Implementation of the fifth link of the chain of survival concept for out-of-hospital cardiac arrest.

Background: The American Heart Association 2010 resuscitation guidelines recommended adding a fifth link (multidisciplinary postresuscitation care in a regional center) to the previous 4 in the chain of survival concept for out-of-hospital cardiac arrest. Our study aimed to determine the effectiveness of this fifth link.

Methods And Results: This multicenter prospective cohort study involved all eligible out-of-hospital cardiac arrest patients in the Aizu region (n=1482, suburban/rural, Fukushima, Japan).

Aortic arch resection under temporary bypass grafting for advanced thymic cancer.

Extensive surgery for malignant disease requiring cardiopulmonary bypass may cause postoperative immunosuppression. We conducted resection of the aortic arch and total arch replacement under temporary bypass grafting in a patient with advanced thymic cancer invading the aortic arch. No major postoperative complications such as brain damage or paraplegia occurred.