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

Abstract

Background: The strategy to place public-access automated external defibrillators (AEDs) has not yet been established in real settings.

Methods and results: This, 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).

Conclusions: This 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.

Keywords: automated external defibrillator; cardiac arrest; cardiopulmonary resuscitation; death, sudden; epidemiology.

Figure 1.

Overview of emergency medical service (EMS)‐treated cardiac arrests with an abridged Utstein template from January 1, 2005 to December 31, 2011. EMS indicates emergency medical service.

Figure 2.

Trends in the proportion of public‐access AED use by laypersons among bystander‐witnessed OHCAs of cardiac origin in public places according to the location. AED indicates automated external defibrillation; OHCAs, out‐of‐hospital cardiac arrests.