Recruitments of trained citizen volunteering for conventional cardiopulmonary resuscitation are necessary to improve the outcome after out-of-hospital cardiac arrests in remote time-distance area: A nationwide population-based study.
To compare the factors associated with survival after out-of-hospital cardiac arrests (OHCAs) among three time-distance areas (defined as interquartile range of time for emergency medical services response to patient's side).



From a nationwide, prospectively collected data on 716,608 OHCAs between 2007 and 2012, this study analyzed 193,914 bystander-witnessed OHCAs without pre-hospital physician involvement.



Overall neurologically favourable 1-month survival rates were 7.4%, 4.1% and 1.7% for close, intermediate and remote areas, respectively. We classified BCPR by type (compression-only vs. conventional) and by dispatcher-assisted CPR (DA-CPR) (with vs. without); the effects on time-distance area survival were analyzed by BCPR classification. Association of each BCPR classification with survival was affected by time-distance area and arrest aetiology (p<0.05). The survival rates in the remote area were much higher with conventional BCPR than with compression-only BCPR (odds ratio; 95% confidence interval, 1.26; 1.05-1.51) and with BCPR without DA-CPR than with BCPR with DA-CPR (1.54; 1.29-1.82). Accordingly, we classified BCPR into five groups (no BCPR, compression-only with DA-CPR, conventional with DA-CPR, compression-only without DA-CPR, and conventional without DA-CPR) and analyzed for associations with survival, both cardiac and non-cardiac related, in each time-distance area by multivariate logistic regression analysis. In the remote area, conventional BCPR without DA-CPR significantly improved survival after OHCAs of cardiac aetiology, compared with all the other BCPR groups. Other correctable factors associated with survival were short collapse-to-call and call-to-first CPR intervals.



Every effort to recruit trained citizens initiating conventional BCPR should be made in remote time-distance areas.
Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan; Department of Medical Science and Technology, Hiroshima International University, Higashi-hiroshima, Japan. Electronic address: y-takei@hs.hirokoku-u.ac.jp.
Yutaka
Y
Takei
Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan. Electronic address: kamitaka911@gmail.com.
Takahisa
T
Kamikura
Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan. Electronic address: ntaiki24@yahoo.co.jp.
Taiki
T
Nishi
Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan. Electronic address: tetsumae@med.kanazawa-u.ac.jp.
Tetsuo
T
Maeda
Department of Cardiology, Kanazawa Medical Centre, Kanazawa, Japan. Electronic address: afib@kinbyou.hosp.go.jp.
Satoru
S
Sakagami
Department of Paediatrics, Ishikawa Prefectural Central Hospital, Kanazawa, Japan. Electronic address: min-kubo3e@ipch.jp.
Minoru
M
Kubo
Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan. Electronic address: hidinaba@med.kanazawa-u.ac.jp.
Hideo
H
Inaba
D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000379:methods; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy; D011446:Prospective Studies; D016019:Survival Analysis; D061665:Time-to-Treatment; D014838:Volunteers / Q000193:education*
Bystander; Conventional cardiopulmonary resuscitation; Dispatcher-assisted; Out-of-hospital cardiac arrest; Survival