Department of Integrated Science and Engineering for Sustainable Societies, Faculty of Science and Engineering, Chuo University, Japan.
Research Institute of Disaster Management and Emergency Medical System, Kokushikan University, Japan; Graduate School of Emergency Medical System, Kokushikan University, Japan.
Resuscitation. 2024 Oct;203:110386. doi: 10.1016/j.resuscitation.2024.110386. Epub 2024 Sep 5.
The association between out-of-hospital cardiac arrest (OHCA) and the appropriate provision of public access defibrillation (PAD) remains unclear. This study aimed to evaluate the factors associated with whether or not PAD was provided.
This retrospective cohort study utilized the All-Japan Utstein and Emergency Transport Registries in 2021. We included OHCA patients who were applied to automated external defibrillators (AEDs) by bystanders and were deemed eligible for defibrillation by an AED. We defined PAD provided or no PAD provided based on bystander defibrillation. Multivariable logistic regression analysis with the Firth bias adjustment method was employed to estimate the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the exploratory evaluation of factors associated with PAD provided.
1949 patients were eligible for analysis (PAD provided, n = 1696 [87.0%]; no PAD provided, n = 253 [13.0%]). Factors positively associated with PAD provided were male (AOR [95% CI], 1.61 [1.17-2.21]; vs. female), other public place incidence (AOR [95% CI], 10.65 [1.40-1367.54]; vs. public place), non-family member witnessed (AOR [95% CI], 2.51 [1.86-3.42]; vs. unwitnessed) and conventional cardiopulmonary resuscitation (CPR), (AOR [95% CI], 1.75 [1.17-2.67]; vs. hands-only CPR). Conversely, factors negatively associated with no PAD provided were over 65 years old (AOR [95% CI], 0.48 [0.28-0.80]; vs. 19-64 yr), night-time onset (AOR [95% CI], 0.61 [0.45-0.83]; vs. daytime), non-cardiogenic (AOR [95% CI], 0.43 [0.31-0.61]; vs. cardiogenic), home setting (AOR [95% CI], 0.33 [0.14-0.83]; vs. public place), healthcare facility setting (AOR [95% CI], 0.40 [0.23-0.66]; vs. public place), no bystander CPR (AOR [95% CI], 0.31 [0.14-0.71]; vs. hands-only CPR), and dispatcher-assistance (AOR [95% CI], 0.72 [0.53-0.97]; vs. no dispatcher-assistance).
Male patients, other public place onset, witnessed by non-family and conventional CPR were associated with PAD provide. Therefore, training skilled first responders to use AEDs appropriately is necessary.
院外心脏骤停（OHCA）与公共获取除颤器（PAD）的适当提供之间的关联仍不清楚。本研究旨在评估与是否提供 PAD 相关的因素。
这是一项回顾性队列研究，利用了 2021 年全日本 Utstein 和紧急转运登记处的数据。我们纳入了由旁观者应用自动体外除颤器（AED）并被 AED 判定为可除颤的 OHCA 患者。我们根据旁观者除颤来定义提供或未提供 PAD。采用 Firth 偏倚校正法的多变量逻辑回归分析来估计与提供 PAD 相关的因素的调整后优势比（AOR）和 95%置信区间（CI）。
共有 1949 名患者符合分析条件（提供 PAD，n=1696[87.0%]；未提供 PAD，n=253[13.0%]）。与提供 PAD 相关的因素包括男性（AOR[95%CI]，1.61[1.17-2.21]；vs.女性）、其他公共场所发病（AOR[95%CI]，10.65[1.40-1367.54]；vs.公共场所）、非家庭成员见证（AOR[95%CI]，2.51[1.86-3.42]；vs.未见证）和传统心肺复苏术（CPR）（AOR[95%CI]，1.75[1.17-2.67]；vs.仅手CPR）。相反，与未提供 PAD 相关的因素包括年龄超过 65 岁（AOR[95%CI]，0.48[0.28-0.80]；vs.19-64 岁）、夜间发病（AOR[95%CI]，0.61[0.45-0.83]；vs.白天）、非心源性（AOR[95%CI]，0.43[0.31-0.61]；vs.心源性）、家庭环境（AOR[95%CI]，0.33[0.14-0.83]；vs.公共场所）、医疗机构环境（AOR[95%CI]，0.40[0.23-0.66]；vs.公共场所）、无旁观者 CPR（AOR[95%CI]，0.31[0.14-0.71]；vs.仅手 CPR）和调度员协助（AOR[95%CI]，0.72[0.53-0.97]；vs.无调度员协助）。
男性患者、其他公共场所发病、非家庭成员见证和传统 CPR 与 PAD 提供有关。因此，有必要培训熟练的第一响应者正确使用 AED。
