Public-access automated external defibrillation and bystander-initiated cardiopulmonary resuscitation in schools: a nationwide investigation in Japan

Abstract

We aimed to reveal the effects of application of public-access automated external defibrillators (AEDs) and bystander-initiated cardiopulmonary resuscitation (CPR) on survival of paediatric patients with out-of-hospital cardiac arrest (OHCA) occurring on school campuses in Japan. Data were obtained from a nationwide prospective observational study of paediatric OHCAs in school settings in Japan, termed Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS). Non-traumatic OHCA patients from elementary school, junior high school, and high school/technical college between April 2008 and December 2015 were enrolled. A multivariable logistic regression analysis was conducted to assess the effect of bystander interventions (i.e. public-access AED application and bystander-CPR) on 30-day survival with favourable neurological outcome. In total, 232 OHCA cases were analysed. The proportion of 30-day survival with favourable neurological outcome was significantly higher among the patients receiving both public-access AED application and bystander-CPR than those without any bystander intervention (50.9% vs. 20.0%, adjusted odds ratio 4.08, 95% confidence interval 1.25-13.31; P = 0.020). During the study period, the proportion of patients to whom public-access AEDs were applied increased significantly (from 61.9% in 2008 to 87.0% in 2015, P-for trend = 0.014). Accordingly, the proportion of 30-day survival with favourable neurological outcome improved significantly (from 38.1% in 2005 to 56.5% in 2015, P-for trend = 0.026). The combination of public-access AED application and bystander-CPR increased the chance of survival approximately four-fold in schools. The nationwide efforts towards disseminating public-access defibrillation systems in school settings may reduce the risk of sudden cardiac death among school children.