Abstract 222: Public Access Defibrillation Programs with Automated External Defibrillators Need Targeted Cardiopulmonary Resuscitation Training: Lessons from a Local Japanese City Database

Abstract

Background: Public access defibrillation (PAD) with automated external defibrillator (AED) is well known as a common and good implication in the public location for out of hospital cardiac arrests (OHCAs). In Japan, AED is being implemented in public and residential space, and could be used by bystander since July 2004. PAD may improve survival from sudden OHCA, however, the effect for OHCA in a local Japanese city outcome and characteristics remains unclear. Here we examined to identify the clinical outcome, prevalence and problem of PAD five years later since 2004. Methods and Results: We studied 836 OHCAs in Gifu city between 2009 and 2010 using Gifu city emergency medical service database. Of these, only 42 (5.02%) were attached with AED (male 25 (mean 67.5 year-old), female 17 (mean 88.7 year-old)). After written informed consent was obtained, we interviewed and characterized bystanders. Location of OHCA were nursing home (n=27 (64.3%)), prison (n=6 (14.3%)), sports institution (n=3 (7.2%)), public space (n=3 (7.2%)), and others (shopping mall, hotel, and office). The incidence in nursing home was significantly older than other group (86.7 vs. 56.9 year-old) (p < 0.01). Bystander cardiopulmonary resuscitation (CPR) was performed 36 (86%) with 50% witnessed. AED records showed the incidence of ventricular fibrillation was 26% (n=11), and asystole was 52%. Eight patients were shock delivered and eleven patients got return of spontaneous circulation by CPR and AED. The one month survival rate after OHCA was 14% (n=6). Lay rescuers were almost staff of the institution (n=38 (90%)) and the rate of health care provider (HCP) was 33% (n=14). We obtained and analyzed the data of 22 bystanders (including HCP (n=3)). Twenty one bystanders participated in any CPR training (non AHA program) within five years and the half of them within one year. However 18 (81.8%) bystanders had some difficulty and environmental stress in practical AED use as a PAD program. Conclusions: PAD with AED need to be more appropriately education and implementation with constant PAD program including targeted CPR training, such as AHA program.