Abstract 13555: Impact of Public-Access Defibrillation at School on the Outcome After Out-of-Hospital Cardiac Arrest of Cardiac Origin in Elementary and Middle School Students: A Japanese Nationwide Survey
Background: Since the lay use of automatic external defibrillator (AED) was legally approved in Japan in July 2004, the percentage of AED placement increased up to 72.0 and 89.8% in elementary and middle schools in Japan, as of May 2008. We hypothesized that public-access defibrillation (PAD) at school was associated with the improved outcome after out-of-hospital cardiac arrest of cardiac origin (OHCA) in such students at the national level.
Methods: We conducted a nationwide, retrospective, hospital-based, observational survey of elementary and middle school students who had OHCA and received pre-hospital cardiopulmonary resuscitation (CPR) during 2005–09 in Japan. The primary endpoint was a favorable neurological outcome 1 month after OHCA, defined as Glasgow-Pittsburgh cerebral performance category 1 (CPC1).
Results: 50 patients (median age: 12y) were recruited: 45 patients (90%) were witnessed by bystanders; 40 patients (80%) had ventricular fibrillation as the first documented rhythm; 36 patients (72%) received bystander CPR (21 patients by school teachers, 7 by family members, 8 by others); 35 patients (70%) received AED-based pre-hospital defibrillation (22 by emergency medical service (EMS) personnel, 10 by school teachers, 3 by other bystanders). 25 patients (50%) had OHCA at school. Cardiac causes included hypertrophic cardiomyopathy (in 8 patients), congenital heart disease (in 8), long QT syndrome (in 7), and coronary anomaly (in 5). 27 patients (54%) exhibited CPC1, while 14 patients (28%) had died at one month after OHCA. In univariate analyses, CPC1 was associated with bystander CPR (66.7 vs 21.4% in EMS-initiated CPR, p<.01), AED use (68.6 vs 20.0% in CPR without AED use, p<.01), OHCA at school (72.0 vs 36.0% in OHCA out of school, p<.01), bystander CPR at school (81.0 vs 46.7% in bystander CPR out of school, p<.05), and bystander-based AED use at school (90.9 vs 50.0 % in AED use out of school, p<.05). OHCA at school (44.0 vs 8.0% in OHCA out of school, p<.01) and bystander CPR at school (52.4 vs 13.3% in bystander CPR out of school, p<.05) were associated with the bystander-based AED use.
Conclusions: PAD at school is associated with a favorable neurological outcome after OHCA in elementary and middle school students at the national level in Japan.
- Sudden cardiac death
- Cardiopulmonary resuscitation
- Pediatric cardiology
- Arrhythmias, treatment of
- © 2010 by American Heart Association, Inc.