Abstract
BackgroundJapanese rice cake (“mochi”) is a major cause of food-choking accidents in Japan. However, the epidemiology of out-of-hospital cardiac arrests (OHCAs) due to suffocation caused by rice cakes is poorly understood.MethodsOHCA data from 2005 to 2012 were obtained from the population-based OHCA registry in Osaka Prefecture. Patients aged ≥20 years who experienced OHCA caused by suffocation that occurred before the arrival of emergency-medical-service (EMS) personnel were included. Patient characteristics, prehospital interventions, and outcomes were compared based on the cause of suffocation (rice cake and non-rice-cake). The primary outcome was 1-month survival after OHCA.ResultsIn total, 46 911 adult OHCAs were observed during the study period. Of the OHCAs, 7.0% (3,294/46,911) were due to suffocation, with choking due to rice cake as the cause in 9.5% of cases (314/3,294), and of these, 24.5% (77/314) occurred during the first 3 days of the New Year. In crude analysis, 1-month survival was 17.2% (54/314) in those with suffocation caused by rice cake and 13.4% (400/2,980) in those with suffocation due to other causes. In the multivariable analysis for all-cause suffocation, younger age, arrest witnessed by bystanders, and earlier EMS response time were significantly related to better 1-month survival.ConclusionApproximately 10% of OHCAs due to suffocation were caused by rice-cake choking, and 25% of these occurred during the first 3 days of the New Year. Further efforts for establishing preventive measures as well as improving the early recognition of choking and encouraging bystanders to call EMS sooner are needed.
Highlights
More than 120 000 out-of-hospital cardiac arrests (OHCAs) are documented in Japan every year,[1] and OHCA is recognized as a national public health problem
In terms of the daily distribution, cases of OHCA caused by rice-cake choking were concentrated in the first 3 days of the New Year, as 24.5% (77=314) of all OHCAs caused by rice-cake choking occurred during those days (Figure 2B)
In the fully adjusted multivariable analysis, younger age, arrest witnessed by bystanders, intravenous fluid administration, and earlier EMS response time were significantly related to better survival, whereas cause of suffocation and initiation of bystander cardiopulmonary resuscitation (CPR) did not show a significant relationship
Summary
More than 120 000 out-of-hospital cardiac arrests (OHCAs) are documented in Japan every year,[1] and OHCA is recognized as a national public health problem. More than 9000 deaths are reported annually in Japan due to accidental suffocation, and half of these deaths are attributed to food choking.[3] The most common cause of food-choking accidents in Japan is rice cake, or “mochi,”[4] which is a Japanese traditional food made of glutinous rice pounded into paste and molded into shape. While it is eaten throughout the year, it is most commonly sold and consumed during the New Year holidays. The epidemiology of out-of-hospital cardiac arrests (OHCAs) due to suffocation caused by rice cakes is poorly understood
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