Key result
Each 1-minute increment in time to defibrillation was associated with a lower likelihood of 1-month neurologically favorable survival.
Why the study?
Does early defibrillation with public-access AEDs improve neurologically favorable survival in out-of-hospital cardiac arrest?
Observational (n=9,453)
Does early defibrillation with public-access AEDs improve neurologically favorable survival in out-of-hospital cardiac arrest?
Public-access defibrillation programs successfully increased AED use in public places, and earlier shock delivery significantly improved neurologically favorable survival after out-of-hospital cardiac arrest.
Answers are grounded in this paper and cite their sources.
Supports minimizing defibrillation delays in public OHCA; extends observational evidence on AED timing and neurologic outcomes.
BACKGROUND: The strategy to place public-access automated external defibrillators (AEDs) has not yet been established in real settings. METHODS AND RESULTS: This, prospective, population-based observational study in Osaka, Japan, included consecutive out-of-hospital cardiac arrest (OHCA) patients with resuscitation attempts during 7 years, from January 2005 through December 2011. The trends in the proportion of public-access AED use and 1-month survival with neurologically favorable outcome were evaluated by location. Factors associated with neurologically favorable outcome (defined as cerebral performance category 1 or 2) after ventricular fibrillation were also assessed using multiple logistic regression analysis. A total of 9453 bystander-witnessed OHCAs of cardiac origin were documented and 894 (9.5%) of them occurred at public places. The proportion of public-access AED use significantly increased from 0.0% (0/20) in 2005 to 41.2% (7/17) in 2011 at railway stations and from 0.0% (0/7) to 56.5% (13/23) at sports facilities. Mean time from collapse to shock was 5.0 minutes among those who received shocks with public-access AEDs. The proportion of neurologically favorable outcome was 28.0% (33/118) at railway stations, 51.6% (48/93) at sports facilities, 23.3% (20/86) in public buildings, and 41.9% (13/31) in schools. In multivariate analysis, early defibrillation, irrespective of bystander or emergency medical service (EMS) personnel, was significantly associated with neurologically favorable outcome (adjusted odds ratio for 1-minute increment, 0.89; 95% confidence interval, 0.87 to 0.92). CONCLUSIONS: This large, population-based OHCA registry demonstrated that earlier shock, irrespective the shock provider (bystander or EMS personnel), contributed to improving outcome, and a public-access defibrillation program was successfully implemented so that shocks with public-access AEDs were delivered to over 40% of bystander-witnessed OHCAs and time to shock was shortened in some kinds of public places.
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Murakami et al. (2014) conducted an observational in Out-of-hospital cardiac arrest (n=9,453). Time to defibrillation (1-minute increment) was evaluated on 1-month survival with neurologically favorable outcome (OR 0.89, 95% CI 0.87-0.92). Each 1-minute increment in time to defibrillation was associated with a lower likelihood of 1-month neurologically favorable survival.
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