Cardiac Arrest Cases and Automated External Defibrillator Use in Railroad Stations in Tokyo

Satoko Fukuike,Yasuhiro Otomo

doi:10.4236/ijcm.2014.520170

Abstract

Objective: Nationwide dissemination of public-access defibrillation (PAD) contributed to an increase of survival rate in Japan. We analysed cardiac arrests (CAs) that occurred in railroad stations in Tokyo to evaluate PAD in the metropolis. Methods: We collected Utstein data from the Tokyo Fire Department (TFD) and analysed CA cases that occurred in stations. In total, 245 non-traumatic CAs from January 1, 2007 to March 31, 2008 were analysed; CAs in children under 8 years were excluded. Results: The rates of pre-hospital return of spontaneous circulation (ROSC) were 41 out of 145 witnessed CA patients (28.3%) and 12 ROSC out of 100 unwitnessed CA patients (12%). Of 245 CA cases, bystander cardiopulmonary resuscitation (CPR) performed in 156 (63.7%), automated external defibrillator (AED) used in 117 (47.8%) and shock delivered in 65 (26.5%). Rates of ROSC were 31.6% (37/117) with AED use significantly higher than those of 12.5% (16/128) without AED use (P < 0.001). Most CAs occurred on platforms; the use of AEDs on platforms increased from 18/31 (58.1%) in 2007 to 32/43 (74.4%) in 2008 and ROSC rates increased from 8 (25.8%) to 14 (32.6%), respectively. On train CAs: ROSC cases were very few, 1 case each year (8.3%; 7.7%) while the use of AED increased from 8/12 (66.7%) in 2007 to 10/13 (76.9%) in 2008. Conclusion: Bystander CPR and the use of AED at railroad stations improved ROSC for out-of-hospital cardiac arrest (OHCA) patients. AED location and strategies for dealing with CAs on trains should be re-evaluated.

Highlights

The Japanese Ministry of Health, Labour and Welfare approved public access defibrillation (PAD) in 2004 [1].How to cite this paper: Fukuike, S. and Otomo, Y. (2014) Cardiac Arrest Cases and Automated External Defibrillator Use in Railroad Stations in Tokyo
Analysis of the data to determine the incidence of cardiac arrests (CAs) and automated external defibrillator (AED) use by bystanders in stations was approved by the Emergency Medical Service Division of the Tokyo Fire Department (TFD)
CA cases in stations in Tokyo during 2 years from April 1, 2007 to December 31, 2008 were extracted from the Utstein database and analysed for the following characteristics: the address the ambulance was dispatched to, the place of incidence within the station, the month and hour of incidence, the age and gender of the patient, the type of incidence, the presence of witness, whether bystander-initiated cardiopulmonary resuscitation (CPR) was performed, the availability of an AED and whether it was used by bystanders, bystander defibrillation was performed or not, and whether return of spontaneous circulation (ROSC) was observed by the ambulance technician before arrival at hospital

Summary

Introduction

The Japanese Ministry of Health, Labour and Welfare approved public access defibrillation (PAD) in 2004 [1].How to cite this paper: Fukuike, S. and Otomo, Y. (2014) Cardiac Arrest Cases and Automated External Defibrillator Use in Railroad Stations in Tokyo. The basic life support training (BLS) including the use of AED is taught to students in elementary schools [4] These efforts on PAD have improved the outcomes of out-of-hospital cardiac arrests (OHCA) for patients in Japan [5]. In the area under the supervision of the Tokyo Fire Department (TFD), for the 23 special administrative districts and 28 out of 30 municipalities in the Tama area [14], the data show a large number of CAs occurring in railroad facilities (hereinafter, stations); these numbers amounted to 385 in 2007 through 2008 [8] [9] This makes railroads the fifth most common place for OHCAs and the second most common place for CAs occurring outside houses each year.

Methods

Results

Conclusion