Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan.
Tokyo Fire Department, 1-3-5, Otemachi, Chiyoda-ku, Tokyo 100-8119, Japan.
Resuscitation. 2021 Jul;164:4-11. doi: 10.1016/j.resuscitation.2021.04.032. Epub 2021 May 6.
To investigate the effectiveness of public-access automated external defibrillators (AEDs) at Tokyo railroad stations.
We analysed data from a population-based registry of out-of-hospital cardiac arrests in Tokyo, Japan (2014-2018). We identified patients aged ≥18 years who experienced bystander-witnessed cardiac arrest due to ventricular fibrillation of presumed cardiac origin at railroad stations. The primary outcome was survival at 1 month after cardiac arrest with favourable neurological outcomes (cerebral performance category 1-2).
Among 280 eligible patients who had bystander-witnessed cardiac arrest and received defibrillation at railroad stations, 245 patients (87.5%) received defibrillation using public-access AEDs and 35 patients (12.5%) received defibrillation administered by emergency medical services (EMS). Favourable neurological outcomes at 1 month after cardiac arrest were significantly more common in the group that received defibrillation using public-access AEDs (50.2% vs. 8.6%; adjusted odds ratio: 11.2, 95% confidence interval: 1.43-88.4) than in the group that received defibrillation by EMS. Over a 5-year period, favourable neurological outcomes at 1 month after cardiac arrest of 101.9 cases (95% confidence interval: 74.5-129.4) were calculated to be solely attributable to public-access AED use. The incremental cost-effectiveness ratio to gain one favourable neurological outcome obtained from public-access AEDs at railroad stations was lower than that obtained from nationwide deployment (48.5 vs. 2133.4 AED units).
Deploying public-access AEDs at Tokyo railroad stations presented significant benefits and cost-effectiveness. Thus, it may be prudent to prioritise metropolitan railroad stations in public-access defibrillation programs.
调查东京火车站公共接入自动体外除颤器（AED）的效果。
我们分析了日本东京一项基于人群的院外心脏骤停登记数据库（2014-2018 年）的数据。我们确定了年龄≥18 岁的患者，这些患者在火车站经历了旁观者目击的、由于室颤引起的、疑似心源性心脏骤停。主要结局是心脏骤停后 1 个月的生存情况，其神经功能结局良好（脑功能分级 1-2 级）。
在 280 名符合条件的、在火车站经历旁观者目击的心脏骤停并接受除颤的患者中，245 名患者（87.5%）接受了公共接入 AED 除颤，35 名患者（12.5%）接受了紧急医疗服务（EMS）除颤。心脏骤停后 1 个月神经功能结局良好的患者，在接受公共接入 AED 除颤的组中明显更为常见（50.2% vs. 8.6%；调整后比值比：11.2，95%置信区间：1.43-88.4），而在接受 EMS 除颤的组中则不然。在 5 年期间，根据 101.9 例（95%置信区间：74.5-129.4）心脏骤停后 1 个月神经功能结局良好的情况计算，公共接入 AED 的使用仅归因于 101.9 例良好的神经功能结局。与全国部署相比，从火车站公共接入 AED 获得一个良好的神经功能结局的增量成本效益比更低（48.5 比 2133.4 个 AED 单位）。
在东京火车站部署公共接入 AED 具有显著的益处和成本效益。因此，在公共除颤计划中，优先考虑大都市火车站可能是明智之举。
