An outcome study of out-of-hospital cardiac arrest using the Utstein template—a Japanese experience

Incidence of Ventricular Fibrillation in Patients With Out-of-Hospital Cardiac Arrest in Japan Survey of Survivors After Out-of-Hospital Cardiac Arrest in Kanto Area (SOS-KANTO)

“…However, the outcomes of the present study, such as the proportion of patients with cardiac arrest from cardiac causes, witnessed collapse, bystander instituted CPR and VF or pulseless VT as the first cardiac rhythm, and the time intervals between events were similar to those of the population-based survey in Osaka prefecture, Japan. 12, 13 The present study could not demonstrate where to locate public access defibrillators, although the number of cases of VF or pulseless VT in public place was higher than in home.…”

“…2,20,21 Epidemiologic data indicate that structural coronary arterial abnormalities and their consequences cause 80% of the cases of VF or pulseless VT, 2,20,22 dilated and hypertrophic cardiomyopathies account for the second largest proportion of 10-15% 2,20 and other cardiac disorders, such as primary electrical and genetic ion-channel abnormalities, valvular or congenital heart disease, account for only a small proportion. 2,20 Although small-scale studies of sudden cardiac death, such as those involved in the WHO-MONICA project 23,24 or autopsy, 25 have reported that the incidence of sudden cardiac death from acute coronary syndrome is lower among patients with out-of-hospital cardiac arrest in Japan than in Europe and the USA, 3 large-scale Japanese studies that used the Utstein guidelines have demonstrated that cardiac etiology accounted for the largest proportion (>50%) of patients with out-of-hospital cardiac arrest, [13][14][15][16] and the proportion of cases of VF or pulseless VT as the first cardiac rhythm was approximately 10% of thoses who were in cardiac arrest before the arrival of EMS personnel who gave CPR. [13][14][15][16] On the other hand, Nagao et al also used the Utstein guidelines and showed that the proportion of VF or pulseless VT as the first cardiac rhythm was 38% with a mean call-to-scene interval of approximately 5.5 min, 26 and the cause of VF was acute coronary syndrome in 78%, which included the initial angiogram of the acute coronary syndrome related artery that had Thrombolysis in Myocardial Infarction flow grade 0-2 in 77%.…”

“…2,20 Although small-scale studies of sudden cardiac death, such as those involved in the WHO-MONICA project 23,24 or autopsy, 25 have reported that the incidence of sudden cardiac death from acute coronary syndrome is lower among patients with out-of-hospital cardiac arrest in Japan than in Europe and the USA, 3 large-scale Japanese studies that used the Utstein guidelines have demonstrated that cardiac etiology accounted for the largest proportion (>50%) of patients with out-of-hospital cardiac arrest, [13][14][15][16] and the proportion of cases of VF or pulseless VT as the first cardiac rhythm was approximately 10% of thoses who were in cardiac arrest before the arrival of EMS personnel who gave CPR. [13][14][15][16] On the other hand, Nagao et al also used the Utstein guidelines and showed that the proportion of VF or pulseless VT as the first cardiac rhythm was 38% with a mean call-to-scene interval of approximately 5.5 min, 26 and the cause of VF was acute coronary syndrome in 78%, which included the initial angiogram of the acute coronary syndrome related artery that had Thrombolysis in Myocardial Infarction flow grade 0-2 in 77%. 27 The Utstein guidelines for cardiac arrest are intended to provide a structure for evaluating an EMS system and the usefulness of the Utstein style has been confirmed by the many communities that have identified weakness in the "Chain of Survival" of their emergency cardiovascular care.…”

“…5,16 The studies conducted according to the Utstein style have indicated that there are several characteristics of the EMS system in Japan that account for the low proportion of VF or pulseless VT as the first cardiac rhythm. (1) The criteria of CPR attempt by EMS personnel is broad: more than 93% of patients with out-of-hospital cardiac arrest had a CPR attempt by EMS personnel, [13][14][15][16] compared with approximately 50% in Seattle, Washington. 3 (2) The frequency of bystander instituted CPR is low in Japan, despite the knowledge that CPR will prolong VF.…”

“…3 (2) The frequency of bystander instituted CPR is low in Japan, despite the knowledge that CPR will prolong VF. 28,29 In Japan, approximately 25% of patients with cardiac arrest on arrival of the EMS personnel have received bystander CPR, [13][14][15][16] compared with more than 50% of those in Seattle, Washington. 1 (3) The time interval from the call to initial recorded ECG by EMS personnel is a mean of 11.1 min compared with 4 min in Seattle, Washington.…”