Public access defibrillation improved the outcome after out-of-hospital cardiac arrest in school-age children: a nationwide, population-based, Utstein registry study in Japan

The purpose of this study was to determine whether implementation of public access defibrillation (PAD) improves the outcome after out-of-hospital cardiac arrest (OHCA) in school-age children at national level. We conducted a prospective, nationwide, population-based Japanese Utstein registry study of consecutive OHCA cases in elementary and middle school children (715 years of age) who had a bystander-witnessed arrest of presumed cardiac origin during 200509 and received pre-hospital resuscitation by emergency responders. The primary endpoint was a favourable neurological outcome 1 month after an arrest. Among 230 eligible patients enrolled, 128 had ventricular fibrillation (VF) as an initial rhythm. Among these 128 patients, 29 (23) children received a first shock by a bystander. Among these 29 patients, the proportion of the favourable neurological outcome after OHCA was 55. During the study period, the proportion of patients initially shocked by a bystander among eligible patients increased from 2 to 21 (P 0.002 for trend). The proportion of patients with a favourable neurological outcome after OHCA increased from 12 to 36 overall (P 0.006). The collapse to defibrillation time was shorter in bystander-initiated defibrillation when compared with defibrillation by emergency responders (3.3 3.7 vs. 12.9 5.8 min, P 0.001), and was independently associated with a favourable neurological outcome after OHCA [P 0.03, odds ratio (OR) per 1 min increase, 0.90 (95 confidence interval 0.820.99)]. A non-family members witness was independently associated with VF as the initial rhythm [P 0.001, OR 4.03 (2.087.80)]. Implementation of PAD improved the outcome after OHCA in school-age children at national level in Japan.