Takahiro Nakashima1, Teruo Noguchi1, Yoshio Tahara2, Kunihiro Nishimura1, Satoshi Yasuda1, Daisuke Onozuka3, Taku Iwami4, Naohiro Yonemoto5, Ken Nagao6, Hiroshi Nonogi7, Takanori Ikeda8, Naoki Sato9, Hiroyuki Tsutsui10. 1. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan. 2. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan. Electronic address: tahara@ncvc.go.jp. 3. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan; Department of Health Communication, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan. 4. Kyoto University Health Service, Kyoto, Japan. 5. Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan. 6. Cardiovascular Centre, Nihon University Hospital, Tokyo, Japan. 7. Intensive Care Centre, Shizuoka General Hospital, Shizuoka, Japan. 8. Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan. 9. Cardiology and Intensive Care Unit, Nippon Medical School, Musashi-Kosugi Hospital, Kawasaki, Japan. 10. Department of Cardiovascular Medicine, Kyushu University, Fukuoka, Japan.
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.
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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Authors: Jan Claassen; Yama Akbari; Sheila Alexander; Mary Kay Bader; Kathleen Bell; Thomas P Bleck; Melanie Boly; Jeremy Brown; Sherry H-Y Chou; Michael N Diringer; Brian L Edlow; Brandon Foreman; Joseph T Giacino; Olivia Gosseries; Theresa Green; David M Greer; Daniel F Hanley; Jed A Hartings; Raimund Helbok; J Claude Hemphill; H E Hinson; Karen Hirsch; Theresa Human; Michael L James; Nerissa Ko; Daniel Kondziella; Sarah Livesay; Lori K Madden; Shraddha Mainali; Stephan A Mayer; Victoria McCredie; Molly M McNett; Geert Meyfroidt; Martin M Monti; Susanne Muehlschlegel; Santosh Murthy; Paul Nyquist; DaiWai M Olson; J Javier Provencio; Eric Rosenthal; Gisele Sampaio Silva; Simone Sarasso; Nicholas D Schiff; Tarek Sharshar; Lori Shutter; Robert D Stevens; Paul Vespa; Walter Videtta; Amy Wagner; Wendy Ziai; John Whyte; Elizabeth Zink; Jose I Suarez Journal: Neurocrit Care Date: 2021-07-08 Impact factor: 3.210