Public-Access Defibrillation and Survival of Out-of-Hospital Cardiac Arrest in Public vs. Residential Locations in Japan

Abstract

Background: This study assessed whether the dissemination of public-access defibrillation (PAD) at the population level is associated with an increase in neurologically favorable outcomes among patients experiencing ventricular fibrillation (VF) in public vs. residential locations in Japan. Methods and Results: We enrolled adult patients with bystander-witnessed VF between 2013 and 2015. The primary outcome measure was 1-month neurologically favorable outcome defined by cerebral performance category 1 or 2. The number of survivors with neurologically favorable outcome attributed to PAD after VF arrest was estimated by location of arrest. A total of 16,252 adult patients with bystander-witnessed VF arrest were analyzed. In public locations, 29.3% (2,334/7,973) of out-of-hospital cardiac arrest (OHCA) patients received PAD, whereas 1.1% (89/8,279) of OHCA patients received PAD in residential locations. OHCA patients with PAD had significantly better neurological outcomes compared with those without PAD in public locations (51.8% vs. 25.5%, P<0.001), whereas there were no significant differences in neurologically favorable outcome between patients with or without PAD in residential locations (22.5% vs. 18.6%, P=0.357). The total number of patients with neurologically favorable outcomes attributed to PAD was estimated at 615 in public locations, but only 3 in residential locations. Conclusions: In Japan, when compared with residential locations, PAD works more successfully in public locations for adults with bystander-witnessed VF arrest.

Prehospital cardiopulmonary resuscitation duration and neurological outcome after adult out-of-hospital cardiac arrest by location of arrest

“…Previous studies showed that public access AEDs and/or bystander CPR were more effective in public locations than in residential locations. 8,15–17 In this study on prehospital CPR duration, patients with OHCA that occurred in public locations also had a higher proportion of one-month survival with favourable neurological outcome than those that occurred in residential locations. The predictive probability of favourable neurological outcome showed a higher proportion in public locations than in residential locations at any given time.…”

“…Previous studies showed that public access AEDs and/or bystander CPR were more effective in public locations than in residential locations. 8,[15][16][17] In this study on prehospital CPR duration, patients with Figure 2. Non-linear relationship between the prehospital CPR duration and predictive probability of favourable neurological outcome using predictive margins in the univariable logistic regression model.…”

“…The differences in the OHCA outcome by the location of arrest would be explained by prognostic factors for OHCA patients. 15,17,23,24 Indeed, patients with OHCA that occurred in public locations were more likely to be younger, witnessed by bystanders and received bystander interventions compared with those in residential locations. Thus, as patients with OHCA that occurred in public locations had many good prognostic factors, they would attain a high one-month survival rate with favourable neurological outcome regardless of the length of prehospital CPR duration, which suggests that resuscitation efforts should continue for a long time in the case of OHCA that occurs in public locations.…”

“…9,10 In previous studies on cardiopulmonary resuscitation (CPR) duration, the possibility of survival with favourable neurological outcome was almost zero when the CPR duration exceeded 40-45 minutes [11][12][13][14] in adult patients with OHCA. Importantly, patient and EMS characteristics and outcomes of adult patients with OHCA differed by the location of arrest, [15][16][17] but the association between CPR duration for adult patients with OHCA and the location of arrest has not been sufficiently investigated.…”

Effect of Implantable Cardioverter-defibrillator Therapy for Ventricular Fibrillation Patients with Out-of-hospital Cardiac Arrest

“…In Japan, OHCA patients with public-access defibrillation had significantly better neurological outcomes compared with those without such facilities, while no significant differences in outcomes were identified for OHCA patients in residential locations 16 . ICD therapy could therefore help to reduce post-resuscitation encephalopathy with OHCA patients in residential locations, and the present data might have significant implications for the general clinical management of VF-OHCA.…”