volume 2 no 1. (english ed.) february 21, 2018 digest of als in the jrc 2015 guidelines . . . . . ....

JRCNewsletter

Volume 2 No 1. (English ed.) February 21, 2018

Japan Resuscitation Council

www.japanresuscitationcouncil.org/jrc-newsletter/

ISSN 2433-3123

ContentsA digest of ALS in the JRC 2015 guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

　　Mayuki Aibiki, Auditor of the Japan Resuscitation Council （Ehime University ）　

Issue：Critical.care.of.mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2　Gen Ishikawa (Nippon Medical School Chiba Hokusoh Hosp）　

　Maternal Death in Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3　Junichi Hasegawa (St. Marianna University School of Medicine）　

　Cardiac arrest during pregnancy from the viewpoint of critical care medicine. . . . . 4Atsushi Sakurai (Nihon University School of Medicine), et al.　

　Management of maternal cardiac arrest including perimortem cesarean section. . . 5Katsuo Terui (Saitama Medical Center)　

　The difference of Japanese consensus and the world consensuses about maternal

cardiac arrest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7　Tomoyuki Yamashita (Japanese Red Cross Medical Center）　

　The current situation of perimortem cesarean delivery in Japan. . . . . . . . . . . . . . . 8　Jun Murotsuki (Miyagi Children’s Hospital)　

　J-CIMELS：background of establishment and current activity status. . . . . . . . . . . . 9　Akihiko Sekizawa (Showa University School of Medicine)　

Nepal inspection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10　Kazuo Okada, Emeritus President of the Japan Resuscitation Council 　

Editorial Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

　Masao Nagayama, Secretary-General of the Japan Resuscitation Council

(International University of Health and Welfare School of Medicine)

the.Editorial.Board

　＜ Editor in chief ＞ HiroshiNonogi（ShizuokaGeneralHospital）

　＜ Members of editorial board ＞　 MigakuKikuchi　（DokkyoMedicalUniversityHospital） ToshikiSera（HiroshimaPrefecturalHospital） SatoshiTakeda（JikeiUniversitySchoolofMedicine） MasaoNagayama(InternationalUniversityofHealthandWelfareSchoolofMedicine）　 EiseiHoshiyama　（DokkyoMedicalUniversityHospital）

1Japan Resuscitation Council

JRC Newsletter Volume 2. No 1. (English ed.). p1, 2018

Revised ALS recommendations from 2010 GLs

guideline (GLs) :

1) subsequently increase cardioversion energy ifineffectiveforVF/pVTs;

2) supplyhighpossibleoxygenconcentrationduringCPR, but need adjusted normal PaO2 afterROSC;acapnography,amonitor forROSCandendotrachealtube (ET)placement,shouldnotbeappliedonprognositicationduringCPR;

3) any chest compression devices should notbe employed routinely, but is indicated formaintainingthecompressionqualityoravoidingharmtoCPRproviders;ECPRcouldbeachoiceforpersistentCPAsifregulatedbycriteria;

4) echocardiographycoulddetectcausesofCA,alsorevealETpositioning;

5)Adrenalinshouldbegivensoon,especiallyforthenon-shockables;AmiodaronemightbeeffectiveforpersistentVF/pVTs,butifnotworknifekalantorlidocainecouldbeanalternative,butwhichmightbechangedin2020.

6)TMshouldbe lasted forat least24hoursatalevelbetween32and36centigrade;A2017studytestingeffectsof24vs48hoursat33centigradeshowedno neurological benefits, but includesintriguing results that havebeendescribed inan editorial (1).Kaneko et al. reportedmeritsfromhypothermia inOHCAs<30minutes (2),sofurtherstudiesareneeded.

A.digest.of.ALS.in.the.JRC.2015.guidelines.

Perspectives for 2020 GLs

ILCOR has introduced the continuous evidenceevaluation intheCoSTRdevelopment,whichprovidesthenewest information.Thus, JRChasreformed theGLsgenerating system.ThePICOquestionwill bemodifiedtoPICOST(PICO+StudydesignandTimeframe);also,thenumberofPICOshasbeenreducedforconcentratingonprogressiveissues.　Reference:1)AibikiM.Editorial for thepaperofDr.HansKirkegaardetal. JAMA2017;318:341-50. JEmergCritCareMed2017.doi:10.21037/jeccm.2017.11.02.

2)KanekoT,KasaokaS,NakaharaT,etal.Effectivenessoflowertarget temperature therapeutic hypothermia in post-cardiacarrestsyndromepatientswitharesuscitation intervalof ≤ 30min.JIntensiveCare.2015;3(1):28.doi:10.1186/s40560-015-0095-2.

Mayuki.Aibiki.MD,.PhD .Auditor.of.the.Japan.Resuscitation.Council.(JRC),.Chair.of.the.Department.of.Emergency.and.Critical.Care.Medicine,.Ehime.University.Graduate.School.of.Medicine .Vice-President.of.Ehime.University.Hospital .

2 Japan Resuscitation Council

　Thesymposiumsessionentitled theCriticalCareofMotherswasheld in the10thJapanResuscitationScienceSymposiumon17July,2017inYokohama. In thissession,sixexpertspresentedandreviewedtopics. JHshowedtheachievementof thenationwideregistrationsystemofmaternaldeaths,underlinedtherealitythatone-fourthofmaternaldeathswereduetopostpartumhemorrhage(PPH)andalsoshowedtherealitythatthemostfrequentperiodofonsetofCPAwere1to3hoursafterinitialsymptomsofPPH.JHhighlightedtheimportanceofimmediatehemostasis,bloodtransfusionandmaternaltransport.KTshowedthetopicoftheAHAScientificStatement:CardiacArrestinPregnancy (Circulation.2015;132:1747-1773). Inthis topicthe importanceofmanual leftuterinedisplacement(LUD)andconsiderationofperimortemcesareandelivery (PMCD)whileresuscitationwerediscussed.AtSshowedtherealitythatpoorprognosisafterROSCwasoftenseenincaseofmaternalcardiacarrestofnon-cardiacoriginbecauseofantecedentcerebralischemia.Inaddition,AtScasttheideaofdevelopingmaternalRSSforin-hospitaland“obstetricbypass”forprimaryhealthcarelevelespeciallyformaternalemergency.TYreviewedtheJRCGuidelines2015comparingtoAHA,ERC,ANZCORGuidelinesandCoSTR2015.Otherthanguidelines,TYalsoreviewedtheConsensusStatementofSocietyforObstetricAnesthesiaPerinatologyin2014andtheAHAScientificStatement:CardiacArrestinPregnancy.TYhighlightedimportanceofaccumulatingevidenceofmaternalemergencycasesandestablishingclinicalstrategyforbeneficialoutcome.JMshowedtheresultsofsurveyworkbytheLiaisonCouncilofMFICUinJapan.Inthissurvey,thefactthat18PMCDcasesexistedwasrevealed.Amongthem,twelvecasesobtainedROSCafterPMCDandthreeweresurvivedin intact. Inthistopic,JMspeculatedefficacyofExtra-corporealLifeSupportonthisfield.AkSshowedthedisseminationprojectofmaternalemergency life supportcourseprogram (J-MELS)byJapanCouncil forImplementationofMaternalEmergencyLifeSupportSystem (J-CIMELS). It isexpected thatprognosisofmaternalemergencycouldbeimprovedbyspreadingthosecourses;J-MELSbasicandadvanced.　AlthoughproblemthatremainstobesolvedhasbeenstillinJapan,maternalmortalityratioisinthelowestgroup in theworld. InJapanmorethanhalfofalldeliveriesaremanagednot in tertiarycarecenter,butinprivateclinicsoperatedbyoneortwoobstetricians.Thesecretandendeavorof lowmortality inJapanshouldbeanalyzedandprovedtotheworld.Sothat,itcouldleadtocontributionofimprovementofmaternalmortalityintheworld.

Issue：Critical.care.of.mothersFrom.the.10th.J-ReSS.Symposium.1　“Critical.care.of.mothers”

（17.July,.2017.in.Yokohama）

Gen.Ishikawa,.MD,.PhD .　Senior.Assistant.Professor,.Nippon.Medical.School.Chiba.Hokusoh.Hosp .


Maternal.death.in.JapanJunichi.Hasegawa,.MD,.PhD .　Associate.Professor,.St ..Marianna.University.School.of.Medicine　

　ThecurrentmaternalmortalityrateinJapan,whichisestimatedtobearound4in100,000deliveries,issimilarto that inotherdevelopedcountries. In2010, theJapanAssociationofObstetriciansandGynecologists (JAOG)establishedaregistrationsystemandtheMaternalDeathExploratoryCommitteetofurtherreducethenumberofmaternaldeaths.Inordertoprovide informationthatcouldhelp inthepreventionofmaternaldeaths,andtoimprovethequalityofobstetrichealthcare,theCommitteeconductedacausalanalysisofeachmaternaldeathandreporteditsrecommendationsforgeneralobstetricalpracticebywhichthenumbermaternaldeathsduetosimilarcausescouldbereduced.Maternaldeathswere frequentlycausedbyobstetrichemorrhage (23%), stroke (16%),amnioticfluidembolism(12%),cardiovasculardisease(8%)andpulmonarydisease(8%).Thecommitteeconsideredthatitwasimpossibletopreventdeathin51%ofthecases,whereastheyconsideredpreventionin26%,15%and7%of thecasestobeslightly,moderatelyandhighlypossible,respectively. Itwasdifficult topreventmaternaldeathsduetoamnioticfluidembolismandstroke.Incontrast,halfofthedeathsduetoobstetrichemorrhagewereconsideredpreventable,becausethepeakdurationbetweentheinitialsymptomsandinitialcardiopulmonaryarrestwas1-3hours.Arangeofmeasures, including individualeducationand theconstructionofgoodrelationshipsamongregionalhospitals, shouldbeestablished in thenear future to improveprimarycare forpatientswithmaternalhemorrhageandtosavethelivesofmothersinJapan.

JRC Newsletter Volume 2. No1. (English ed.). p 3, 2018

From.the.10th.J-ReSS.Symposium.1　“Critical.care.of.mothers”（17.July,.2017.in.Yokohama）


Cardiac.arrest.during.pregnancy. from.the.viewpoint.of. critical.care.medicine

Atsushi. Sakurai 1,8）, . Yasufumi. Miyake2,8）, . Tomoaki. Ikeda3,8）, . Atsunor i . Yamahata4,8）,..Akihiko.Sekizawa5,8）,.Junichi.Hasegawa6,8）,.Takashi.Okai7,8）

1 ..Division.of.Emergency.and.Critical.Care.Medicine.Department.of.Acute.Medicine,.Nihon.University.School.of.Medicine2 ..Department.of.Emergency.Medicine,.Teikyo.University.Hospital3 ..Department.of.Obstetrics.and.Gynecology.Mie.University.Faculty.of.Medicine4 ..Department.of.Emergency.Medicine,.Kyoto.Prefectural.University.of.Medicine5 ..Department.of.Obstetrics.and.Gynecology.Showa.University.School.of.Medicine6 ..Department.of.Obstetrics.and.Gynecology.St ..Marianna.University.School.of.Medicine7 ..Aiiku.Hospital8 ..Japan.Council.for.Implementation.of.Maternal.Emergency.Life-Saving.System.(J-CIMELS)

Background

　Ingeneral,goodneurologicaloutcome ispredictedformostcardiacarrest (CA)patientswithcardiacetiology(ischemicheartdisease,arrhythmia,etc.).On theotherhand,poorneurologicaloutcome isoftenpredicted formanypatientswithnon-cardiacetiologycausedbyhypoxiaandhypo-perfusion.Hasegawaetal. reportedthatthecauseofmaternaldeaths is frequentlyrelatedtonon-cardiacetiology (Hasegawa,BMJ,2016). Subsequently,manypregnantwomenwhosuccumbtomaternaldeathmayhavealreadysufferedfrombrain ischemiacausedbyhypoxiaandhypo-perfusionpriortoCA.Insuchcases,pooroutcomecanbepredicted.TreatmentpriortoCAoccurrenceshouldbeactivelypursued.Rapid Response System (RRS)

　TopreventCAatamedical institute,RRShasrecentlyemergedworldwideandbecomethefirst link inthechainofsurvivalaccordingtothe2015AmericanHeartAssociationGuideline.Morethanhalfofalldeliveriesarehandledatprivateclinicsoperatedbyone,sometimestwo,obstetricians.DependingontheRRSpolicy,acriticalpregnantpatientshouldbe transferred fromaclinic toanadvancedmedical instituteprior toCAoccurrence.Thereforeestablishingclearcriteria foremergency transferof criticalpregnantpatients fromaclinic toanadvancedmedical instituteprior toCAoccurrenceandasafe transportsystem,suchasanambulancewithadoctoronboard,isconsideredimportant.Transport to an advanced medical institute

　TreatmentforCA,difficultairway,respiratoryfailure,massivehemorrhagewithcoagulopathy,etc.involvingacriticalpregnantpatientshouldbehandledatanadvancedmedicalinstitute.Consequentlycollaborationbetweentheobstetricianandthemedicalstaff,includingtheemergencyphysician,anesthesiologist,othersurgeonsandtheintensivist.Equipmentsuchasarapidinfusionfluidwarmingdevice,massivetransfusionsystem,ventilator,bloodpurificationdeviceandECMOshouldbeonhand.Discussiononobstetricbypass,similartotraumabypass,wherethemostcritically ill traumapatientsbypasscloserhospitalsandare transporteddirectly toa traumacenterandaretreatedbyanadvancedmedicalstaffandequipment isneeded.Whenestablishinganobstetricbypasssystem,simultaneousconsiderationofthecriteriaforemergencytransportfromaclinic inordertopreventCAduringtransporttoadistantadvancedmedicalinstitute.Hence,over-triageshouldbeallowedandcriticalpregnantpatientswithstablevitalsignsshouldbetransportedatanearlierpoint.Furtherstudyregardingtheacceptable

JRC Newsletter Volume 2. No1. (English ed.). p4-5, 2018


Volume 2. No 1. (English ed.). 2018


patientratioofover-triageforeachregion.Establishment of a system for each region

Intheestablishmentofanobstetrictransportsystemtopreventmaternaldeath,conditionsmayvarybyindividualregion inJapan.Consequentlycollaborationbetweenthemedicalmanagementcouncilandtheperinatalmedicalcouncilineachregioninordertoappropriatelyassignadvancedmedicalinstitutes,establishthetransportcriteriaandmaintaintheobstetrictransportsystem.


Management. of.maternal. cardiac. arrest. including.perimortem.cesarean.section

　Themost importantpoint inmanagingmaternal cardiac arrest is highqualityCPRwith effective chestcompressionsand immediateAED.AEDcanbesafelyappliedduringpregnancywith standardenergy. JRCresuscitationguideline2015basically followedILCORconsensusstatement,andsuggestedperimortemcesareansectionwithweakrecommendationandveryweakevidence.Theguidelinedidnotmakeanyrecommendationonleftpelvictiltorleftuterinedisplacementbecauseofinadequateevidence.　AHAguidelineonmaternalcardiacarrestin2015isoneofthemostdetailedguidelinesforpregnantwomen.Ittakesintoconsiderationphysiologicalchangesduringpregnancyandfindingsfromobstetricanesthesialiterature.BLS for in-hospitalmaternalcardiacarrestbeginswithemergencycallbywitnessingunresponsive,apneicorabnormalbreathingpatternpatientwith fundalheightaboveumbilicus.Firstrespondermustcall forat least3personsandemergencycart.MaternalACLSteamneedstobecalled forat thesametime.Highqualitychestcompression is thefirststep,with thepatient insupineposition.Onceextrahandsareavailable,USguidelinerecommendsmanualleftuterinedisplacementbyoneortwohands,butnottiltingthepatienttable.Leftuterinedisplacement isexpectedtorelieveaortocavalcompressionbygraviduterus. ItrecommendsCPRsequenceasC-A-B-U(uterinedisplacement).Perimortemcesareansection is theextremewayof increasingvenous returnduringCPR.PMCDshouldbestronglyconsideredforeverymotherinwhomROCShasnotbeenachievedafterabout4minutesofresuscitativeefforts(ClassIIa,LOEC).

JRC Newsletter Volume 2. No 1. (English ed.). p 6, 2018


Katsuo.Terui,.MD,.PhD .Professor,.Saitama.Medical.Center,.Saitama.Medical.University


The.difference.of.Japanese.consensus.and.the.world.consensuses.about.maternal.cardiac.arrest

Tomoyuki.Yamashita,.MD .Dept ..of.Emergency.and.Critical.Care.Medicine,.Japanese.Red.Cross.Medical.Center

　JapanResuscitationCouncilResuscitationGuidelines2015 (JRC2015) suggestcesareandeliveryof the fetusforwomenof latepregnancy inthesituationofcardiacarrest.However, there isnosuggestion for leftuterinedisplacement(LUD)nortimingoffetusdelivery.　In theAmericanHeartAssociation (AHA)Guidelines2015,LUDandpreparationofCesareansectionrightaftercardiacarrestisrecommended.Cesareandeliveryshouldbeconsideredat4minutesafteronsetofmaternalcardiacarrestorresuscitativeefforts ifROSC isnotseen.Thecesareandeliveryshouldnotbedelayedeven ifmaternalresuscitation is futile.Systematicpreparationandtraining iscrucial tomeet theserecommendations.Heart&StrokeFoundationofCanada(HSFC)GuidelineisroughlysimilartoAHA2015.　IncomparisontoAHA,EuropeanResuscitationCouncil (ERC)guidelines2015allows left lateral tilt insteadofLUD,ifhigh-qualitychestcompressioncanbecontinued.Italsorecommendsthepositionofchestcompressiontobeslightlyhigheronthesternuminthirdtrimesterofpregnancy.ERC2015recommendsemergencyhysterotomyorCaesareansectionfordeliveryoffetuswithin5minutes,andalsoemphasizestheimportanceofdifficultairwaymanagement,intravascularaccessabovethediaphragmandregulartrainingtoprepareforobstetricemergencies.AustralianandNewZeelandCouncilofResuscitation(ANZCOR)guideline2011hassimilarrecommendations.Inaddition toguidelines,Society forObstetricAnesthesiaPerinatologyConsensusStatement2014andAHAScientificStatement2015,havedetailedrecommendationsthatanswerclinicallysignificantquestions.NextguidelinesofJRC,weneedtoconsiderincludingdetailsandhowtoeducatenewconsensuses.




The.current.situation.of.perimortem.cesarean.delivery.in.JapanJun.Murotsuki　Department.of.Maternal.and.Fetal.Medicine,.Tohoku.University.Graduate.School.of.Medicine,.Miyagi.Children’s.Hospital

[Objective]

　Perimortemcesareandelivery (PCD) isacesareansectionpreformedduringmaternalcardiacarrest is toincreasethechanceofsuccessfullyresuscitatingthemother.Theaimofthisstudywastoinvestigatetheactualconditions,results,andproblemsofPCDconductedinJapan.[Study design]

　Wesentaprimarysurveyformto187secondaryandtertiaryperinatalcentersandexaminedthenumberofPCD.Then,wesentasecondarysurveyformtothefacilitythatrespondedtotheprimarysurvey,andinvestigatedthedetailsofPCD.[Results]

　Therewere18cases in14 facilitiesofPCD identified;10 in-hospitalcasesand8out-of-hospitalcases. Of18PCDwithpotentiallyresuscitatablecases,8casesofmotherswereresuscitatedandsurvived,butonly5casesdischargedfromthehospitalingoodcondition.FourothermothersweresuccessfullyresuscitatedafterPCD,butdiedfromcomplicationsofatonicbleedingandmultipleorganfailure.Themajorcausesofmaternalcardiacarrestareperipartumcardiomyopathy, lungedema,aorticdissection. Fifteen infantssurvived (3setsof twin);2otherinfantssurvivedinitially,butdiedseveraldaysafterthedeliveries.[Conclusion]

　PCDwithin5minutesofmaternalcardiacarrestimprovesmaternalandneonataloutcomes.Foranyindicationofmaternalcardiacarrest,thecesareandeliveryshouldbeperformed.




J-CIMELS：background.of. establishment. and. current. activity.status

Akihiko.Sekizawa,.MD,.PhD　Department.of.Obstetrics.and.Gynecology,.Showa.University.School.of.Medicine

　TheJapanAssociationofObstetriciansandGynecologists (JAOG)establishedaregistrationsystemand theMaternalDeathExploratoryCommittee in 2010 to reduce thenumberofmaternaldeaths.TheCommitteecontinues conductingcausal analysis for eachmaternaldeath.Themost frequent causeofmaternaldeathsbetween1992and2017waspostpartumhemorrhage(PPH)althoughthematernalmortalityrateassociatedwithPPHreducedfrom38%to22%.Ofallmaternaldeaths,halfoccurredafterdeliveryorcesareansection.InthePPHcases, intervalbetweeninitialsymptomsandcardiopulmonaryarrest isnottooshort,and itspeakdurationwas1–3h.NocasesofPPHwererecordedwhereincardiopulmonaryarrestoccurredwithin30min.Therefore, thecommitteeconsidersthatimprovementofthemanagementofPPHcanreducethematernalmortalityrate.Vitalsignsandtheamountofbleedingshouldbeimmediatelydetermined;efficientprimarycare,includinghemostasis,vitalcare,andprimaryresuscitationarerequired.Thecommitteeannouncedtoremindthe importanceofvitalsignsasoneof therecommendations.Thus, thecommitteemaderecommendations forsavingmothers’ lives ineachyearthroughtheanalysesofmaternaldeaths.However, thenumberofmaternaldeathwas40-50cases ineachyearanddidnotdecreasedespiteoftheseefforts.Becauseitisimportanttoconsiderchangesinvitalsignsattheearlystageandsubsequentinitialtreatment,thecommitteethoughtthatdailytrainingandsimulationenableustotakepromptactionduringrealemergencies.Therefore, theJapanCouncil forImplementationofMaternalEmergencyLife-SavingSystem (J-CIMELS)hasestablished in2015toreducematernalmortalityrate.TheaimofthesimulationcourseorganizedbyJ-CIMELSis forallcaregivers indeliveryservicetounderstandmaternalconditionsanddevelopskillsregardingprimarycareformaternalemergencywiththehelpofdoctorswelltrainedinemergencymedicine.Werecommendedthatallcaregiversindeliveryserviceshouldparticipateinthiscourseand improvetheirskills forsafemanagementofwomenduringpregnancyand labor.WebelievethatmaternaldeathrateinJapanwillgraduallydecreasethroughtheactivityofJ-CIMELS.




JRC Newsletter Volume 2. No 1. (English ed.). pp 10-11, 2018

　IcouldhavethechancetovisitNepalinOctoberof2017.　This country is geographically situated inwestpartofAsia.AsIhaveworkedforILCORsince2000,newCo-chairs, Prof. Neumar andGavin stronglyinsistedthatnextcoming2015to2020, ILCORshouldcoverglobally.NotonlyseveralcountriesbutalsoallterritoryshouldbecoveredbyILCORsystem in theworld.　However,RCAcouldnotincludeallAsiancountries,Taiwan,Korea,JapanandSingaporewerethefoundingcountries in 2005 RCA establishment. Since thenPhilippine,Thailand, andHongKong joined to thisOrganization.Whileurgent request forassemblingall countries interritoryofRCA,stillitcouldnotbeaccomplisheduntilnow.　ChairofNepalResuscitationCouncilDr.MaharjanvisitedmeatRCAGeneralAssemblyheldinSingaporeonFebruary2016.

Nepal.inspection

Kazuo.Okada　　Emeritus.Chair,.Japan.Resuscitation.Council.

　Thisisthefirsttimetomeethimand　heexpressedto join toRCA.He is eagerly explained thatRCAmembership is importanttoadvanceNepalCPRwiththe international collaborationofRCA.HeexplainedthattheGovernmentcouldmoreeasilyunderstandtheimportanceof resuscitationandwillbemoreexpandtheactivitytoCPRinNepal.

Picture 1　At RCA2016 with Dr. Maharjan

Figure 1　Importance of CPR in Asia and Nepal

Figure 2　From Dr. Maharjan's lecture



　IcoulddecidetovisitNepalandsurveyhowistheorganizationofCPR training system.Following thissurvey I could recommend ifNepal has beenwelleducatedandtrainedCPR.IhavearrivedatKatmanduairporton18th,October,2017.NextdayProf.MaharjanorganizedSymposium‘ImportanceofCPRinAsiaandNepal’,where Ihavepresented ‘thestep toestablishRCA’ and Prof.Maharjan ‘PreventiveEmergencyMedicine inNepal’ andDr. Shrestha ‘Updates onCPRGuidelines learning from theWorld’ Thesepresentationswere followed ‘AEDdemonstrationandpracticeofAEDusage’byamemberofNihonKohdenCo.Japan　AfterhavingpassedthecheckingCPRknowledgeandpractice,BLScoursestartedtocandidateswithseveralInstructors in theafternoon.Thiswasorganizedby‘NADEM’ (NepalDisaster andEmergencyMedicineCenter), and 2017 is anniversary ofNADEM10th

years. 7yearshaspassedNCEM(NepalColleagueofEmergencyMedicine)sinceitsestablishment.　Training was almost the same as JRC, RCAGuidelines,butairwaymanagementseemedalittlebitdifferent fromRCAGuidelines　andCoSTR.　Thismightbe caused fromNepal instructor’sdeficit.Asthesummaryof thiscourse、itwasalmost thesametoRCA, JRCGuidelines, butnumbersof instructorsare not enough.Urgent increase of instructors ismandatory inNepal.AEDhasnotbeenpermitted touseforcitizensbygovernment,thiscouldnotenhancetheincreaseofsurvivalratefromarrestedvictims..Thismay be financial problemwhich should besupportedfromtheworld,speciallyfromJapan.　Nepal is situated inwest part ofAsia, however,asRCAandJRCweshouldencourageNepal to joinRCA.Prof.Maharjanwouldsincerely like tobecomeamemberofRCA,whichcontributes theadvanceofCPR inNepal.Saving livesshouldbeexpanded inallRCAterritory.

Picture 4　NADEM Token of Appreciation 2017 Presented

Picture 2　Training at NADEM

Picture 5　Cremation ceremony at KatmanduPicture 3　Training at NADEM


Editorial.Note.

　Itwasagreatpleasure forthoseofuswiththeJapanResuscitationCouncil (JRC) tohave launchedtheJRCNewsletter:EnglishEdition lastyearat the15thanniversaryofourfounding.Thefirst issuewaswelcomedbymanycolleaguesintheworld.Here,thesecondissueofthisnewsletterisbrieflyintroduced.　First,ProfessorMayukiAibikibrieflysummarized theAdvancedLifeSupport (ALS)chapterof theJRCResuscitationGuidelines2015 ;otherchapterswillbesummarizedbrieflyinsubsequentissues.Next,wepublishedtheabstractsfromtheextremelypopularsymposium“MaternalResuscitation” fromthetenthJ-ReSS (Japan-ResuscitationScienceSymposium)heldatYokohama last July.Third,ProfessorKazuoOkada, the foundingChairandnowtheEmeritusChairof theJRC,contributedanarticle,anobservationalreportontheKingdomofNepal,wherehewasinvitedlastAutumntodiscusseducationregardingresuscitationinthisgreatAsiancountry.　JRC is an interdisciplinary academic society of highpublic interest dedicated tothe improvement of clinical and scientific affairs on cardiopulmonary and cerebralresuscitation.TogetherwiththeInternationalLiaisonCommitteeonResuscitation(ILCOR)andtheResuscitationCouncilofAsia(RCA)andothers,JRCiscreatingJRCResuscitationGuidelines2020 .Inthenextissue,wewillintroduceabriefsketchofprogress.　WeaskyourfeedbackontheJRCNewsletter:EnglishEdition,asweintendforittobeavaluableresourcefortheglobalanddomesticprogressofresuscitationandresuscitationscience.

　　　　　　　　　　　　　　　　　　Masao.Nagayama,.MD,.PhD,.FAAN,.FJSIM　　　　　　　　　　　　　　　　　　Secretary-General,.Japan.Resuscitation.Council.(JRC)　　　　　　　　　　　　　　　　　　Professor,.Department.of.Neurology,.　　　　　　　　　　　　　　　　　　International.University.of.Health.and.Welfare.School.of.Medicine

Members.of.the.Japan.Resuscitation.Council<MemberSocietiesoftheBoardofDirectors>　JapaneseAssociationforAcuteMedicine　JapaneseCirculationSociety　JapaneseSocietyofAnesthesiologists　JapaneseSocietyofIntensiveCareMedicine　JapanSocietyofPerinatalandNeonatalMedicine<MemberSocietiesandOrganizations>　JapanFirstaidandEmergencycareFoundation　JapanFoundationforEmergencyMedicine　JapanPediatricSociety　JapanSocietyofNeurologicalEmergenciesandCriticalCare　JapaneseDentalSocietyofAnesthesiology　JapaneseParamedicsAssociation　JapaneseRedCrossSociety　JapaneseSocietyforEmergencyMedicine　JapaneseSocietyofEmergencyPediatrics　JapaneseSocietyofInternalMedicine<NonprofitSocietiesandOrganizations>　JapanSocietyforInstructionSystemsinHealthcare　JapanSocietyforPrehospitalMedicine　JapanSocietyofNeurosurgicalEmergency　JapaneseAssociationofBrainHypothermiaandTemperatureManagement　JapaneseSocietyofPediatricAnesthesiology　JapaneseSocietyofReanimatology　JapanACLSAssociation　OsakaLifeSupportAssociation　

JRC Newsletter

Publishedon21thFebruary,2018Publisher JapanResucitationCouncil(JRC)

FormerSakakibaraHeartInstitute,JapanResearchPromotionSocietyforCardiovascular　　　　　　　　　　　　　　Diseases,2-5-4,Yoyogi,2-5-4,Sibuya-ku,Tokyo,151-0053，Japan

Editorial.office AcademicResearchCommunications（ARC）


©PrintedinJapan

http://www.japanresuscitationcouncil.org/jrc-newsletter/

Supporting.members.of.the.Japan.Resuscitation.Council<SupportingOrganization>　JapanMedicalAssociation

<SupportingCompanies>　IMI.Co.,Ltd　AsahiKaseiZOLLMedicalCorporation　AthenaKogyoCo.,Ltd.　KawasumiLaboratories　DaikenMedicalCo.,Ltd.　NihonKohdenCorporation　Physio-ControlJapan,Inc.　PhilipsElectronicsJapan,Ltd.　Laerdal®andResusci®areregisteredtrademarksofLaerdalMedicalCorporation.

volume 2 no 1. (english ed.) february 21, 2018 digest of als in the jrc 2015 guidelines . . . . . ....

Documents