Outcomes of Out‐of‐Hospital Cardiac Arrest by Public Location in the Public‐Access Defibrillation Era

Abstract

BackgroundThe strategy to place public‐access automated external defibrillators (AEDs) has not yet been established in real settings.Methods and ResultsThis, prospective, population‐based observational study in Osaka, Japan, included consecutive out‐of‐hospital cardiac arrest (OHCA) patients with resuscitation attempts during 7 years, from January 2005 through December 2011. The trends in the proportion of public‐access AED use and 1‐month survival with neurologically favorable outcome were evaluated by location. Factors associated with neurologically favorable outcome (defined as cerebral performance category 1 or 2) after ventricular fibrillation were also assessed using multiple logistic regression analysis. A total of 9453 bystander‐witnessed OHCAs of cardiac origin were documented and 894 (9.5%) of them occurred at public places. The proportion of public‐access AED use significantly increased from 0.0% (0/20) in 2005 to 41.2% (7/17) in 2011 at railway stations and from 0.0% (0/7) to 56.5% (13/23) at sports facilities. Mean time from collapse to shock was 5.0 minutes among those who received shocks with public‐access AEDs. The proportion of neurologically favorable outcome was 28.0% (33/118) at railway stations, 51.6% (48/93) at sports facilities, 23.3% (20/86) in public buildings, and 41.9% (13/31) in schools. In multivariate analysis, early defibrillation, irrespective of bystander or emergency medical service (EMS) personnel, was significantly associated with neurologically favorable outcome (adjusted odds ratio for 1‐minute increment, 0.89; 95% confidence interval, 0.87 to 0.92).ConclusionsThis large, population‐based OHCA registry demonstrated that earlier shock, irrespective the shock provider (bystander or EMS personnel), contributed to improving outcome, and a public‐access defibrillation program was successfully implemented so that shocks with public‐access AEDs were delivered to over 40% of bystander‐witnessed OHCAs and time to shock was shortened in some kinds of public places.

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

“…Advantages of this approach include the provision of “willing and trained bystanders” who are prepared and equipped with onsite AEDs to act in a cardiac arrest emergency. Successful targeted AED programs have been reported in busy airports, casinos, sports arenas, and railway stations 19, 20, 21, 29, 30. This Sao Paulo Metro targeted AED program achieved similar survival rates with intact neurological function as those observed with such programs in the United States, Europe, and Japan (Table 5).…”

“…Targeted AED programs for airports, casinos, railway stations, and sports venues in the United States, Europe, and Japan have shown similar positive results, but this is the first report of such a successful program in a large Latin American city 19, 20, 21, 29, 30…”

Effective deployment of public‐access automated external defibrillators to improve out‐of‐hospital cardiac arrest outcomes

“…Like other countries, approximately 80% of cases occur at home or in residential facilities 40, 41. Murakami et al 40.…”

“…29, 38, 44, 45 Race tracks and casinos have a high incidence in societies where such recreations are popular, whereas casinos do not exist in some countries 39. Although early experiences indicated success of PAD deployment in airports, OHCA incidence in airports differs greatly between countries, with some having a very low incidence: A study in the UK showed a high incidence in airports, but studies in Australia, Canada, and Japan did not 39, 40, 44, 45…”

Public Access Defibrillation Programs: Improving Outcomes Worldwide

“…In order to provide rapid access to defibrillation, PAD programs have been established to provide access to defibrillators in high‐use public areas. Studies show that PAD programs in railways, casinos, and airports in the United States, Europe, and Japan have improved survival in patients with OHCA 3, 4, 5, 6, 7. Despite this, a study showed that PAD was deployed successfully in less than 2% of OHCA, suggesting that there are still areas that can improve their access and deployment of PAD 8.…”