Nationwide Public-Access Defibrillation in Japan

Kitamura, Tetsuhisa; Iwami, Taku; Kawamura, Takashi; Nagao, Ken; Tanaka, Hideharu; Hiraide, Atsushi

doi:10.1056/nejmoa0906644

Cited by 531 publications

(433 citation statements)

References 24 publications

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“…The number of public‐access AEDs has rapidly increased, with >360 000 devices located throughout Japan in 2012 (including 25 000 in Osaka Prefecture) 9. Previous studies suggested that the nationwide dissemination of public‐access AEDs allowed early defibrillation by bystanders, leading to increased survival rates after OHCA 10, 11. Nevertheless, in the era of the public‐access defibrillation (PAD), we identified no published studies of the long‐term effects of bystander CPR and public‐access AED on the outcome of exercise‐related OHCA.…”

Section: Introductionmentioning

confidence: 92%

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

Kiyohara

Nishiyama

Nishiuchi

et al. 2017

JAHA

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BackgroundExercise 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).Methods and Results 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).ConclusionsThe 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.

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Section: Introductionmentioning

confidence: 92%

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

Kiyohara

Nishiyama

Nishiuchi

et al. 2017

JAHA

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“…Many studies, including a prospective, randomized trial, have shown that public access defibrillation (PAD) programs improve the rate of survival among patients with an OHCA. As a result of these findings, PAD programs have been introduced in many areas 8, 10, 11, 12, 17, 18…”

Section: Introductionmentioning

confidence: 99%

“…Long‐term survival can increase as much as 2 to 3 times if a bystander/first responder also uses an automated external defibrillator (AED) before emergency medical service (EMS) arrival 2, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. Many studies, including a prospective, randomized trial, have shown that public access defibrillation (PAD) programs improve the rate of survival among patients with an OHCA.…”

Section: Introductionmentioning

confidence: 99%

Survival After Ventricular Fibrillation Cardiac Arrest in the Sao Paulo Metropolitan Subway System: First Successful Targeted Automated External Defibrillator (AED) Program in Latin America

Gianotto‐Oliveira

Gonzalez

Vianna

et al. 2015

JAHA

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BackgroundTargeted automated external defibrillator (AED) programs have improved survival rates among patients who have an out‐of‐hospital cardiac arrest (OHCA) in US airports, as well as European and Japanese railways. The Sao Paulo (Brazil) Metro subway carries 4.5 million people per day. A targeted AED program was begun in the Sao Paulo Metro with the objective to improve survival from cardiac arrest.Methods and ResultsA prospective, longitudinal, observational study of all cardiac arrests in the Sao Paulo Metro was performed from September 2006 through November 2012. This study focused on cardiac arrest by ventricular arrhythmias, and the primary endpoint was survival to hospital discharge with minimal neurological impairment. A total of 62 patients had an initial cardiac rhythm of ventricular fibrillation. Because no data on cardiac arrest treatment or outcomes existed before beginning this project, the first 16 months of the implementation was used as the initial experience and compared with the subsequent 5 years of full operation. Return of spontaneous circulation was not different between the initial 16 months and the subsequent 5 years (6 of 8 [75%] vs. 39 of 54 [72%]; P=0.88). However, survival to discharge was significantly different once the full program was instituted (0 of 8 vs. 23 of 54 [43%]; P=0.001).ConclusionsImplementation of a targeted AED program in the Sao Paulo Metro subway system saved lives. A short interval between arrest and defibrillation was key for good long‐term, neurologically intact survival. These results support strategic expansion of targeted AED programs in other large Latin American cities.

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“…An automated external defibrillator (AED) allows bystander rescuers to defibrillate out‐of‐hospital ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) before the emergency medical service arrives 17, 18, 19, 20, 21, 22, 23, 24, 25. In fact, nationwide dissemination of publicly accessible AEDs in Japan resulted in an earlier administration of shocks by bystanders and has improved the rate of survival 26, 27. The AED effectiveness is dependent on the device's ability to detect lethal arrhythmias and on the operator's ability to use the device correctly,28 and errors associated with AED use have been identified as device dependent or operator dependent 29, 30.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Commercially Available Automated External Defibrillators

Nishiyama

Negishi

et al. 2015

JAHA

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BackgroundAlthough automated external defibrillators (AEDs) have contributed to a better survival of out‐of‐hospital cardiac arrests, there have been reports of their malfunctioning. We investigated the diagnostic accuracy of commercially available AEDs using surface ECGs of ventricular fibrillation (VF), ventricular tachycardia (VT), and supraventricular tachycardia (SVT).Methods and ResultsECGs(VF 31, VT 48, SVT 97) were stored during electrophysiological studies and transmitted to 4 AEDs, the LifePak CR Plus (CR Plus), HeartStart FR3 (FR3), and CardioLife AED‐2150 (CL2150) and ‐9231 (CL9231), through the pad electrode cables. For VF, the CL2150 and CL9231 advised shocks in all cases, and the CR Plus and FR3 advised shocks in all but one VF case. For VTs faster than 180 bpm, the ratios for advising shocks were 79%, 36%, 89%, and 96% for the CR Plus, FR3, CL2150, and CL9231, respectively. The FR3 and CR Plus did not advise shocks for narrow QRS SVTs, whereas the CL9231 tended to treat high‐rate tachycardias faster than 180 bpm even with narrow QRS complexes. The characteristics of the shock advice for the FR3 differed from that for the CL9231 (kappa coefficient [κ]=0.479, P<0.001), and the CR Plus and CL2150 had characteristics somewhere between the 2 former AEDs (κ=0.818, P<0.001).ConclusionsCommercially available AEDs diagnosed VF almost always correctly. For VT and SVT diagnoses, a discrepancy was evident among the 4 investigated AEDs. The differences in the arrhythmia diagnosis algorithms for differentiating SVT from VT were thought to account for these differences.

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Nationwide Public-Access Defibrillation in Japan

Abstract: Nationwide dissemination of public-access AEDs in Japan resulted in earlier administration of shocks by laypersons and in an increase in the 1-month rate of survival with minimal neurologic impairment after an out-of-hospital cardiac arrest.

Cited by 531 publications

References 24 publications

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

Survival After Ventricular Fibrillation Cardiac Arrest in the Sao Paulo Metropolitan Subway System: First Successful Targeted Automated External Defibrillator (AED) Program in Latin America

Diagnostic Accuracy of Commercially Available Automated External Defibrillators

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