Original Article
Nationwide Public-Access Defibrillation in Japan
N Engl J Med 2010; 362:994-1004March 18, 2010
- Abstract
Background
It is unclear whether dissemination of automated external defibrillators (AEDs) in public places can improve the rate of survival among patients who have had an out-of-hospital cardiac arrest.
Methods
From January 1, 2005, through December 31, 2007, we conducted a prospective, population-based, observational study involving consecutive patients across Japan who had an out-of-hospital cardiac arrest and in whom resuscitation was attempted by emergency responders. We evaluated the effect of nationwide dissemination of public-access AEDs on the rate of survival after an out-of-hospital cardiac arrest. The primary outcome measure was the 1-month rate of survival with minimal neurologic impairment. A multivariate logistic-regression analysis was performed to assess factors associated with a good neurologic outcome.
Results
A total of 312,319 adults who had an out-of-hospital cardiac arrest were included in the study; 12,631 of these patients had ventricular fibrillation and had an arrest that was of cardiac origin and that was witnessed by bystanders. In 462 of these patients (3.7%), shocks were administered by laypersons with the use of public-access AEDs, and the proportion increased, from 1.2% to 6.2%, as the number of public-access AEDs increased (P<0.001 for trend). Among all patients who had a bystander-witnessed arrest of cardiac origin and who had ventricular fibrillation, 14.4% were alive at 1 month with minimal neurologic impairment; among patients who received shocks from public-access AEDs, 31.6% were alive at 1 month with minimal neurologic impairment. Early defibrillation, regardless of the type of provider (bystander or emergency-medical-services personnel), was associated with a good neurologic outcome after a cardiac arrest with ventricular fibrillation (adjusted odds ratio per 1-minute increase in the time to administration of shock, 0.91; 95% confidence interval, 0.89 to 0.92; P<0.001). The mean time to shock was reduced from 3.7 to 2.2 minutes, and the annual number of patients per 10 million population who survived with minimal neurologic impairment increased from 2.4 to 8.9 as the number of public-access AEDs increased from fewer than 1 per square kilometer of inhabited area to 4 or more.
Conclusions
Nationwide dissemination of public-access AEDs in Japan resulted in earlier administration of shocks by laypersons and in an increase in the 1-month rate of survival with minimal neurologic impairment after an out-of-hospital cardiac arrest.
Media in This Article
Figure 1
Study Population and Outcomes.Table 1
Temporal Trends in the Cumulative Number of Public-Access Automated External Defibrillators (AEDs) and in the Incidence of Out-of-Hospital Cardiac Arrests in Japan.Article Activity
- Article
Sudden death from cardiac arrest is a major public health problem in the industrialized world.1 The rate of survival after an out-of-hospital cardiac arrest has been increasing as improvements are made in connecting the links in the “chain of survival,” but it is still low.1-3 Although early defibrillation plays a key role in the chain of survival,1,4 it is difficult to reduce the time from a patient's collapse to defibrillation by emergency medical service personnel.
One way to improve the rate of survival after an out-of-hospital cardiac arrest is to have laypersons administer defibrillation to the patient immediately, with the use of an automated external defibrillator (AED). Many studies, including a large, randomized trial,5-10 have shown that a public-access–defibrillation program improves the rate of survival among patients with an out-of-hospital cardiac arrest, and as a result of these findings, public-access–defibrillation programs have been introduced in many areas. However, these studies were conducted in limited geographic areas or situations,1,5-12 and whether the nationwide dissemination of public-access AEDs would actually increase the rate of survival among people who have had an out-of-hospital cardiac arrest remains to be determined.
Since July 2004, it has been legal for any citizen in Japan to use an AED, and public-access AEDs have become increasingly available.13 In January 2005, the Fire and Disaster Management Agency (FDMA) of Japan launched a prospective, nationwide, population-based, cohort study involving persons who had an out-of-hospital cardiac arrest. The purpose of the study is to evaluate the effect of the nationwide dissemination of public-access AEDs on the rate of survival among patients who have had an out-of-hospital cardiac arrest of cardiac origin.
Methods
Study Design
The All-Japan Utstein Registry of the FDMA is a prospective, nationwide, population-based registry of out-of-hospital cardiac arrests that is based on the standardized Utstein style.14,15 We enrolled in this observational study all patients 18 years of age or older who, between January 1, 2005, and December 31, 2007, had an out-of-hospital cardiac arrest of cardiac origin before the arrival of emergency medical services (EMS) personnel, were treated by EMS personnel, and were then transported to medical institutions. The ethics committee at Kyoto University Graduate School of Medicine approved the study. The requirement of written informed consent was waived.
Cardiac arrest was defined as the cessation of cardiac mechanical activity, as confirmed by the absence of signs of circulation.14,15 The arrest was presumed to be of cardiac origin unless it was caused by cerebrovascular disease; respiratory disease; malignant tumors; external factors, including trauma, hanging, drowning, drug overdose, and asphyxia; or any other noncardiac factor. The cardiac or noncardiac origin was determined clinically by the physician in charge, in collaboration with the EMS personnel, and was confirmed by a staff member at the FDMA.
EMS System in Japan
Japan has an area of approximately 378,000 km2 and an inhabited area of 121,000 km2 (defined in Japan as areas in which people can live, excluding forests, fields, marshes, and lakes),16 and its population was approximately 127 million in 2005.17 There were 807 fire stations with dispatch centers in 2007; EMS at these fire stations is provided by municipal governments. In most cases, an ambulance has a crew of three emergency providers, including at least one emergency lifesaving technician, a person who has undergone extensive training in the provision of emergency care before a patient's arrival at the hospital. Emergency lifesaving technicians are allowed to insert an intravenous line and an adjunct airway and to use semiautomated external defibrillators to treat patients who are having an out-of-hospital cardiac arrest. Since July 2004, specially trained emergency lifesaving technicians have been permitted to insert tracheal tubes, and since April 2006, they have been permitted to administer intravenous epinephrine. All EMS providers perform cardiopulmonary resuscitation (CPR) according to the Japanese CPR guidelines, which until September 2006 were based on the 2000 American Heart Association (AHA) guidelines and since October 2006 have been based on the 2005 AHA guidelines.18 EMS providers are not permitted to terminate resuscitation in the field. Therefore, most patients with an out-of-hospital cardiac arrest who are treated by EMS personnel are transported to hospitals. Training in conventional CPR, which includes chest compressions and rescue breathing, as outlined in the Japanese CPR guidelines, has been offered to approximately 1.4 million Japanese citizens per year, mainly by members of local fire departments.19
Dissemination of AEDs in Japan
Since July 2004, it has been legal for any citizen in Japan to use an AED. Placement of AEDs in public areas, including schools, medical and nursing facilities, work places, sports and cultural facilities, and transportation facilities, depends on both public and private initiatives.20,21 The cumulative number of public-access AEDs, excluding those in medical facilities and EMS institutions, as estimated from sales of AEDs, increased from 9906 to 88,265 during the 3-year study period (Table 1Table 1
Temporal Trends in the Cumulative Number of Public-Access Automated External Defibrillators (AEDs) and in the Incidence of Out-of-Hospital Cardiac Arrests in Japan.).13 Data Collection and Quality Control
Data were collected prospectively with the use of a data form that was based on the Utstein-style guidelines for reporting out-of-hospital cardiac arrests14,15; the data that were collected included the sex and age of the patient, the initial cardiac rhythm, and the time course of resuscitation, as well as information on whether the arrest was witnessed by a bystander, whether a bystander initiated CPR, whether the patient was intubated, whether epinephrine was administered, and whether spontaneous circulation was restored before the patient's arrival at the hospital. In addition, information was collected on survival and neurologic status 1 month after the event. The times of the receipt of an emergency call by the EMS, the arrival of a vehicle at the scene, the initial contact with the patient, the initiation of CPR, defibrillation by EMS personnel, and arrival at the hospital were recorded according to the times on the clock used by the EMS system that responded to the call. An AED analyzes a patient's rhythm automatically and delivers a shock only when it detects ventricular fibrillation. Therefore, when laypersons delivered shocks with the use of a public-access AED, the patient's first recorded rhythm was regarded as ventricular fibrillation, which included ventricular tachycardia in the absence of a pulse. In cases in which bystanders initiated CPR, chest compression alone and conventional CPR with rescue breathing were recorded as “CPR by bystander.” The times of collapse, administration of the first shock from a public-access AED, and initiation of CPR by a bystander were determined through an interview that EMS personnel conducted with the bystander before the EMS personnel left the scene. If the time of administration of the first shock from the public-access AED was not ascertained, the interval from the patient's collapse to administration of a shock from the AED was replaced with the interval from the patient's collapse to the time CPR was administered by the bystander. The time of the initiation of CPR was defined as the time CPR was initiated by bystanders or by EMS personnel, whichever was earlier. Similarly, the time of the administration of the first shock was defined as the time of the administration of the shock by laypersons or by EMS personnel, whichever was earlier.
All patients who survived the cardiac arrest were followed for up to 1 month after the event by the EMS providers in charge. Neurologic outcome was determined by means of a follow-up interview 1 month after successful resuscitation, with the use of the Cerebral Performance Category (CPC) scale, on which category 1 represents good cerebral performance; category 2, moderate cerebral disability; category 3, severe cerebral disability; category 4, coma or vegetative state; and category 5, death.14,15
The data form was completed by the EMS personnel in cooperation with the physicians in charge of the patients and was transferred to their fire stations; the data were then integrated into the registry system on the FDMA database server. The data were checked for consistency by the computer system and were confirmed by the study investigators. If the data form was incomplete, the FDMA returned it to the fire station, and the form was completed.
End Points
The primary end point was survival at 1 month with minimal neurologic impairment, which was defined as a CPC category of 1 or 2.14,15 Secondary end points were the return of spontaneous circulation before arrival at the hospital and survival at 1 month.
Statistical Analysis
Data on cardiac arrests that were of cardiac origin, involved patients who were in ventricular fibrillation, and were witnessed by a bystander were included in the analyses. The age-adjusted annual incidence of out-of-hospital cardiac arrests was calculated with the use of 2005 census data and data from a 1985 Japanese population model.17,22 Trends in categorical and continuous variables were analyzed with the use of univariate regression models and linear tests. A multivariate analysis was used to assess the factors associated with a good neurologic outcome, and odds ratios and their 95% confidence intervals were calculated. Potential confounding factors that were adjusted for in the multivariate analysis included the sex and age of the patient, the relation of the bystander to the patient (family member or other), the type of CPR initiated by a bystander (compression-only or conventional CPR), the use or nonuse of a public-access AED to administer a first shock, the time from the patient's collapse to the initiation of CPR, and the time from the patient's collapse to the first shock. The interaction between the provider of the shock (bystander using a public-access AED or EMS personnel) and the time to the first shock was also incorporated in the multivariate analysis. The mean time from collapse to shock, the annual incidence of the administration of a shock with the use of a public-access AED, and the subsequent rate of survival with minimal neurologic impairment per 10 million daytime population were compared among prefectures according to the number of public-access AEDs per square kilometer of inhabited area (<1, 1 to <4, or 4 or more). All statistical analyses were performed with the use of the SPSS statistical package, version 16.0J (SPSS). All tests were two-tailed, and P values of less than 0.05 were considered to indicate statistical significance.
Results
Cardiac Arrests and Availability of Public-Access AEDs
During the 3 years of the study, 312,319 out-of-hospital cardiac arrests in adults were documented (Figure 1Figure 1
Study Population and Outcomes.), of which 168,827 were presumed to be of cardiac origin; 55,271 of these were witnessed by bystanders. A total of 12,631 adults with a cardiac arrest of cardiac origin witnessed by a bystander had an initial ventricular fibrillation. Of these, 462 received a first shock from a public-access AED before the arrival of EMS personnel, 11,697 received a first shock from EMS personnel, and 472 received no shocks.Over the course of the 3-year study period, the number of public-access AEDs increased from 0.11 to 0.97 per square kilometer of inhabited area (Table 1). The age-adjusted annual incidence of out-of-hospital cardiac arrests among adults during the study period was 54.1 per 100,000 person-years, and the incidence of out-of-hospital cardiac arrests of cardiac origin was 28.0 per 100,000 person-years. Of these arrests, 9.6 per 100,000 person-years were witnessed by a bystander and 2.6 per 100,000 person-years also involved patients who were in ventricular fibrillation. Incidences gradually increased year by year.
Survival with Minimal Neurologic Impairment
Among the people who received a first shock from a public-access AED, the rate of survival with minimal neurologic impairment at 1 month was 84.5% for patients in whom spontaneous circulation was restored before the arrival of EMS personnel (71 of 84 patients), as compared with 22.9% for those who continued to have ventricular fibrillation (32 of 140) and 18.1% for those who did not have ventricular fibrillation but had pulseless electrical activity or asystole at the time that EMS personnel administered CPR (43 of 238). Data on neurologic outcome 1 month after the event were not available for 55 of the 12,631 patients who had bystander-witnessed arrests and ventricular fibrillation.
Temporal Trends
Table 2Table 2
Temporal Trends in Characteristics and Outcomes of Bystander-Witnessed Arrests among Patients with Ventricular Fibrillation and in the Use of a Public-Access Automated External Defibrillator (AED) to Administer a First Shock. shows temporal trends in the characteristics of the patients and in the outcomes of bystander-witnessed arrests among patients who had ventricular fibrillation and arrests for which public-access AEDs were used to administer the first shock. Among bystander-witnessed arrests in patients who had ventricular fibrillation, no significant temporal trend was found in either the mean age of the patients or the ratio of male to female patients. Over the course of the 3 years, the prevalence of bystander-initiated CPR increased from 43.3% to 53.6% (P<0.001). Compression-only CPR accounted for more than 50% of cardiac arrests involving bystander-initiated CPR. The time from the patient's collapse to the initiation of CPR decreased from 6.5 minutes to 5.7 minutes (P<0.001), whereas the time to administration of the first shock did not change significantly (P=0.36). Consequently, the percentage of persons who survived and had minimal neurologic impairment at 1 month increased from 10.6% in 2005 (406 of 3841 persons) to 19.2% in 2007 (843 of 4402) (P<0.001). The percentage of patients who received a shock from a public-access AED increased from 1.2% in 2005 (45 of 3841 patients) to 6.2% in 2007 (274 of 4402) (P<0.001 for trend). The mean age of these patients decreased over the course of the 3-year study period from 66.6 years to 60.6 years (P<0.001), and the mean time from collapse to the administration of the first shock or initiation of CPR decreased from 3.6 minutes to 2.9 minutes (P=0.03). The proportion of arrests witnessed by family members was only 13.2%. The frequency of a good neurologic outcome among patients who received a shock from a public-access AED increased from 24.4% in 2005 (11 of 45 patients) to 34.3% in 2007 (94 of 274), although the difference was not significant (P=0.11). Among patients who had a good neurologic outcome after ventricular fibrillation, the proportion who had received AED shocks administered by a bystander increased markedly, from 2.7% (11 of 406 patients) to 11.2% (94 of 843 patients) (P<0.001 for trend).Factors Associated with a Good Neurologic Outcome
In a multivariate analysis (Table 3Table 3
Factors Contributing to 1-Month Survival with Minimal Neurologic Impairment among Patients with Bystander-Witnessed Cardiac Arrests and Ventricular Fibrillation.), earlier administration of shock and earlier initiation of CPR were associated with a good neurologic outcome, but the provider of the shock (bystander or EMS personnel) was not (adjusted odds ratio per 1-minute increase in the time to administration of shock, 0.91; 95% confidence interval [CI], 0.89 to 0.92; adjusted odds ratio per 1-minute increase in the time to initiation of CPR, 0.98; 95% CI, 0.96 to 0.99; adjusted odds ratio for shock administered by a bystander with the use of an AED, 1.21; 95% CI, 0.81 to 1.82). Both compression-only CPR and conventional CPR administered by a bystander were associated with a good neurologic outcome (adjusted odds ratio for compression-only CPR, 1.65; 95% CI, 1.40 to 1.96; adjusted odds ratio for conventional CPR, 1.67; 95% CI, 1.40 to 2.00).Factors Associated with Availability of Public-Access AEDs
Table 4Table 4
Variables Associated with the Administration of a Shock with the Use of a Public-Access Automated External Defibrillator (AED), According to the Number of Public-Access AEDs per Square Kilometer of Inhabited Area. shows the interval from a patient's collapse to the first administration of a shock from a public-access AED, the annual incidence of shocks administered with the use of a public-access AED, and the rate of survival with minimal neurologic impairment after the administration of shocks from a public-access AED, according to the number of public-access AEDs per square kilometer of inhabited area. The mean (±SD) interval from a patient's collapse to defibrillation decreased as the number of public-access AEDs per inhabited area increased (3.7±4.8 minutes when there was <1 public-access AED per square kilometer, 3.2±5.3 minutes when there were 1 to less than 4, and 2.2±3.7 minutes when there were 4 or more; P<0.001). The annual number of patients per 10 million population who had minimal neurologic impairment after a shock from a public-access AED increased as the number of public-access AEDs per square kilometer of inhabited area increased (2.4±4.1 patients per 10 million population when there was <1 public-access AED per square kilometer, 7.6±5.1 when there were 1 to less than 4, and 8.9±5.8 when there were 4 or more) (P=0.01).Discussion
An analysis of data from a nationwide registry of patients with out-of-hospital cardiac arrests showed that the number of patients who received shocks from public-access AEDs and who survived increased as the number of public-access AEDs increased year by year. Thus, our study shows the actual effect of the greater dissemination of public-access AEDs throughout Japan.
Our study shows that the reduction in time to the administration of a first shock that resulted from the nationwide dissemination of public-access AEDs increased the rate of survival after an out-of-hospital cardiac arrest. Previous studies have shown mixed results of public-access–defibrillation programs, but all these studies were conducted in limited areas or situations.1,5-12 Even the Public Access Defibrillation trial (PAD; ClinicalTrials.gov number, NCT00004560), which was a large, community-based intervention trial involving 19,000 volunteers,5 did not show whether the nationwide dissemination of public-access AEDs would actually increase the rate of survival after cardiac arrests, because an intervention trial itself is a special situation. Our study, which shows the success of nationwide dissemination of public-access AEDs, provides support for the concept of public-access defibrillation and should encourage other countries or communities to promote public-access–defibrillation programs.
We also found that increasing the number of public-access AEDs per square kilometer of inhabited area was strongly associated with shortening the time to the administration of a first shock and in increasing the number of patients who survived with minimal neurologic impairment after receiving a shock. On the basis of our data, we can extrapolate that if the number of public-access AEDs increased from 1 per square kilometer (i.e., a unit placed every 1000 linear meters) to more than 4 per square kilometer (i.e., a unit placed every 500 linear meters), the rate of survival with minimal neurologic impairment in the area could increase about four times. These data support the recommendation that public-access AEDs be made available within a 1.0-minute to 1.5-minute brisk walk from any location.23 Although the number of public-access AEDs per square kilometer of inhabited area increased during the 3 years of the study, their availability is still not sufficient in most areas.
In Japan, the placement of public-access AEDs is not controlled and depends on both public and private initiatives.20 A total of 25% of public-access AEDs are located in schools, 19% in medical or nursing facilities, 16% in workplaces, 4% in sports facilities, 3% in cultural facilities, and 3% in public transportation facilities.21 Depending on the location, AEDs have been shown to be either very effective in reducing mortality after out-of-hospital arrests among patients with ventricular fibrillation (e.g., in airports or casinos)5-9 or of minimal effectiveness (e.g., in homes).12 The association between the locations of public-access AEDs and their effectiveness requires further investigation.
In this study, we observed a significant improvement in the rate of survival in the brief span of 3 years. There may be various factors other than the dissemination of public-access AEDs that would improve the outcome of out-of-hospital cardiac arrest. The improvement in survival that occurred during the study period could be explained in part by the changes to the 2005 CPR guidelines.24 Advanced life-support treatments administered before arrival at the hospital, as well as special treatments administered in the hospital, such as hypothermia, might result in improved survival after an out-of-hospital cardiac arrest.25,26 However, the notable increase in the proportion of patients who received AED shocks administered by bystanders among patients who had a good neurologic outcome after ventricular fibrillation suggests the effect of the dissemination of public-access AEDs on improving survival.
This study underscores the importance not only of shocks administered early after a cardiac arrest but also of bystander-initiated CPR, irrespective of the type of CPR. The time from a patient's collapse to the initiation of CPR was reduced because of the increase in bystander-initiated CPR, and both early shock and early initiation of CPR contributed to a better outcome. Familiarity with the use of an AED, along with increased dissemination of public-access AEDs, might promote both a willingness to use an AED and a positive attitude toward CPR.27 A previous study showed that dissemination of public-access AEDs without an emphasis on CPR did not improve the rate of survival after an out-of-hospital cardiac arrest.28 The present study reinforces the importance of the combination of early initiation of CPR and early defibrillation.1
Although public-access AEDs are becoming increasingly available, among patients with out-of-hospital cardiac arrests who have ventricular fibrillation, the frequencies of shock administration and CPR initiation by bystanders are still only 7% and 50%, respectively, and the rate of survival is still low. Even in the intensive intervention trial of public-access defibrillation, CPR was attempted by a bystander in only half the cases of out-of-hospital cardiac arrests that were witnessed by bystanders, and a public-access AED was used in only one third of the cases.5 Using an AED and performing CPR are known to be difficult for laypersons.23 To overcome this problem, the use of CPR that involves chest compression only, a skill that is simpler and easier to learn and perform, should be encouraged.29,30 Further efforts are warranted to strengthen the four elements in public-access–defibrillation programs — planning the program, training laypersons, establishing a link with the EMS system, and setting up a system for maintaining the device and for monitoring quality improvement.23
This study has some limitations. First, we did not obtain detailed information on the place of collapse or on the location of the public-access AED. Second, we had data only on cases in which public-access AEDs were used and the shock was delivered; we did not have data on cases in which an attempt was made to use an AED but the shock was not delivered. Therefore, we could not evaluate how many cases there were in which an attempt was made to use an AED in patients who did not have ventricular fibrillation or how many cases there were in which a patient with ventricular fibrillation did not receive a shock because of human or mechanical error. Since AEDs have a high sensitivity for detecting ventricular fibrillation, however, one can assume that they would rarely miss ventricular fibrillation.31 Third, information is lacking on the bystanders who used AEDs, including the conditions under which they witnessed the out-of-hospital cardiac arrest and administered shocks. Fourth, as with all epidemiologic studies, the integrity and validity of the data, as well as ascertainment bias, are potential limitations of our study. The use of uniform data collection based on Utstein-style guidelines for reporting cardiac arrest, the large sample size, and the population-based design should minimize these potential sources of bias. If the rate of survival is improved by the dissemination of public-access AEDs, it is also essential to perform an economic analysis. Investigators in the PAD trial estimated that the cost-effectiveness of public-access defibrillation was similar to that of other medical interventions.32
In conclusion, this large, population-based, observational study showed that nationwide dissemination of public-access AEDs increased the frequency of the administration of shocks with the use of public-access AEDs and contributed to improved outcomes after out-of-hospital ventricular-fibrillation arrests of cardiac origin that were witnessed by bystanders. This finding reinforces the importance of the public-access–defibrillation concept for increasing survival after out-of-hospital cardiac arrests.
Supported by grants from the Fire and Disaster Management Agency (to Dr. Hiraide, on behalf of the study group concerning strategy for applying the results of Utstein report for improvement of emergency service) and the Ministry of Education, Culture, Sports, Science and Technology (19390458).
No potential conflict of interest relevant to this article was reported.
We thank all the emergency medical services personnel and concerned physicians in Japan, and the staffs of the Fire and Disaster Management Agency and Institute for Fire Safety and Disaster Preparedness of Japan for their generous cooperation in establishing and following the Utstein database; and Seishiro Marukawa for providing the essential data on the number of public-access automated external defibrillators in Japan.
Source Information
From Kyoto University Health Service (T. Kitamura, T.I., T. Kawamura) and the Center for Medical Education, Kyoto University Graduate School of Medicine (A.H.) — both in Kyoto, Japan; and the Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital (K.N.), and the Graduate School of Sport System, Kokushikan University (H.T.) — both in Tokyo.
Address reprint requests to Dr. Iwami at Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan, or at iwamit@e-mail.jp.
The investigators and coordinators participating in the Implementation Working Group for the All-Japan Utstein Registry of the Fire and Disaster Management Agency of Japan are listed in the Appendix.
Appendix
The investigators and coordinators participating in the Implementation Working Group for the All-Japan Utstein Registry of FDMA are as follows. Writing Committee: T. Kitamura, T. Iwami, T. Kawamura, K. Nagao, H. Tanaka, A. Hiraide. Investigators and coordinators (all in Japan): Disaster Prevention Bureau, Aichi Prefectural Government Office, Aichi: T. Iwasa. Ambulance Service Planning Office, Fire and Disaster Management Agency, Tokyo: T. Mizoguchi, T. Kaito, T. Koitabashi, H. Kaide. Foundation for Ambulance Service Development, Tokyo: N. Asahi. Institute for Fire Safety and Disaster Preparedness, Tokyo: Z. Hu. Kokushikan University, Tokyo: H. Tanaka. Kyoto University, Kyoto: T. Kitamura, T. Iwami, T. Kawamura, A. Hiraide. National Cardiovascular Center, Suita: T. Okamura. Nippon Medical School, Tokyo: H. Yokota. Osaka Municipal Fire Department, Osaka: S. Nisou. Saga Fire Bureau, Saga: K. Ogata. Sapporo Fire Bureau, Sapporo: Y. Sasaki. Surugadai Nihon University Hospital, Tokyo: K. Nagao. Teikyo University, Tokyo: T. Sakamoto. Tokyo Rinkai Hospital, Tokyo: Y. Yamamoto. Yokohama City Safety Management Bureau, Yokohama: K. Kikuchi.
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- Citing Articles (38)
Citing Articles
1
Takeru Abe, Takashi Nagata, Manabu Hasegawa, Akihito Hagihara. (2012) Life support techniques related to survival after out-of-hospital cardiac arrest in infants. Resuscitation 83:5, 612-618
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Seizan Tanabe, Toshio Ogawa, Manabu Akahane, Soichi Koike, Hiromasa Horiguchi, Hideo Yasunaga, Tatsuhiro Mizoguchi, Tetsuo Hatanaka, Hiroyuki Yokota, Tomoaki Imamura. (2012) Comparison of Neurological Outcome between Tracheal Intubation and Supraglottic Airway Device Insertion of Out-of-hospital Cardiac Arrest Patients: A Nationwide, Population-based, Observational Study. The Journal of Emergency Medicine
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R. S. Howard, P. A. Holmes, A. Siddiqui, D. Treacher, I. Tsiropoulos, M. Koutroumanidis. (2012) Hypoxic-ischaemic brain injury: imaging and neurophysiology abnormalities related to outcome. QJM
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Noritoshi Ito, Shinsuke Nanto, Ken Nagao, Tetsuo Hatanaka, Kei Nishiyama, Tatsuro Kai. (2012) Regional cerebral oxygen saturation on hospital arrival is a potential novel predictor of neurological outcomes at hospital discharge in patients with out-of-hospital cardiac arrest. Resuscitation 83:1, 46-50
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Kenji Isayama, Toshio Nakatani, Masanobu Tsuda, Akihiko Hirakawa. (2012) Current status of establishing a venous line in CPA patients by Emergency Life-Saving Technicians in the prehospital setting in Japan and a proposal for intraosseous infusion. International Journal of Emergency Medicine 5:1, 2
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John Rickard, Salim Ahmed, Martin Baruch, Bernard Klocman, David O. Martin, Venu Menon. (2011) Utility of a novel watch-based pulse detection system to detect pulselessness in human subjects. Heart Rhythm 8:12, 1895-1899
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P. Ray. (2011) Staying alive : il reste du pain sur la planche !. Réanimation 20:6, 471-472
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J.B. López-Messa, H. Martín-Hernández, J.L. Pérez-Vela, R. Molina-Latorre, P. Herrero-Ansola. (2011) Novedades en métodos formativos en resucitación. Medicina Intensiva 35:7, 433-441
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J.B. López-Messa, H. Martín-Hernández, J.L. Pérez-Vela, R. Molina-Latorre, P. Herrero-Ansola. (2011) Novelities in resuscitation training methods. Medicina Intensiva (English Edition) 35:7, 433-441
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Chika Nishiyama, Taku Iwami, Graham Nichol, Tetsuhisa Kitamura, Atsushi Hiraide, Tatsuya Nishiuchi, Yasuyuki Hayashi, Hiroshi Nonogi, Takashi Kawamura. (2011) Association of out-of-hospital cardiac arrest with prior activity and ambient temperature. Resuscitation 82:8, 1008-1012
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Marcus Eng Hock Ong, Sang Do Shin, Hideharu Tanaka, Matthew Huei-Ming Ma, Pairoj Khruekarnchana, Nik Hisamuddin, Ridvan Atilla, Paul Middleton, Kentaro Kajino, Benjamin Sieu-Hon Leong, Muhammad Naeem Khan. (2011) Pan-Asian Resuscitation Outcomes Study (PAROS): Rationale, Methodology, and Implementation. Academic Emergency Medicine 18:8, 890-897
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Soichi Koike, Seizan Tanabe, Toshio Ogawa, Manabu Akahane, Hideo Yasunaga, Hiromasa Horiguchi, Shinya Matsumoto, Tomoaki Imamura. (2011) Effect of time and day of admission on 1-month survival and neurologically favourable 1-month survival in out-of-hospital cardiopulmonary arrest patients. Resuscitation 82:7, 863-868
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A. M. NIELSEN, L. S. RASMUSSEN. (2011) Data management in automated external defibrillators: a call for a standardised solution. Acta Anaesthesiologica Scandinavica 55:6, 708-712
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Soichi Koike, Seizan Tanabe, Toshio Ogawa, Manabu Akahane, Hideo Yasunaga, Hiromasa Horiguchi, Shinya Matsumoto, Tomoaki Imamura. (2011) Immediate Defibrillation or Defibrillation After Cardiopulmonary Resuscitation. Prehospital Emergency Care 15:3, 393-400
CrossRef15
Ivor Kovic, Ileana Lulic. (2011) Mobile phone in the Chain of Survival. Resuscitation 82:6, 776-779
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Giuseppe Lippi, Rosalia Aloe, Filippo Numeroso, Gianfranco Cervellin. (2011) The significance of protein S-100B testing in cardiac arrest patients. Clinical Biochemistry 44:8-9, 567-575
CrossRef17
Charles D Deakin. (2011) Advances in defibrillation. Current Opinion in Critical Care 17:3, 231-235
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Mark A. Hlatky, Paul A. Heidenreich. (2011) The Year in Epidemiology, Health Services Research, and Outcomes Research. Journal of the American College of Cardiology 57:19, 1859-1866
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Kayo Tanigawa, Taku Iwami, Chika Nishiyama, Hiroshi Nonogi, Takashi Kawamura. (2011) Are trained individuals more likely to perform bystander CPR? An observational study. Resuscitation 82:5, 523-528
CrossRef20
Manabu Akahane, Toshio Ogawa, Soichi Koike, Seizan Tanabe, Hiromasa Horiguchi, Tatsuhiro Mizoguchi, Hideo Yasunaga, Tomoaki Imamura. (2011) The Effects of Sex on Out-of-Hospital Cardiac Arrest Outcomes. The American Journal of Medicine 124:4, 325-333
CrossRef21
Hideo Yasunaga, Hiroaki Miyata, Hiromasa Horiguchi, Seizan Tanabe, Manabu Akahane, Toshio Ogawa, Soichi Koike, Tomoaki Imamura. (2011) Population density, call-response interval, and survival of out-of-hospital cardiac arrest. International Journal of Health Geographics 10:1, 26
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Hiroshi Endoh, Seiji Hida, Satomi Oohashi, Hidenori Kinosita, Yusuke Hayashi, Naoki Saitoh, Tadayuki Honda. (2011) Effective deployment of AEDs targeting sudden cardiac arrest in the home: simulation study using a geographic information system. Nihon Kyukyu Igakukai Zasshi 22:1, 1-8
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Tomohiko Sakai, Taku Iwami, Tetsuhisa Kitamura, Chika Nishiyama, Takashi Kawamura, Kentaro Kajino, Hiroshi Tanaka, Seishiro Marukawa, Osamu Tasaki, Tadahiko Shiozaki, Hiroshi Ogura, Yasuyuki Kuwagata, Takeshi Shimazu. (2011) Effectiveness of the new ‘Mobile AED Map’ to find and retrieve an AED: A randomised controlled trial. Resuscitation 82:1, 69-73
CrossRef24
Soichi Koike, Toshio Ogawa, Senzan Tanabe, Shinya Matsumoto, Manabu Akahane, Hideo Yasunaga, Hiromasa Horiguchi, Tomoaki Imamura. (2011) Collapse-to-emergency medical service cardiopulmonary resuscitation interval and outcomes of out-of-hospital cardiopulmonary arrest: a nationwide observational study. Critical Care 15:3, R120
CrossRef25
Hideo Mitamura. (2011) Usefulness and problems of voice navigation system in automated external defibrillator (AED). Nihon Shuchu Chiryo Igakukai zasshi 18:1, 20-22
CrossRef26
Tetsuhisa Kitamura, Taku Iwami, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Robert A. Berg, Atsushi Hiraide. (2011) Time-dependent effectiveness of chest compression-only and conventional cardiopulmonary resuscitation for out-of-hospital cardiac arrest of cardiac origin. Resuscitation 82:1, 3-9
CrossRef27
Mie Sasaki, Taku Iwami, Tetsuhisa Kitamura, Shinichi Nomoto, Chika Nishiyama, Tomohiko Sakai, Kayo Tanigawa, Kentaro Kajino, Taro Irisawa, Tatsuya Nishiuchi, Sumito Hayashida, Atsushi Hiraide, Takashi Kawamura. (2011) Incidence and Outcome of Out-of-Hospital Cardiac Arrest With Public-Access Defibrillation. Circulation Journal 75:12, 2821-2826
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R.W. Koster, M.A. Baubin, L.L. Bossaert, A. Caballero, P. Cassan, M. Castrén, C. Granja, A.J. Handley, K.G. Monsieurs, G.D. Perkins, V. Raffay, C. Sandroni. (2010) Basismaßnahmen zur Wiederbelebung Erwachsener und Verwendung automatisierter externer Defibrillatoren. Notfall + Rettungsmedizin 13:7, 523-542
CrossRef29
Jerry P. Nolan, Jasmeet Soar, David A. Zideman, Dominique Biarent, Leo L. Bossaert, Charles Deakin, Rudolph W. Koster, Jonathan Wyllie, Bernd Böttiger. (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 81:10, 1219-1276
CrossRef30
Jerry P. Nolan, Mary Fran Hazinski, John E. Billi, Bernd W. Boettiger, Leo Bossaert, Allan R. de Caen, Charles D. Deakin, Saul Drajer, Brian Eigel, Robert W. Hickey, Ian Jacobs, Monica E. Kleinman, Walter Kloeck, Rudolph W. Koster, Swee Han Lim, Mary E. Mancini, William H. Montgomery, Peter T. Morley, Laurie J. Morrison, Vinay M. Nadkarni, Robert E. O’Connor, Kazuo Okada, Jeffrey M. Perlman, Michael R. Sayre, Michael Shuster, Jasmeet Soar, Kjetil Sunde, Andrew H. Travers, Jonathan Wyllie, David Zideman. (2010) Part 1: Executive summary. Resuscitation 81:1, e1-e25
CrossRef31
Rudolph W. Koster, Michael A. Baubin, Leo L. Bossaert, Antonio Caballero, Pascal Cassan, Maaret Castrén, Cristina Granja, Anthony J. Handley, Koenraad G. Monsieurs, Gavin D. Perkins, Violetta Raffay, Claudio Sandroni. (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 81:10, 1277-1292
CrossRef32
Jasmeet Soar, Mary E. Mancini, Farhan Bhanji, John E. Billi, Jennifer Dennett, Judith Finn, Matthew Huei-Ming Ma, Gavin D. Perkins, David L. Rodgers, Mary Fran Hazinski, Ian Jacobs, Peter T. Morley. (2010) Part 12: Education, implementation, and teams. Resuscitation 81:1, e288-e332
CrossRef33
Keso Skhirtladze, Bruno Mora, Andrea Moritz, Beatrice Birkenberg, Hendrik Jan Ankersmit, Martin Dworschak. (2010) Impaired recovery of cardiac output and mean arterial pressure after successful defibrillation in patients with low left ventricular ejection fraction. Resuscitation 81:9, 1123-1127
CrossRef34
Gordon A. Ewy, Arthur B. Sanders. (2010) Continuous chest compression CPR preferred for primary cardiac arrest. Resuscitation 81:6, 639-640
CrossRef35
H.-J. Trappe. (2010) Frühdefibrillation in Japan. Der Kardiologe 4:3, 236-238
CrossRef36
Alexandra King. (2010) Arrhythmias: Widespread use of public-access AEDs improves survival after cardiac arrest. Nature Reviews Cardiology 7:5, 242-242
CrossRef37
Ken Nagao. (2010) Nifekalant Hydrochloride for Patients With Cardiac Arrest Caused by Shockable Rhythm. Circulation Journal 74:11, 2285-2287
CrossRef38
Kenichi Matsuda, Takeshi Moriguchi, Norikazu Harii. (2010) Nihon Shuchu Chiryo Igakukai zasshi 17:4, 479-489
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