Public-access defibrillation and neurological outcomes in patients with out-of-hospital cardiac arrest in Japan: a population-based cohort study

Japanese Circulation Society with Resuscitation Science Study Group

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: More than 80% of public-access defibrillation attempts do not result in sustained return of spontaneous circulation in patients who have had an out-of-hospital cardiac arrest (OHCA) and a shockable heart rhythm before arrival of emergency medical service (EMS) personnel. Neurological and survival outcomes in such patients have not been evaluated. We aimed to assess the neurological status and survival outcomes in such patients. Methods: This is a retropective analysis of a cohort study from a prospective, nationwide, population-based registry of 1 299 784 patients who had an OHCA event between Jan 1, 2005, and Dec 31, 2015 in Japan. The primary outcome was favourable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after the OHCA and the secondary outcome was survival at 30 days following the OHCA. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, UMIN000009918. Findings: We identified 28 019 patients with bystander-witnessed OHCA and shockable heart rhythm who had received CPR from a bystander. Of these, 2242 (8·0%) patients did not achieve return of spontaneous circulation with CPR plus public-access defibrillation, and 25 087 (89·5%) patients did not achieve return of spontaneous circulation with CPR alone before EMS arrival. The proportion of patients with a favourable neurological outcome was significantly higher in those who received public-access defibrillation than those who did not (845 [37·7%] vs 5676 [22·6%]; adjusted odds ratio [OR] after propensity score-matching, 1·45 [95% CI 1·24–1·69], p<0·0001). The proportion of patients who survived at 30 days after the OHCA was also significantly higher in those who received public-access defibrillation than those who did not (987 [44·0%] vs 7976 [31·8%]; adjusted OR after propensity score-matching, 1·31 [95% CI 1·13–1·52], p<0·0001). Interpretation: Our findings support the benefits of public-access defibrillation and greater accessibility and availability of automated external defibrillators in the community. Funding: None.

Original languageEnglish
Pages (from-to)2255-2262
Number of pages8
JournalThe Lancet
Volume394
Issue number10216
DOIs
Publication statusPublished - Dec 21 2019

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Out-of-Hospital Cardiac Arrest
Japan
Cohort Studies
Population
Cardiopulmonary Resuscitation
Propensity Score
Emergency Medical Services
Survival
Registries
Odds Ratio
Defibrillators
Information Services
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Public-access defibrillation and neurological outcomes in patients with out-of-hospital cardiac arrest in Japan : a population-based cohort study. / Japanese Circulation Society with Resuscitation Science Study Group.

In: The Lancet, Vol. 394, No. 10216, 21.12.2019, p. 2255-2262.

Research output: Contribution to journalArticle

Japanese Circulation Society with Resuscitation Science Study Group. / Public-access defibrillation and neurological outcomes in patients with out-of-hospital cardiac arrest in Japan : a population-based cohort study. In: The Lancet. 2019 ; Vol. 394, No. 10216. pp. 2255-2262.
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title = "Public-access defibrillation and neurological outcomes in patients with out-of-hospital cardiac arrest in Japan: a population-based cohort study",
abstract = "Background: More than 80{\%} of public-access defibrillation attempts do not result in sustained return of spontaneous circulation in patients who have had an out-of-hospital cardiac arrest (OHCA) and a shockable heart rhythm before arrival of emergency medical service (EMS) personnel. Neurological and survival outcomes in such patients have not been evaluated. We aimed to assess the neurological status and survival outcomes in such patients. Methods: This is a retropective analysis of a cohort study from a prospective, nationwide, population-based registry of 1 299 784 patients who had an OHCA event between Jan 1, 2005, and Dec 31, 2015 in Japan. The primary outcome was favourable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after the OHCA and the secondary outcome was survival at 30 days following the OHCA. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, UMIN000009918. Findings: We identified 28 019 patients with bystander-witnessed OHCA and shockable heart rhythm who had received CPR from a bystander. Of these, 2242 (8·0{\%}) patients did not achieve return of spontaneous circulation with CPR plus public-access defibrillation, and 25 087 (89·5{\%}) patients did not achieve return of spontaneous circulation with CPR alone before EMS arrival. The proportion of patients with a favourable neurological outcome was significantly higher in those who received public-access defibrillation than those who did not (845 [37·7{\%}] vs 5676 [22·6{\%}]; adjusted odds ratio [OR] after propensity score-matching, 1·45 [95{\%} CI 1·24–1·69], p<0·0001). The proportion of patients who survived at 30 days after the OHCA was also significantly higher in those who received public-access defibrillation than those who did not (987 [44·0{\%}] vs 7976 [31·8{\%}]; adjusted OR after propensity score-matching, 1·31 [95{\%} CI 1·13–1·52], p<0·0001). Interpretation: Our findings support the benefits of public-access defibrillation and greater accessibility and availability of automated external defibrillators in the community. Funding: None.",
author = "{Japanese Circulation Society with Resuscitation Science Study Group} and Takahiro Nakashima and Teruo Noguchi and Yoshio Tahara and Kunihiro Nishimura and Satoshi Yasuda and Daisuke Onozuka and Taku Iwami and Naohiro Yonemoto and Ken Nagao and Hiroshi Nonogi and Takanori Ikeda and Naoki Sato and Hiroyuki Tsutsui",
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T1 - Public-access defibrillation and neurological outcomes in patients with out-of-hospital cardiac arrest in Japan

T2 - a population-based cohort study

AU - Japanese Circulation Society with Resuscitation Science Study Group

AU - Nakashima, Takahiro

AU - Noguchi, Teruo

AU - Tahara, Yoshio

AU - Nishimura, Kunihiro

AU - Yasuda, Satoshi

AU - Onozuka, Daisuke

AU - Iwami, Taku

AU - Yonemoto, Naohiro

AU - Nagao, Ken

AU - Nonogi, Hiroshi

AU - Ikeda, Takanori

AU - Sato, Naoki

AU - Tsutsui, Hiroyuki

PY - 2019/12/21

Y1 - 2019/12/21

N2 - Background: More than 80% of public-access defibrillation attempts do not result in sustained return of spontaneous circulation in patients who have had an out-of-hospital cardiac arrest (OHCA) and a shockable heart rhythm before arrival of emergency medical service (EMS) personnel. Neurological and survival outcomes in such patients have not been evaluated. We aimed to assess the neurological status and survival outcomes in such patients. Methods: This is a retropective analysis of a cohort study from a prospective, nationwide, population-based registry of 1 299 784 patients who had an OHCA event between Jan 1, 2005, and Dec 31, 2015 in Japan. The primary outcome was favourable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after the OHCA and the secondary outcome was survival at 30 days following the OHCA. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, UMIN000009918. Findings: We identified 28 019 patients with bystander-witnessed OHCA and shockable heart rhythm who had received CPR from a bystander. Of these, 2242 (8·0%) patients did not achieve return of spontaneous circulation with CPR plus public-access defibrillation, and 25 087 (89·5%) patients did not achieve return of spontaneous circulation with CPR alone before EMS arrival. The proportion of patients with a favourable neurological outcome was significantly higher in those who received public-access defibrillation than those who did not (845 [37·7%] vs 5676 [22·6%]; adjusted odds ratio [OR] after propensity score-matching, 1·45 [95% CI 1·24–1·69], p<0·0001). The proportion of patients who survived at 30 days after the OHCA was also significantly higher in those who received public-access defibrillation than those who did not (987 [44·0%] vs 7976 [31·8%]; adjusted OR after propensity score-matching, 1·31 [95% CI 1·13–1·52], p<0·0001). Interpretation: Our findings support the benefits of public-access defibrillation and greater accessibility and availability of automated external defibrillators in the community. Funding: None.

AB - Background: More than 80% of public-access defibrillation attempts do not result in sustained return of spontaneous circulation in patients who have had an out-of-hospital cardiac arrest (OHCA) and a shockable heart rhythm before arrival of emergency medical service (EMS) personnel. Neurological and survival outcomes in such patients have not been evaluated. We aimed to assess the neurological status and survival outcomes in such patients. Methods: This is a retropective analysis of a cohort study from a prospective, nationwide, population-based registry of 1 299 784 patients who had an OHCA event between Jan 1, 2005, and Dec 31, 2015 in Japan. The primary outcome was favourable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after the OHCA and the secondary outcome was survival at 30 days following the OHCA. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, UMIN000009918. Findings: We identified 28 019 patients with bystander-witnessed OHCA and shockable heart rhythm who had received CPR from a bystander. Of these, 2242 (8·0%) patients did not achieve return of spontaneous circulation with CPR plus public-access defibrillation, and 25 087 (89·5%) patients did not achieve return of spontaneous circulation with CPR alone before EMS arrival. The proportion of patients with a favourable neurological outcome was significantly higher in those who received public-access defibrillation than those who did not (845 [37·7%] vs 5676 [22·6%]; adjusted odds ratio [OR] after propensity score-matching, 1·45 [95% CI 1·24–1·69], p<0·0001). The proportion of patients who survived at 30 days after the OHCA was also significantly higher in those who received public-access defibrillation than those who did not (987 [44·0%] vs 7976 [31·8%]; adjusted OR after propensity score-matching, 1·31 [95% CI 1·13–1·52], p<0·0001). Interpretation: Our findings support the benefits of public-access defibrillation and greater accessibility and availability of automated external defibrillators in the community. Funding: None.

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