An Utstein-style Examination of Out-of-hospital Cardiac Arrest Patients in Saga Prefecture, Japan

Basic life support by citizens in Kawasaki City, Japan - a descriptive epidemiological study of out-of-hospital cardiac arrest patients

AIM

To better understand the current status and barriers to making basic life support a common practice among the citizens of Kawasaki City, Japan.

METHOD

We extracted data according to the Utstein-style guidelines specifically regarding out-of-hospital cardiac arrests (OHCAs) of cardiac etiology. The items were as follows: (i) OHCA witnessed by a citizen, (ii) the victim received bystander cardiopulmonary resuscitation (CPR), (iii) an automatic external defibrillator was used by the witness. We compared the rate of each item and the 1-month survival rates with the national average in Japan. We further divided Kawasaki City into three areas and compared each item. We also examined the rate of bystander CPR in each time period and location. Statistical analysis was carried out using the χ²-test and Fisher's test.

RESULTS

The 1-month survival rates did not differ significantly from the national average for cases meeting conditions (i)-(iii): (i) 14.0% versus 13.3%, (ii) 19.1% versus 16.4%, (iii) 71.4% versus 53.3%, respectively. However, the rate of condition (i) was significantly lower (47.5% versus 55. 8%, P = 0.01). The rate of condition (ii) was higher in the northern area of Kawasaki City, as well as in a location other than the home in the daytime. The rate of condition (ii) was low in the home.

CONCLUSIONS

Although the 1-month survival rates of OHCAs witnessed by citizens in Kawasaki City did not differ significantly from the national average, the low rate of bystander CPR was notable, especially in the southern and middle areas of the city and when the location was in the home, which implies that basic life support knowledge should be spread to these areas.

A systematic review and meta-analysis of the effect of dispatcher-assisted CPR on outcomes from sudden cardiac arrest in adults and children

BACKGROUND

Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) has been reported in individual studies to significantly increase the rate of bystander CPR and survival from cardiac arrest.

METHODS

We undertook a systematic review and meta-analysis to evaluate the impact of DA-CPR programs on key clinical outcomes following out-of-hospital cardiac arrest. We searched the PubMED, EMBASE, CINAHL, ERIC and Cochrane Central Register of Controlled Trials databases from inception until July 2018. Eligible studies compared systems with and without dispatcher-assisted CPR programs. The results of included studies were classified into 3 categories for the purposes of more accurate analysis: comparison of outcomes in systems with DA-CPR programs, case-based comparison of DA-CPR to bystander CPR, and case-based comparisons of DA-CPR to no CPR before EMS arrival. The GRADE system was used to assess certainty of evidence at an outcome level. We used random-effects models to produce summary effect sizes across all outcomes.

RESULTS

Of 5531 citations screened, 33 studies were eligible for inclusion. All included studies were observational. Evidence certainty across all outcomes was assessed as low or very low. In system-level and patient-level comparisons, the provision of DA-CPR compared with no DA-CPR was consistently associated with improved outcome across all analyses. Comparison of DA-CPR to bystander CPR produced conflicting results. Findings were consistent across sensitivity analyses and the pediatric sub-group.

CONCLUSION

These results support the recommendation that dispatchers provide CPR instructions to callers for adults and children with suspected OHCA. Review registration: PROSPERO- CRD42018091427.