005

Jacobs

, Nadkarni

, Bahr

, et al.; ILCOR Task Force on Cardiac Arrest and Cardiopulmonary Resuscitation Outcomes. Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update and simplification of the Utstein templates for resuscitation registries: A statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation, 2004; 110(21):3385–3397; doi: 10.1161/01.CIR.0000147236.85306.15

Janssen

, Donders

A-R

, Harrell

Jr , et al. Missing covariate data in medical research: To impute is better than to ignore. J Clin Epidemiol, 2010; 63(7):721–727; doi: 10.1016/j.jclinepi.2009.12.008

10.

Japan Resuscitation Council. JRC Resuscitation Guidelines. 2020. Available from: https://www.jrc-cpr.org/jrc-guideline-2020/

11.

Kim

, Lee

, Lim

, et al. Impact of COVID-19 on out-of-hospital cardiac arrest in Korea. J Korean Med Sci, 2023; 38(12):e92; doi: 10.3346/jkms.2023.38.e92

12.

Lemiale

, Dumas

, Mongardon

, et al. Intensive care unit mortality after cardiac arrest: The relative contribution of shock and brain injury in a large cohort. Intensive Care Med, 2013; 39(11):1972–1980; doi: 10.1007/s00134-013-3043-4

13.

Little

, D'Agostino

, Cohen

, et al. The prevention and treatment of missing data in clinical trials. N Engl J Med, 2012; 367(14):1355–1360; doi: 10.1056/NEJMsr1203730

14.

Mathew

, Harrison

, Chalek

, et al. Effects of the COVID-19 pandemic on out-of-hospital cardiac arrest care in Detroit. Am J Emerg Med, 2021; 46:90–96; doi: 10.1016/j.ajem.2021.03.025

15.

McEvoy

, Field

, Moore

, et al. The effect of adherence to ACLS protocols on survival of event in the setting of in-hospital cardiac arrest. Resuscitation, 2014; 85(1):82–87; doi: 10.1016/j.resuscitation.2013.09.019

16.

Nielsen

, Wetterslev

, Cronberg

, et al.; TTM Trial Investigators. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med, 2013; 369(23):2197–2206; doi: 10.1056/NEJMoa1310519

17.

Nolan

, Sandroni

, Böttiger

, et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: Post-resuscitation care. Intensive Care Med, 2021; 47(4):369–421; doi: 10.1007/s00134-021-06368-4

18.

Ong

MEH

, Perkins

, Cariou

. Out-of-hospital cardiac arrest: Prehospital management. Lancet, 2018; 391(10124):980–988; doi: 10.1016/S0140-6736(18)30316-7

19.

Panchal

, Bartos

, Cabañas

, et al.; Adult Basic and Advanced Life Support Writing Group. Part 3: Adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2020; 142(16_suppl_2):S366–S468; doi: 10.1161/CIR.0000000000000916

20.

Sandroni

, Nolan

, Andersen

, et al. ERC-ESICM guidelines on temperature control after cardiac arrest in adults. Intensive Care Med, 2022; 48(3):261–269; doi: 10.1007/s00134-022-06620-5

21.

Sanfilippo

, La Via

, Lanzafame

, et al. Targeted temperature management after cardiac arrest: A systematic review and meta-analysis with trial sequential analysis. J Clin Med, 2021; 10(17):3943; doi: 10.3390/jcm10173943

22.

SOS-KANTO 2012 Study Group. Changes in pre- and in-hospital management and outcomes for out-of-hospital cardiac arrest between 2002 and 2012 in Kanto, Japan: The SOS-KANTO 2012 Study. Acute Med Surg, 2015; 2(4):225–233; doi: 10.1002/ams2.102

23.

Tagami

, Hirata

, Takeshige

, et al. Implementation of the fifth link of the chain of survival concept for out-of-hospital cardiac arrest. Circulation, 2012; 126(5):589–597; doi: 10.1161/CIRCULATIONAHA.111.086173

24.

Tagami

, Matsui

, Fushimi

, et al. changes in therapeutic hypothermia and coronary intervention provision and in-hospital mortality of patients with out-of-hospital cardiac arrest: A nationwide database study. Crit Care Med, 2016; 44(3):488–495; doi: 10.1097/CCM.0000000000001401

25.

Tanaka

, Kuno

, Yokota

, et al.; SOS-KANTO 2012 Study Group. Changes in atropine use for out-of-hospital cardiac arrest patients with non-shockable rhythm between 2002 and 2012. Resuscitation, 2016; 101:e5–e6; doi: 10.1016/j.resuscitation.2015.11.032

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