Use of Public-Access AEDs Leads to Increased Cardiac-Arrest Survival in Japan

Larry Hand

October 26, 2016

KYOTO, JAPAN — Increased use of public-access automated external defibrillators (AEDs) in Japan has led to an increase in the number of out-of-hospital cardiac-arrest survivors at 1 month with a favorable neurological outcome, according to new research[1].

Dr Taku Iwami (Kyoto University Health Service, Japan) and colleagues analyzed data from a registry of patients with out-of-hospital cardiac arrests. They identified 43,762 patients with bystander-witnessed ventricular-fibrillation arrests of cardiac origin between 2005 and 2013.

The results were published in the October 27, 2016 issue of the New England Journal of Medicine.

The researchers estimated that the number of public-access AEDs increased from 10,961 in 2005 to 428,821 in 2013.

Of the 43,762 patients, 4499 (10.3%) received public-access defibrillation and 39,263 (89.7%) did not. Mean age for the patients who received the defibrillation was 63 and mean age for those who did not was 64.8. Almost 80% of the patients in both groups were male.

The researchers found that the percentage of patients who received public-access defibrillation rose from 1.1% in 2005 to 16.5% in 2013 (P<0.001) and that the percentage of patients who were alive at 1 month with a favorable neurological outcome was 38.5% for those who received public-access defibrillation, compared with 18.2% for those who did not (adjusted odds ratio 1.99, 95% CI 1.80–2.19).

They estimated that the number of survivors with a favorable neurological outcome attributed to public-access defibrillation increased from six in 2005 to 201 in 2013 (P<0.001).

The group that received the defibrillation was more likely to also receive bystander CPR (99.4% vs 51.3%). Although the time from collapse to contact with a patient by EMS staff was longer in the defibrillator group, the time from collapse to first shock was shorter.

Cardiologists, Iwami told heartwire from Medscape, "should make their efforts to spread CPR and AED education to save their patients, and tell families of their patients to learn how to perform CPR and AED use."

He said the Japan results should be generalizable to developed countries such as the US and other Western countries.

He continued, "There are still many lives that we can save with AEDs. Although this paper demonstrated that AEDs save a lot of lives, we have to consider the ways to make AEDs more effective and save more lives with disseminated AEDs, including education in CPR and AED use and developing new ways to supply AEDs on scene."

The researchers pointed out in their paper that many public-access defibrillators are in buildings or other areas that are not accessible on weekends.

The authors reported no relevant financial relationships.

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