title: Public access defibrillation improved the outcome after out-of-hospital cardiac arrest in school-age children: a nationwide, population-based, Utstein registry study in Japan.
abstract: OBJECTIVE
  The purpose of this study was to determine whether implementation of public access defibrillation (PAD) improves the outcome after out-of-hospital cardiac arrest (OHCA) in school-age children at national level.
  
  
  RESULTS
  We conducted a prospective, nationwide, population-based Japanese Utstein registry study of consecutive OHCA cases in elementary and middle school children (7-15 years of age) who had a bystander-witnessed arrest of presumed cardiac origin during 2005-09 and received pre-hospital resuscitation by emergency responders. The primary endpoint was a favourable neurological outcome 1 month after an arrest. Among 230 eligible patients enrolled, 128 had ventricular fibrillation (VF) as an initial rhythm. Among these 128 patients, 29 (23%) children received a first shock by a bystander. Among these 29 patients, the proportion of the favourable neurological outcome after OHCA was 55%. During the study period, the proportion of patients initially shocked by a bystander among eligible patients increased from 2 to 21% (P = 0.002 for trend). The proportion of patients with a favourable neurological outcome after OHCA increased from 12 to 36% overall (P = 0.006). The collapse to defibrillation time was shorter in bystander-initiated defibrillation when compared with defibrillation by emergency responders (3.3 ± 3.7 vs. 12.9 ± 5.8 min, P < 0.001), and was independently associated with a favourable neurological outcome after OHCA [P = 0.03, odds ratio (OR) per 1 min increase, 0.90 (95% confidence interval 0.82-0.99)]. A non-family member's witness was independently associated with VF as the initial rhythm [P < 0.001, OR 4.03 (2.08-7.80)].
  
  
  CONCLUSIONS
  Implementation of PAD improved the outcome after OHCA in school-age children at national level in Japan.
authors.affiliation: Department of Pediatrics, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture 514-8507, Japan. ymitani@clin.medic.mie-u.ac.jp
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Mitani
authors.forename: Kunio
authors.initials: K
authors.lastname: Ohta
authors.forename: Noriko
authors.initials: N
authors.lastname: Yodoya
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Otsuki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ohashi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Sawada
authors.forename: Masami
authors.initials: M
authors.lastname: Nagashima
authors.forename: Naokata
authors.initials: N
authors.lastname: Sumitomo
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Komada
mesh_terms: D000293:Adolescent; D002648:Child; D047548:Defibrillators / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000517:prevention & control*; D012042:Registries; D012307:Risk Factors; D013334:Students / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Cardiopulmonary resuscitation; Public access defibrillation; School health; School-age children; Sudden unexplained death