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

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. 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. 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. 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.

Kobayashi D ，Sado J ，Kiyohara K ，Kitamura T ，Kiguchi T ，Nishiyama C ，Okabayashi S ，Shimamoto T ，Matsuyama T ，Kawamura T ，Iwami T ... -  《-》

Location of arrest and survival from out-of-hospital cardiac arrest among children in the public-access defibrillation era in Japan.

Our objective was to assess the characteristics such as public-access defibrillation (PAD) by laypersons and the outcomes after pediatric out-of-hospital cardiac arrest by location in the PAD era. From a nationwide, prospective, population-based registry of out-of-hospital cardiac arrest patients in Japan, we enrolled consecutive pediatric patients aged ≤17 years before emergency medical service (EMS) arrival between 2013 and 2015. The primary outcome measure was 1-month survival, with favorable neurologic outcome defined as cerebral performance category 1 or 2. Factors associated with favorable neurologic outcome were assessed using multivariable logistic regression analysis. Among 3991 eligible pediatric out-of-hospital cardiac arrests, the proportion of PAD was 0.2% (5/2888) at residence, 1.6% (2/125) in public areas, 0.9% (3/321) on streets/highways, 21.6% (11/51) at recreation/sports event areas, 46.1% (82/178) at education institutions, and 1.2% (5/428) in others. In the multivariable analysis, arrest witnessed by family members (adjusted odds ratio [AOR], 5.25; 95% confidence interval [CI], 3.22-8.58) and nonfamily members (AOR, 2.45; 95% CI, 1.26-4.77), first documented ventricular fibrillation (AOR, 12.29; 95% CI, 7.08-21.35), PAD (AOR, 2.63; 95% CI, 1.23-5.62), and earlier EMS response time (AOR for 1-min increment, 0.88; 95% CI, 0.81-0.94) were associated with improving outcome. As for locations, recreation/sports event areas (AOR, 3.43; 95% CI, 1.17-10.07) and education institutions (AOR, 3.03; 95% CI, 1.39-6.63) were also associated with favorable neurologic outcome. In Japan, where public-access automated external defibrillators are well disseminated, characteristics such as PAD and outcomes for pediatric out-of-hospital cardiac arrest before EMS arrival differed substantially by location.

Matsui S ，Kitamura T ，Sado J ，Kiyohara K ，Kobayashi D ，Kiguchi T ，Nishiyama C ，Okabayashi S ，Shimamoto T ，Matsuyama T ，Kawamura T ，Iwami T ，Tanaka R ，Kurosawa H ，Nitta M ，Sobue T ... -  《-》

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

Kiguchi T ，Kiyohara K ，Kitamura T ，Nishiyama C ，Kobayashi D ，Okabayashi S ，Shimamoto T ，Matsuyama T ，Kawamura T ，Iwami T ... -  《-》

Outcomes of out-of-hospital cardiac arrest by public location in the public-access defibrillation era.

Murakami Y ，Iwami T ，Kitamura T ，Nishiyama C ，Nishiuchi T ，Hayashi Y ，Kawamura T ，Utstein Osaka Project ... -  《Journal of the American Heart Association》

Exercise-Related Out-of-Hospital Cardiac Arrest Among the General Population in the Era of Public-Access Defibrillation: A Population-Based Observation in Japan.

Exercise can trigger sudden cardiac arrest. Early initiation of cardiopulmonary resuscitation and automated external defibrillator use by laypersons could maximize the survival rate following exercise-related out-of-hospital cardiac arrest (OHCA). OHCA data between 2005 and 2012 were obtained from a prospective population-based OHCA registry in Osaka Prefecture. Patients with OHCA of presumed cardiac origin and occurring before emergency medical service personnel arrival were included. The incidence trends of exercise-related OHCA over the 8-year study period were assessed. Among patients with bystander-witnessed, exercise-related OHCA, the trends in the initiation of bystander cardiopulmonary resuscitation, public-access defibrillation, and outcome were evaluated. The primary outcome was 1-month survival with favorable neurological outcome, defined as cerebral performance category 1 or 2. During the study period, 0.7% of OHCAs of cardiac origin (222/31 030) were exercise related. The incidence of exercise-related OHCA increased from 1.8 (per million population per year) in 2005 to 4.3 in 2012. Of these, 83.8% (186/222) were witnessed by bystanders. Among the patients with bystander-witnessed, exercise-related OHCA, the proportion that received bystander cardiopulmonary resuscitation (50.0% in 2005 and 86.2% in 2012) and public-access defibrillation (7.1% in 2005 and 62.1% in 2012) significantly increased during the study period. Furthermore, the rate of 1-month survival with favorable neurological outcome among these patients significantly improved (from 28.6% in 2005 to 58.6% in 2012). The incidence rate of exercise-related OHCA was low in the study population. The increase in bystander cardiopulmonary resuscitation and public-access defibrillation rates were associated with improved outcome among patients with bystander-witnessed, exercise-related OHCA.

Kiyohara K ，Nishiyama C ，Kiguchi T ，Nishiuchi T ，Hayashi Y ，Iwami T ，Kitamura T ... -  《Journal of the American Heart Association》