title: Outcomes of out-of-hospital cardiac arrest by public location in the public-access defibrillation era.
abstract: BACKGROUND
  The strategy to place public-access automated external defibrillators (AEDs) has not yet been established in real settings.
  
  
  RESULTS
  This, prospective, population-based observational study in Osaka, Japan, included consecutive out-of-hospital cardiac arrest (OHCA) patients with resuscitation attempts during 7 years, from January 2005 through December 2011. The trends in the proportion of public-access AED use and 1-month survival with neurologically favorable outcome were evaluated by location. Factors associated with neurologically favorable outcome (defined as cerebral performance category 1 or 2) after ventricular fibrillation were also assessed using multiple logistic regression analysis. A total of 9453 bystander-witnessed OHCAs of cardiac origin were documented and 894 (9.5%) of them occurred at public places. The proportion of public-access AED use significantly increased from 0.0% (0/20) in 2005 to 41.2% (7/17) in 2011 at railway stations and from 0.0% (0/7) to 56.5% (13/23) at sports facilities. Mean time from collapse to shock was 5.0 minutes among those who received shocks with public-access AEDs. The proportion of neurologically favorable outcome was 28.0% (33/118) at railway stations, 51.6% (48/93) at sports facilities, 23.3% (20/86) in public buildings, and 41.9% (13/31) in schools. In multivariate analysis, early defibrillation, irrespective of bystander or emergency medical service (EMS) personnel, was significantly associated with neurologically favorable outcome (adjusted odds ratio for 1-minute increment, 0.89; 95% confidence interval, 0.87 to 0.92).
  
  
  CONCLUSIONS
  This large, population-based OHCA registry demonstrated that earlier shock, irrespective the shock provider (bystander or EMS personnel), contributed to improving outcome, and a public-access defibrillation program was successfully implemented so that shocks with public-access AEDs were delivered to over 40% of bystander-witnessed OHCAs and time to shock was shortened in some kinds of public places.
authors.affiliation: Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Murakami
authors.forename: Taku
authors.initials: T
authors.lastname: Iwami
authors.forename: Tetsuhisa
authors.initials: T
authors.lastname: Kitamura
authors.forename: Chika
authors.initials: C
authors.lastname: Nishiyama
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nishiuchi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawamura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D047548:Defibrillators; D004554:Electric Countershock / Q000295:instrumentation*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D011446:Prospective Studies; D011633:Public Facilities; D012042:Registries; D016019:Survival Analysis; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: automated external defibrillator; cardiac arrest; cardiopulmonary resuscitation; death, sudden; epidemiology
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