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Impact of Public-Access Defibrillation in Japan
Study Questions:
How have public-access automated external defibrillators (AEDs) affected the outcomes of out-of-hospital cardiac arrest (OOHCA) in Japan?
Methods:
The subjects of this study were 43,762 patients (mean age 64.6 years) with OOHCA due to ventricular fibrillation (VF) and witnessed by a bystander, who were enrolled in a national registry of patients with OOHCA. The primary outcome of the study was survival at 1 month with a favorable neurologic status. Comparisons were performed between 4,221 patients who received public-access defibrillation and a propensity-score matched control group of 4,221 patients who did not receive public-access defibrillation.
Results:
Among the 43,762 patients in this study, 10.3% received public-access defibrillation. The primary outcome was achieved in a significantly higher percentage of patients who received public-access defibrillation (38.5%) than in those who did not (18.2%). Based on comparison of the patients identified by propensity-score matching, survival with a favorable neurologic status attributable to the use of an AED increased progressively over time, from six patients in 2005 to 201 patients in 2013.
Conclusions:
Public-access defibrillation has increased the odds of survival with satisfactory neurologic status in patients with OOHCA.
Perspective:
Unfortunately, the magnitude of the incremental benefit of AEDs among victims of OOHCA is small. Even in this study, which limited the analysis to patients in whom VF was the first documented arrhythmia, public-access defibrillation improved survival by only 1.9%. There are several possible reasons for this, including the fact that a majority of OOHCAs do not occur in public places.
Keywords: Arrhythmias, Cardiac, Defibrillators, Heart Arrest, Out-of-Hospital Cardiac Arrest, Secondary Prevention, Survival, Treatment Outcome, Ventricular Fibrillation
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