論文

Background: Extracorporeal cardiopulmonary resuscitation has shown promise in out-of-hospital cardiac arrest, but evidence in younger adults remains limited. Younger adults represent a unique subgroup with distinct etiologies and potentially greater physiological reserve. This study aimed to identify clinical characteristics and assess factors associated with outcomes in younger adults receiving extracorporeal cardiopulmonary resuscitation. Methods: This retrospective observational study analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan registry, which prospectively collected data on adult out-of-hospital cardiac arrest patients receiving extracorporeal cardiopulmonary resuscitation across 36 Japanese institutions (2013–2018). Patients were stratified by age: younger adults (≤ 40 years) versus older adults (> 40 years). The primary outcome was favorable neurological status at discharge (cerebral performance category 1–2). Multivariable logistic regression and restricted cubic spline analyses were performed to identify factors associated with outcomes. Results: Of 2,129 patients, 212 (10.0%) were younger adults (mean age, 32.2 ± 6.8 years) and 1,917 (90.0%) were older adults (mean age, 62.2 ± 11.1 years). Younger adults showed distinct etiological patterns with fewer acute coronary syndromes (13.7% vs. 53.4%) and more arrhythmias (30.2% vs. 9.8%) and myocarditis/cardiomyopathy (13.7% vs. 4.9%). Notably, the proportion of cases with unknown causes was higher among younger adults (40.6%) compared to older adults (18.3%). Multivariable analysis revealed that shockable rhythm was not associated with neurological outcomes in younger adults, in contrast to older adults where shockable rhythm retained its prognostic significance. Nonlinear spline analysis showed that the odds of favorable neurological outcomes remained relatively stable in younger adults despite prolonged low-flow durations, in contrast to older adults who showed deteriorating outcomes with longer ischemic periods. Conclusions: Younger adults undergoing extracorporeal cardiopulmonary resuscitation demonstrated distinct etiological patterns and enhanced tolerance to prolonged low-flow time relative to older adults. These findings generate the hypothesis that age-related differences in tolerance to prolonged low-flow time may exist between younger and older adults. However, given the observational and post-hoc nature of this study, prospective validation is needed before age-stratified extracorporeal cardiopulmonary resuscitation protocols can be recommended.

Background: The global population is aging rapidly. However, research on the characteristics of burn injuries in extremely old individuals remains limited. The current study aimed to identify the characteristics of burn injuries among elderly people by examining a city-wide burn database in Tokyo. Methods: This observational study was conducted at 14 burn centers, and data from the Tokyo Burn Unit Association registry from 1999 to 2020 were used. Demographic characteristics, burn mechanisms and severity, and clinical outcomes were compared among three age groups: >80 (very old), 65–79 (old), and 18–64 years. Results: In total, 11,876 patients with burn, including 1,150 aged > 80 years, 1,916 aged 65–79 years, and 8,810 aged 18–64 years, were analyzed. Older patients had a higher incidence of flame burns, burns in the closed space, and trunk, perineum, and lower extremity injuries. The older population had a greater injury severity, longer length of hospital stay, and higher in-hospital mortality rate. Similar trends were observed in the very old population. Conclusion: This study elucidated the characteristics of burn injuries, which included injury mechanisms and anatomical burn sites, among elderly individuals.

水素ガス吸入療法に関する様々な動物および臨床研究が行われており、種々の疾患・病態に対して治療効果を持つことが示唆され、人に対しての安全性が示されている。特に、急性心筋梗塞や心肺停止蘇生後症候群、さらには新型コロナウイルス感染症においての治療研究が進んでおり、心肺停止蘇生後症候群に関しては、二重盲検下ランダム化比較試験が複数の医療機関において現在進行中である。ここでは、水素ガスの将来の新規薬剤としての可能性を紹介する。