Public-access automated external defibrillation and bystander-initiated cardiopulmonary resuscitation in schools: a nationwide investigation in Japan

Europace. 2019 Mar 1;21(3):451-458. doi: 10.1093/europace/euy261.

Abstract

Aims: We aimed to reveal the effects of application of public-access automated external defibrillators (AEDs) and bystander-initiated cardiopulmonary resuscitation (CPR) on survival of paediatric patients with out-of-hospital cardiac arrest (OHCA) occurring on school campuses in Japan.

Methods and results: Data were obtained from a nationwide prospective observational study of paediatric OHCAs in school settings in Japan, termed Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS). Non-traumatic OHCA patients from elementary school, junior high school, and high school/technical college between April 2008 and December 2015 were enrolled. A multivariable logistic regression analysis was conducted to assess the effect of bystander interventions (i.e. public-access AED application and bystander-CPR) on 30-day survival with favourable neurological outcome. In total, 232 OHCA cases were analysed. The proportion of 30-day survival with favourable neurological outcome was significantly higher among the patients receiving both public-access AED application and bystander-CPR than those without any bystander intervention (50.9% vs. 20.0%, adjusted odds ratio 4.08, 95% confidence interval 1.25-13.31; P = 0.020). During the study period, the proportion of patients to whom public-access AEDs were applied increased significantly (from 61.9% in 2008 to 87.0% in 2015, P-for trend = 0.014). Accordingly, the proportion of 30-day survival with favourable neurological outcome improved significantly (from 38.1% in 2005 to 56.5% in 2015, P-for trend = 0.026).

Conclusion: The combination of public-access AED application and bystander-CPR increased the chance of survival approximately four-fold in schools. The nationwide efforts towards disseminating public-access defibrillation systems in school settings may reduce the risk of sudden cardiac death among school children.

Keywords: Automated external defibrillator; Cardiopulmonary resuscitation; Out-of-hospital cardiac arrest; School; Student.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Cardiopulmonary Resuscitation / adverse effects
  • Cardiopulmonary Resuscitation / instrumentation*
  • Cardiopulmonary Resuscitation / mortality
  • Child
  • Databases, Factual
  • Death, Sudden, Cardiac / prevention & control*
  • Defibrillators*
  • Electric Countershock / adverse effects
  • Electric Countershock / instrumentation*
  • Electric Countershock / mortality
  • Female
  • Health Services Accessibility*
  • Hospital Mortality
  • Humans
  • Japan
  • Male
  • Out-of-Hospital Cardiac Arrest / diagnosis
  • Out-of-Hospital Cardiac Arrest / mortality
  • Out-of-Hospital Cardiac Arrest / physiopathology
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Patient Admission
  • Prospective Studies
  • Recovery of Function
  • Registries
  • Risk Assessment
  • Risk Factors
  • School Health Services*
  • Time Factors
  • Transportation of Patients
  • Treatment Outcome