Public location and survival from out-of-hospital cardiac arrest in the public-access defibrillation era in Japan

Abstract

A B S T R A C TBackground: The use of public-access automated external defibrillators (AEDs) has become common in Japan. To provide a strategy for appropriate public-access AED deployment, we assessed public-access defibrillation (PAD) by laypersons and the outcomes following out-of-hospital cardiac arrest (OHCA) among adult patients by location of arrest. Methods: From a nationwide, prospective, population-based registry of patients after OHCA in Japan, we enrolled adult patients with bystander-witnessed OHCA of medical origin in public locations between 2013 and 2015. The primary outcome measure was one-month favorable neurological outcome defined by cerebral performance category 1 or 2. Factors associated with favorable neurological outcome after ventricular fibrillation (VF) were assessed by multivariable logistic regression analysis.Results: A total of 20,970 adult bystander-witnessed OHCAs of medical origin occurred in public locations. Of those, the proportions of PAD by location were: 13.1% (757/5761) in public areas, 15.9% (333/ 2089) at workplaces, 26.0% (544/2095) in recreation/sports areas, 36.1% (112/310) in educational institutions, and 5.8% (241/4151) on streets/highways. In a multivariable analysis of VF arrests, both bystander cardiopulmonary resuscitation [adjusted odds ratio (AOR), 1.78; 95% confidence interval (CI), 1.54-2.07] and PAD (AOR, 2.33; 95% CI, 2.05-2.66), and emergency medical service (EMS) response time (AOR, 0.89; 95% CI, 0.87-0.90) were associated with improved outcomes. Earlier PAD initiated by bystanders before EMS arrival was also associated with better outcomes after OHCA. Conclusions: In Japan, where public-access AEDs are well-disseminated, the PAD program worked effectively for adult OHCA of medical origin occurring in public locations. Notably, the proportions of PAD differed substantially according to specific public locations.

Neurological outcomes of out-of-hospital cardiac arrest occurring in Tokyo train and subway stations

“…Approximately 30% of OHCAs in Japan occur in public places, and many of these are expected to survive with bystander intervention. 2 In Japan, citizen cardiopulmonary resuscitation (CPR) has been promoted since 1993, and the bystander cardiopulmonary resuscitation rate (BCPR) improved 56.6% by 2018. 3 Over 40,000 automated external defibrillators (AEDs) have been installed throughout Tokyo since the Public Access Defibrillation (PAD) program was introduced in 2004, 4 but the PAD implementation rate remains near 13%.…”

Evaluation of Autonomous Actions on Bystander-Initiated Cardiopulmonary Resuscitation and Public Access Defibrillation in Tokyo

“…It should be noted that family members could be at any OHCA location other than home. 11) Regarding the primary outcomes, group B had significantly less frequent bystander-initiated CPR and AED pad application compared with group A. On the other hand, the secondary outcomes of ROSC before EMS arrival and one-month survival rate were better in group B compared with group A.…”

“…This retrospective observational study demonstrated that autonomous bystander-initiated CPR and public access defibrillation for OHCA patients were significantly less frequent, compared with non autonomous CPR, even after adjusting for age, sex, and witness status. Although the frequency of AED use by citizens has been reported to differ according to specific public location, 11,12) increasing use of bystander defibrillation in public locations has been reported. 6) However, previous reports did not discriminate autonomous CPR (good Samaritans) from non autonomous CPR.…”

Rationale and Design of the Kento Heart Safe City Project

“…Therefore, community ties, regional activation, CPR education systems, emergency request systems, and other community medical initiatives are issues to be addressed 7) .…”