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Now published in The Lancet

Public-Access Defibrillation Leads to Better Neurological Outcome Even in Patients Without Pre-Hospital Return of Spontaneous Circulation: A Population-Based Cohort Study

24 Pages Posted: 5 May 2019

See all articles by Takahiro Nakashima

Takahiro Nakashima

National Cerebral and Cardiovascular Centre - Department of Cardiovascular Medicine

Teruo Noguchi

National Cerebral and Cardiovascular Centre - Department of Cardiovascular Medicine

Yoshio Tahara

National Cerebral and Cardiovascular Centre - Department of Cardiovascular Medicine

Kunihiro Nishimura

National Cerebral and Cardiovascular Centre - Department of Cardiovascular Medicine

Satoshi Yasuda

National Cerebral and Cardiovascular Centre - Department of Cardiovascular Medicine

Daisuke Onozuka

National Cerebral and Cardiovascular Center Research Institute; Kyushu University

Taku Iwami

Kyoto University - Kyoto University Health Service

Naohiro Yonemoto

Kyoto University

Ken Nagao

Nihon University Hospital - Cardiovascular Disease Center

Hiroshi Nonogi

Shizuoka General Hospital

Takanori Ikeda

Toho University - School of Medicine

Naoki Sato

Kawaguchi Cardiovascular and Respiratory Hospital; Nippon Medical School

Hiroyuki Tsutsui

Kyushu University - Faculty of Medical Sciences

Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS) Group

Independent

More...

Abstract

Background: The dissemination of public-access automated external defibrillators has improved outcomes in patients with out-of-hospital cardiac arrest (OHCA) who have a shockable initial rhythm. However, more than 80% of public-access defibrillation attempts do not result in sustained return of spontaneous circulation (ROSC) in OHCA patients with a shockable rhythm before emergency medical service (EMS) contact. Hence, we wish to focus on outcomes of patients with bystander-witnessed OHCA and a shockable rhythm who did not achieve ROSC after public-access defibrillation.

Methods: From a nationwide, prospective, population-based registry of 1,299,784 OHCA patients in Japan, we identified 115,406 patients from 2005 through 2015 with bystander-witnessed cardiac arrests of presumed cardiac origin in whom cardiopulmonary resuscitation (CPR) was attempted. The primary outcome measure was favourable neurological outcome (Cerebral Performance Category of 1 or 2) at 1 month.

Findings: Of 28,019 patients with bystander-witnessed OHCA and a shockable rhythm, 2,242 patients (8%) who did not achieve ROSC with public-access defibrillation and 25,087 patients (92%) who did not achieve ROSC without public-access defibrillation before EMS contact. The rate of favourable neurological outcome was significantly higher in the group with versus without public-access defibrillation (38% [845/2,242] vs. 23% [5,676/25,087], adjusted odds ratio after propensity score matching, 1·45; 95% confidence interval, 1·24 to 1·69, P<0·0001).

Interpretation: Public-access defibrillation before EMS arrival is associated with better neurological outcomes in OHCA patients with a shockable rhythm, even those did not achieve ROSC at time of public-access defibrillation. (the University Hospital Medical Information Network Clinical Trials Registry number, UMIN000009918.)

Funding: There was no funding source for this study.

Declaration of Interest: We declare no conflict of interest.

Ethical Approval: A subcommittee of resuscitation science in the Japanese Circulation Society was provided with registry data after following prescribed governmental legal procedures and approval by the ethics committee of National Cerebral and Cardiovascular Centre. In this registry study, the requirement of written informed consent was waived. Researchers analyzed only deidentified (anonymized) data. It was registered on the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000009918).

Suggested Citation

Nakashima, Takahiro and Noguchi, Teruo and Tahara, Yoshio and Nishimura, Kunihiro and Yasuda, Satoshi and Onozuka, Daisuke and Iwami, Taku and Yonemoto, Naohiro and Nagao, Ken and Nonogi, Hiroshi and Ikeda, Takanori and Sato, Naoki and Tsutsui, Hiroyuki and Group, Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS), Public-Access Defibrillation Leads to Better Neurological Outcome Even in Patients Without Pre-Hospital Return of Spontaneous Circulation: A Population-Based Cohort Study (May 3, 2019). Available at SSRN: https://ssrn.com/abstract=3382396 or http://dx.doi.org/10.2139/ssrn.3382396

Takahiro Nakashima

National Cerebral and Cardiovascular Centre - Department of Cardiovascular Medicine

Japan

Teruo Noguchi

National Cerebral and Cardiovascular Centre - Department of Cardiovascular Medicine

Suita
Japan

Yoshio Tahara (Contact Author)

National Cerebral and Cardiovascular Centre - Department of Cardiovascular Medicine ( email )

Suita
Japan

Kunihiro Nishimura

National Cerebral and Cardiovascular Centre - Department of Cardiovascular Medicine

Suita
Japan

Satoshi Yasuda

National Cerebral and Cardiovascular Centre - Department of Cardiovascular Medicine

Japan

Daisuke Onozuka

National Cerebral and Cardiovascular Center Research Institute ( email )

6-1 Kishibeshin-machi, Suita
Osaka, 564-8565
Japan

Kyushu University ( email )

3-1-1 Maidashi
Higashi-ku
Fukuoka, 812-8582
Japan

Taku Iwami

Kyoto University - Kyoto University Health Service

Yoshida-Honmachi
Japan

Naohiro Yonemoto

Kyoto University

Yoshida-Honmachi
Sakyo-ku
Kyoto, 606-8501
Japan

Ken Nagao

Nihon University Hospital - Cardiovascular Disease Center ( email )

Tokyo
Japan

Hiroshi Nonogi

Shizuoka General Hospital

Shizuoka City, 420-8527
Japan

Takanori Ikeda

Toho University - School of Medicine

6-11-1 Omorinishi
Ota-ku
Tokyo, 143-8541
Japan

Naoki Sato

Kawaguchi Cardiovascular and Respiratory Hospital

Kawaguchi
Japan

Nippon Medical School

Tokyo
Japan

Hiroyuki Tsutsui

Kyushu University - Faculty of Medical Sciences

3-1-1 Maidashi
Higashi-ku
Fukuoka, 812-8582
Japan