Abstract 11175: Public Access Defibrillation Improved the Outcome after Out-Of-Hospital Cardiac Arrests in School-Age Children: A Nationwide, Population-Based, Utstein Registry Study in Japan
Introduction: Since the lay use of automated external defibrillator (AED) was approved in Japan in 2004, the number of AED devices in public locations increased to 203,924 (106.6/100,000 population) in 2009: AEDs were placed in 72% of elementary schools and 89.8% of middle schools at the national level.
Hypothesis: We tested the hypothesis that implementation of public-access defibrillation (PAD) improves the outcome after out-of-hospital cardiac arrests (OHCA) in school-age children at the national level.
Methods: We conducted a prospective, nationwide, population-based Japanese Utstein registry study of consecutive OHCA cases in elementary and middle school children (7-15 years of age) who had a bystander-witnessed arrest of presumed cardiac origin during 2005-09, and received pre-hospital resuscitation by emergency responders.
Results: Among 230 eligible patients enrolled, 128 had ventricular fibrillation (VF) as an initial rhythm. Among these 128 patients, 29 (22.7%) children received a first shock by a layperson. Among these 29 patients, the proportion of the favorable neurological outcome after OHCA was 55.2%. During the research period, the proportion of patients initially shocked by a bystander among total eligible patients increased from 2.4% to 20.5% (p=.002 for trend); the proportion of patients with a favorable neurological outcome after OHCA increased from 12.2% to 36.4% overall (p=.006 for trend). A trend for an increase in both parameters was confirmed in public space events (p=.001, p=.001, respectively), not in non-public space events. The collapse to defibrillation time was shorter in a bystander-initiated defibrillation than an emergency responder-initiated one (3.3±3.7 min vs 12.9±5.8, p<.001), and was independently associated with a favorable neurological outcome after OHCA (p=.033, OR per one-minute increase, 0.90 [0.82-0.99]). A public space event was independently associated with VF as the initial rhythm (p<.001, OR 4.03 [95%CI 2.08-7.80]).
Conclusions: Implementation of PAD improved the outcome after OHCA in school-age children at the national level in Japan.
- © 2012 by American Heart Association, Inc.