Location of Out-of-Hospital Cardiac Arrests in Takatsuki City  Where Should Automated External Defibrillator be Placed?

Muraoka, Hideyuki; Ohishi, Yasuo; Hara, Hiroshi; Negoro, Nobuyuki; Murai, Motonobu; Kawakami, Makiko; Nishihara, Isao; Fukumoto, Hitoshi; Morita, Hiroshi; Hanafusa, Toshiaki

doi:10.1253/circj.70.827

Cited by 35 publications

(10 citation statements)

References 19 publications

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“…Both demand and supply are involved in facility location analysis. From the demand side, AEDs should be placed in high OHCA incidence areas [ 46 ]. In the traditional approach, we can only analyze the spatial clustering pattern of OHCA events and correlate them with certain risk factors separately [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Spatial decision on allocating automated external defibrillators (AED) in communities by multi-criterion two-step floating catchment area (MC2SFCA)

Lin

Chen

et al. 2016

Int J Health Geogr

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BackgroundThe occurrence of out-of-hospital cardiac arrest (OHCA) is a critical life-threatening event which frequently warrants early defibrillation with an automated external defibrillator (AED). The optimization of allocating a limited number of AEDs in various types of communities is challenging. We aimed to propose a two-stage modeling framework including spatial accessibility evaluation and priority ranking to identify the highest gaps between demand and supply for allocating AEDs.MethodsIn this study, a total of 6135 OHCA patients were defined as demand, and the existing 476 publicly available AEDs locations and 51 emergency medical service (EMS) stations were defined as supply. To identify the demand for AEDs, Bayesian spatial analysis with the integrated nested Laplace approximation (INLA) method is applied to estimate the composite spatial risks from multiple factors. The population density, proportion of elderly people, and land use classifications are identified as risk factors. Then, the multi-criterion two-step floating catchment area (MC2SFCA) method is used to measure spatial accessibility of AEDs between the spatial risks and the supply of AEDs. Priority ranking is utilized for prioritizing deployment of AEDs among communities because of limited resources.ResultsAmong 6135 OHCA patients, 56.85 % were older than 65 years old, and 79.04 % were in a residential area. The spatial distribution of OHCA incidents was found to be concentrated in the metropolitan area of Kaohsiung City, Taiwan. According to the posterior mean estimated by INLA, the spatial effects including population density and proportion of elderly people, and land use classifications are positively associated with the OHCA incidence. Utilizing the MC2SFCA for spatial accessibility, we found that supply of AEDs is less than demand in most areas, especially in rural areas. Under limited resources, we identify priority places for deploying AEDs based on transportation time to the nearest hospital and population size of the communities.ConclusionThe proposed method will be beneficial for optimizing resource allocation while considering multiple local risks. The optimized deployment of AEDs can broaden EMS coverage and minimize the problems of the disparity in urban areas and the deficiency in rural areas.

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Section: Discussionmentioning

confidence: 99%

Spatial decision on allocating automated external defibrillators (AED) in communities by multi-criterion two-step floating catchment area (MC2SFCA)

Lin

Chen

et al. 2016

Int J Health Geogr

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“…The proportion has increased rapidly and has just reached ≈50%, similar to those in the preceding studies from Japan. 8 , 13 By contrast, shocks by public‐access AEDs have been more common at sports facilities, airports, and amusement facilities in western countries. 12 Because the annual total number of railway passengers in Japan was ≈22.6 billion in 2011, 22 further promotion of PAD programs for railway station users would therefore be important.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Out‐of‐Hospital Cardiac Arrest by Public Location in the Public‐Access Defibrillation Era

Murakami

Iwami

Kitamura

et al. 2014

JAHA

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BackgroundThe strategy to place public‐access automated external defibrillators (AEDs) has not yet been established in real settings.Methods and ResultsThis, prospective, population‐based observational study in Osaka, Japan, included consecutive out‐of‐hospital cardiac arrest (OHCA) patients with resuscitation attempts during 7 years, from January 2005 through December 2011. The trends in the proportion of public‐access AED use and 1‐month survival with neurologically favorable outcome were evaluated by location. Factors associated with neurologically favorable outcome (defined as cerebral performance category 1 or 2) after ventricular fibrillation were also assessed using multiple logistic regression analysis. A total of 9453 bystander‐witnessed OHCAs of cardiac origin were documented and 894 (9.5%) of them occurred at public places. The proportion of public‐access AED use significantly increased from 0.0% (0/20) in 2005 to 41.2% (7/17) in 2011 at railway stations and from 0.0% (0/7) to 56.5% (13/23) at sports facilities. Mean time from collapse to shock was 5.0 minutes among those who received shocks with public‐access AEDs. The proportion of neurologically favorable outcome was 28.0% (33/118) at railway stations, 51.6% (48/93) at sports facilities, 23.3% (20/86) in public buildings, and 41.9% (13/31) in schools. In multivariate analysis, early defibrillation, irrespective of bystander or emergency medical service (EMS) personnel, was significantly associated with neurologically favorable outcome (adjusted odds ratio for 1‐minute increment, 0.89; 95% confidence interval, 0.87 to 0.92).ConclusionsThis large, population‐based OHCA registry demonstrated that earlier shock, irrespective the shock provider (bystander or EMS personnel), contributed to improving outcome, and a public‐access defibrillation program was successfully implemented so that shocks with public‐access AEDs were delivered to over 40% of bystander‐witnessed OHCAs and time to shock was shortened in some kinds of public places.

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“…Like other countries, approximately 80% of cases occur at home or in residential facilities 40, 41. Murakami et al 40.…”

Section: Issues Concerning Pad That Needs To Be Addressedmentioning

confidence: 99%

“…However, incidents in airports were quite rare (0.1%). Muraoka et al 41. estimated the incidence per site per year and showed that railway stations had the highest incidence (0.30/site/year).…”

Section: Issues Concerning Pad That Needs To Be Addressedmentioning

confidence: 99%

Effective deployment of public‐access automated external defibrillators to improve out‐of‐hospital cardiac arrest outcomes

Nakahara

Sakamoto

2017

J of Gen and Family Med

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Out‐of‐hospital cardiac arrest (OHCA) is a major health concern in Japan and other developed countries with aging populations. Improvements in OHCA outcomes require streamlining the chain of survival. Deployment of public‐access automated external defibrillators (PADs) and defibrillation by bystanders is one strategy that may streamline the chain by reducing the time to defibrillation in individuals with shockable rhythms. Although the effectiveness of PAD programs in increasing survival to discharge has been reported, there have been criticisms and concerns about the small population impact, cost‐effectiveness, and potential negative impact on those with nonshockable rhythms. This article reviews relevant literature regarding the effectiveness and concerns regarding PAD for OHCA.

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Location of Out-of-Hospital Cardiac Arrests in Takatsuki City Where Should Automated External Defibrillator be Placed?

Cited by 35 publications

References 19 publications

Spatial decision on allocating automated external defibrillators (AED) in communities by multi-criterion two-step floating catchment area (MC2SFCA)

Spatial decision on allocating automated external defibrillators (AED) in communities by multi-criterion two-step floating catchment area (MC2SFCA)

Outcomes of Out‐of‐Hospital Cardiac Arrest by Public Location in the Public‐Access Defibrillation Era

Effective deployment of public‐access automated external defibrillators to improve out‐of‐hospital cardiac arrest outcomes

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