Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan.
Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan.
Resuscitation. 2019 Jul;140:93-97. doi: 10.1016/j.resuscitation.2019.05.017. Epub 2019 May 23.
It is recommended globally that shocks by automated external defibrillators (AEDs) should be delivered immediately when a shockable out-of-hospital cardiac arrest (OHCA) occurs. However, the actual time-interval from collapse to first shock by public-access AED and its impact on subsequent outcome has not been extensively investigated in real-world settings.
OHCA data from 2013 to 2015 were obtained from the All-Japan Utstein Registry. Bystander-witnessed OHCA patients with shockable rhythm who were shocked by public-access AED in public locations were included. The primary endpoint was 1-month survival with favourable neurological outcome, and the association between time-interval from collapse to first shock by public-access AED and subsequent outcome was assessed.
During the study period, 28% (2282/8126) of bystander-witnessed OHCA cases with shockable rhythm were shocked by public-access AED in public locations. The proportion of OHCA patients who were shocked by public-access AED within 5 min from collapse was 58% (1323/2282). Among these patients, the proportion of 1-month survival with favourable neurological outcome was 62% (815/1317). The proportion significantly decreased with increased time from collapse to shock by public-access AED (48% for 6-10 min, 38% for 11-15 min, 30% for 16-20 min, and 7% for 21-25 min; p-for-trend <0.001), and no patient survived if shock delivery occurred more than 26 min after OHCA.
In Japan, earlier shock by public-access AED led to better outcome after bystander-witnessed OHCA with shockable rhythm in public locations. However, the proportion of OHCA patients who received early shock was still low in public locations.
全球建议在发生可电击性院外心脏骤停 (OHCA) 时，应立即使用自动体外除颤器 (AED) 进行电击。然而，在现实环境中，尚未广泛研究公共接入 AED 从患者倒地到首次电击的实际时间间隔及其对后续结果的影响。
从 2013 年至 2015 年，从全日本 Utstein 注册中心获得 OHCA 数据。纳入在公共场所目击 OHCA 且具有可电击节律并接受公共接入 AED 电击的旁观者见证者 OHCA 患者。主要终点是 1 个月时具有良好神经功能结局的存活率，评估公共接入 AED 从患者倒地到首次电击的时间间隔与后续结果之间的关联。
在研究期间，28%（2282/8126）具有可电击节律的旁观者见证者 OHCA 患者在公共场所接受了公共接入 AED 电击。在 2282 例患者中，从患者倒地到接受公共接入 AED 电击的时间在 5 分钟内的患者比例为 58%（1323/2282）。在这些患者中，1 个月时具有良好神经功能结局的存活率为 62%（815/1317）。随着从患者倒地到接受公共接入 AED 电击的时间延长，1 个月时具有良好神经功能结局的存活率显著降低（6-10 分钟为 48%，11-15 分钟为 38%，16-20 分钟为 30%，21-25 分钟为 7%；趋势检验 p<0.001），如果在 OHCA 后超过 26 分钟才进行电击，则没有患者存活。
在日本，在公共场所具有可电击节律的旁观者见证者 OHCA 患者接受公共接入 AED 早期电击可改善预后。然而，在公共场所接受早期电击的 OHCA 患者比例仍然较低。
