title: Improper bystander-performed basic life support in cardiac arrests managed with public automated external defibrillators.
abstract: OBJECTIVE
  The aim of the study was to determine the quality of basic life support (BLS) in out-of-hospital cardiac arrests (OHCAs) receiving bystander cardiopulmonary resuscitation (CPR) and public automated external defibrillator (AED) application.
  
  
  METHODS
  From January 2006 to December 2012, data were prospectively collected from OHCA) and impending cardiac arrests treated with and without public AED before emergency medical technician (EMT) arrival. Basic life support actions and outcomes were compared between cases with and without public AED application. Interruptions of CPR were compared between 2 groups of AED users: health care provider (HCP) and non-HCP.
  
  
  RESULTS
  Public AEDs were applied in 10 and 273 cases of impending cardiac arrest and non-EMT-witnessed OHCAs, respectively (4.3% of 6407 non-EMT-witnessed OHCAs). Defibrillation was delivered to 33 (13.3%) cases. Public AED application significantly improved the rate of 1-year neurologically favorable survival in bystander CPR-performed cases with shockable initial rhythm but not in those with nonshockable rhythm. Emergency calls were significantly delayed compared with other OHCAs without public AED application (median: 3 and 2 minutes, respectively; P < .0001). Analysis of AED records obtained from 136 (54.6%) of the 249 cases with AED application revealed significantly lower rate of compressions delivered per minute and significantly greater proportion of CPR pause in the non-HCP group. Time interval between power on and the first electrocardiographic analysis widely varied in both groups and was significantly prolonged in the non-HCP group (P = .0137).
  
  
  CONCLUSIONS
  Improper BLS responses were common in OHCAs treated with public AEDs. Periodic training for proper BLS is necessary for both HCPs and non-HCPs.
authors.affiliation: Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan. Electronic address: ntaiki24@yahoo.co.jp.
authors.forename: Taiki
authors.initials: T
authors.lastname: Nishi
authors.affiliation: Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan; Department of Medical Science and Technology, Hiroshima International University, Higashi-hiroshima, Hiroshima Japan. Electronic address: y-takei@hs.hirokoku-u.ac.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takei
authors.affiliation: Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan. Electronic address: kamitaka911@gmail.com.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kamikura
authors.affiliation: Emergency Medical Center, Ishikawa Prefectural Central Hospital, Kanazawa city, Ishikawa, Japan. Electronic address: keiohta@ipch.jp.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ohta
authors.affiliation: Emergency medical Center, Noto General Hospital, Nanao city, Ishikawa, Japan. Electronic address: hashim@noto-hospital.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hashimoto
authors.affiliation: Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa, Japan. Electronic address: hidinaba@med.kanazawa-u.ac.jp.
authors.forename: Hideo
authors.initials: H
authors.lastname: Inaba
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D047548:Defibrillators; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome