Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan

Kitamura, Tetsuhisa; Kiyohara, Kosuke; Sakai, Tomohiko; Matsuyama, Tasuku; Hatakeyama, Tatsuko; Shimamoto, Tomonari; Izawa, Junichi; Fujii, Tomoaki; Nishiyama, Chika; Kawamura, Takashi; Iwami, Taku

doi:10.1056/nejmsa1600011

Cited by 254 publications

(213 citation statements)

References 36 publications

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“…The All‐Japan Utstein Registry of the FDMA, a nationwide prospective, population‐ and Utstein‐based registry, enabled us to evaluate the effectiveness of continuous chest compressions and defibrillation by lay‐rescuers5 and the importance of continuously improving the chain of survival at the population level 11. In the JAAM‐OHCA Registry, the special committee has systemically merged in‐hospital databases and the All‐Japan Utstein Registry database by focusing on the use of key items in all data sources.…”

Section: Discussionmentioning

confidence: 99%

“…Details of the registry were previously described 2, 5. Data were collected prospectively using the data form of the Utstein‐style international guideline for reporting OHCA 9.…”

Section: Methodsmentioning

confidence: 99%

“…Since the 2000s, various important evidence on bystander interventions as well as procedures by emergency medical service (EMS) personnel at prehospital settings have been provided by the large‐scale Utstein‐based OHCA registries in Japan, such as the SOS‐KANTO Study,3 Utstein Osaka Project,4 and All‐Japan Utstein Registry 5…”

Section: Introductionmentioning

confidence: 99%

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The profile of Japanese Association for Acute Medicine – out‐of‐hospital cardiac arrest registry in 2014–2015

Kitamura

Iwami

Atsumi

et al. 2018

Acute Medicine & Surgery

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AimTo describe the registry design of the Japanese Association for Acute Medicine – out‐of‐hospital cardiac arrest (JAAM‐OHCA) Registry as well as its profile on hospital information, patient and emergency medical service characteristics, and in‐hospital procedures and outcomes among patients with OHCA who were transported to the participating institutions.MethodsThe special committee aiming to improve the survival after OHCA by providing evidence‐based therapeutic strategies and emergency medical systems from the JAAM has launched a multicenter, prospective registry that enrolled OHCA patients who were transported to critical care medical centers or hospitals with an emergency care department. The primary outcome was a favorable neurological status 1 month after OHCA.ResultsBetween June 2014 and December 2015, a total of 12,024 eligible patients with OHCA were registered in 73 participating institutions. The mean age of the patients was 69.2 years, and 61.0% of them were male. The first documented shockable rhythm on arrival of emergency medical services was 9.0%. After hospital arrival, 9.4% underwent defibrillation, 68.9% tracheal intubation, 3.7% extracorporeal cardiopulmonary resuscitation, 3.0% intra‐aortic balloon pumping, 6.4% coronary angiography, 3.0% percutaneous coronary intervention, 6.4% targeted temperature management, and 81.1% adrenaline administration. The proportion of cerebral performance category 1 or 2 at 1 month after OHCA was 3.9% among adult patients and 5.5% among pediatric patients.ConclusionsThe special committee of the JAAM launched the JAAM‐OHCA Registry in June 2014 and continuously gathers data on OHCA patients. This registry can provide valuable information to establish appropriate therapeutic strategies for OHCA patients in the near future.

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Section: Discussionmentioning

confidence: 99%

“…Details of the registry were previously described 2, 5. Data were collected prospectively using the data form of the Utstein‐style international guideline for reporting OHCA 9.…”

Section: Methodsmentioning

confidence: 99%

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The profile of Japanese Association for Acute Medicine – out‐of‐hospital cardiac arrest registry in 2014–2015

Kitamura

Iwami

Atsumi

et al. 2018

Acute Medicine & Surgery

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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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“…With the full cohort, 3 generalized estimating equation models (univariate, adjusted for selected variables, and adjusted for all covariates) were fit using each of the 3 end points as a dependent variable. A set of potential confounders was chosen a priori based on biological plausibility and a priori knowledge 12, 15, 24, 30, 31, 32, 33, 34, 35, 36, 37, 38. These selected variables included the following: age, sex, hospital category (to adjust for the difference in the frequency of mCPR device use between each institution, hospitals were categorized on the basis of the numbers of patients on whom mCPR devices were used: low volume, <20 per year; moderate volume, 20–100 per year; and high volume, >100 per year), witnessed status, bystander CPR, first documented rhythm, presumed cardiac cause, airway management by EMS, prehospital administration of epinephrine by EMS, tracheal intubation during advanced cardiovascular life support, administration of epinephrine, defibrillation attempt, extracorporeal CPR performed in the ED, and time from call to EMS arrival at scene, time from EMS arrival at scene to EMS arrival at the patient's side, time from EMS arrival at the patient's side to CPR initiation, and time from CPR initiation to hospital arrival (while also adjusting for within‐institution clustering effects using a generalized estimating equation,36, 37, 38, 39 because several articles have suggested the existence of hospital‐related differences in survival after OHCA) 40, 41, 42, 43, 44.…”

Section: Methodsmentioning

confidence: 99%

Mechanical Cardiopulmonary Resuscitation and Hospital Survival Among Adult Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest Attending the Emergency Department: A Prospective, Multicenter, Observational Study in Japan (SOS‐KANTO [Survey of Survivors after Out‐of‐Hospital Cardiac Arrest in Kanto Area] 2012 Study)

Hayashida

Tagami

Fukuda

et al. 2017

JAHA

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BackgroundMechanical cardiopulmonary resuscitation (mCPR) for patients with out‐of‐hospital cardiac arrest attending the emergency department has become more widespread in Japan. The objective of this study is to determine the association between the mCPR in the emergency department and clinical outcomes.Methods and ResultsIn a prospective, multicenter, observational study, adult patients with out‐of‐hospital cardiac arrest with sustained circulatory arrest on hospital arrival were identified. The primary outcome was survival to hospital discharge. The secondary outcomes included a return of spontaneous circulation and successful hospital admission. Multivariate analyses adjusted for potential confounders and within‐institution clustering effects using a generalized estimation equation were used to analyze the association of the mCPR with outcomes. Between January 1, 2012 and March 31, 2013, 6537 patients with out‐of‐hospital cardiac arrest were eligible; this included 5619 patients (86.0%) in the manual CPR group and 918 patients (14.0%) in the mCPR group. Of those patients, 28.1% (1801/6419) showed return of spontaneous circulation in the emergency department, 20.4% (1175/5754) had hospital admission, 2.6% (168/6504) survived to hospital discharge, and 1.2% (75/6419) showed a favorable neurological outcome at 1 month after admission. Multivariate analyses revealed that mCPR was associated with a decreased likelihood of survival to hospital discharge (adjusted odds ratio, 0.40; 95% confidence interval, 0.20–0.78; P=0.005), return of spontaneous circulation (adjusted odds ratio, 0.71; 95% confidence interval, 0.53–0.94; P=0.018), and hospital admission (adjusted odds ratio, 0.57; 95% confidence interval, 0.40–0.80; P=0.001).ConclusionsAfter accounting for potential confounders, the mCPR in the emergency department was associated with decreased likelihoods of good clinical outcomes after adult nontraumatic out‐of‐hospital cardiac arrest. Further studies are needed to clarify circumstances in which mCPR may benefit these patients.

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Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan

Abstract: In Japan, increased use of public-access defibrillation by bystanders was associated with an increase in the number of survivors with a favorable neurologic outcome after out-of-hospital ventricular-fibrillation cardiac arrest.

Cited by 254 publications

References 36 publications

The profile of Japanese Association for Acute Medicine – out‐of‐hospital cardiac arrest registry in 2014–2015

The profile of Japanese Association for Acute Medicine – out‐of‐hospital cardiac arrest registry in 2014–2015

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

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