Cardiac Arrest Cases and Automated External Defibrillator Use in Railroad Stations in Tokyo
Affiliation(s)
Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
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.
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.
Cite this paper
Fukuike, S. and Otomo, Y. (2014) Cardiac Arrest Cases and Automated External Defibrillator Use in Railroad Stations in Tokyo. International Journal of Clinical Medicine, 5, 1328-1336. doi: 10.4236/ijcm.2014.520170.
Fukuike, S. and Otomo, Y. (2014) Cardiac Arrest Cases and Automated External Defibrillator Use in Railroad Stations in Tokyo. International Journal of Clinical Medicine, 5, 1328-1336. doi: 10.4236/ijcm.2014.520170.
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http://dx.doi.org/10.1136/hrt.2009.174268
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http://plaza.umin.ac.jp/GHDNet/04/AED_iseirei7010011.pdf [2] Ministry of Education, Culture, Sports, Science and Technology (2014) Survey on AED Deployment in Schools. (In Japanese)
http://www.mext.go.jp/component/a_menu/education/detail/__icsFiles/afieldfile
/2012/04/04/1289307_04.pdf [3] Japan Foundation for Emergency Medicine (2014) AED Map. (In Japanese)
http://www.qqzaidan.jp/AED/aed.htm [4] (In Japanese)
http://www.mext.go.jp/a_menu/kenko/anzen/__icsFiles/afieldfile/2014/09/09/1351843_01.pdf [5] Kitamura, T., Iwami, T., Kawamura, T., Nagano, K., Tanaka, H., et al. (2010) Nationwide Public-Access Defibrillation in Japan. The New England Journal of Medicine, 362, 994-1004.
http://dx.doi.org/10.1056/NEJMoa0906644 [6] Japan Transport Promotion Association (2009) Suji de miru Kanto no un-yu no ugoki (Statistic of Transport in Kanto Area, Japan). Japan Transport Promotion Association. (In Japanese) [7] Ministry of Land, Infrastructure, Transport and Tourism (2014) White Paper on Land, Infrastructure, Transport and Tourism in Japan, 2008.
http://www.mlit.go.jp/common/000221175.pdf [8] Tokyo Fire Department (2007) Kyukyukatsudo no genkyo (Statistic, Emergency Medical Services on Tokyo Fire Department). (In Japanese) [9] Tokyo Fire Department (2008) Kyukyukatsudo no genkyo (Statistic, Emergency Medical Services on Tokyo Fire Department). (In Japanese) [10] Muraoka, H., Ohishi, Y., Hazui, H., Negoro, N., Murai, M., Kwakami, M., et al. (2006) Location of Out-of-Hospital Cardiac Arrests in Takatsuki City— Where Should Automated External Defibrillator Be Placed? Circulation Journal, 70, 827-831.
http://dx.doi.org/10.1253/circj.70.827 [11] Iwami, T., Hiraide, A., Nakanishi, N., Hayashi, Y., Nishiuchi, T., Yukioka, H., et al. (2003) Age and Sex Analyses of Out-of-Hospital Cardiac Arrest in Osaka, Japan. Resuscitation, 57, 145-152.
http://dx.doi.org/10.1016/S0300-9572(03)00035-2 [12] Sasaki, M., Iwami, T., Kitamura, T., Nomoto, S., Nishiyama, C., Sakai, T., et al. (2011) Incidence and Outcome of Out-of-Hospital Cardiac Arrest with Public-Access Defibrillation—A Descriptive Epidemiological Study in a Large Urban Community. Circulation Journal, 75, 2821-2826.
http://dx.doi.org/10.1253/circj.CJ-11-0316 [13] Murakami, Y., Iwami, T., Kitamura, T., Nishiyama, C., Nishiuchi, T., Hayashi, Y. et al. (2014) Outcomes of Out-of-Hospital Cardiac Arrest by Public Location in the Public-Access Defibrillation Era. Journal of the American Heart Association, 3, 1-11.
http://jaha.ahajournals.org/content/3/2/e000533.full [14] http://www.metro.tokyo.jp/ENGLISH/PROFILE/overview02.htm [15] (In Japanese) http://www.jreast.co.jp/press/2005_1/20050607.pdf [16] (In Japanese) http://www.tokyometro.jp/news/2005/2005-26.html [17] Ong, M.E.H., Tan, E.H., Yan, X., Anushia, P., Lim, S.H., Leong, B.S.H., et al. (2008) An Observational Study Describing the Geographic-Time Distribution of Cardiac Arrests in Singapore: What Is the Utility of Geographic Information Systems for Planning Public Access Defibrillation? (PADS Phase I). Resuscitation, 76, 388-396.
http://dx.doi.org/10.1016/j.resuscitation.2007.09.006 [18] MacDonald, R., Mottley, J. and Weinstein, C. (2002) Impact of Prompt Defibrillation on Cardiac Arrest at a Major International Airport. Prehospital Emergency Care, 6, 1-5.
http://dx.doi.org/10.1080/10903120290938689 [19] Engdahl, J. and Herlitz, J. (2005) Localization of Out-of-Hospital Cardiac Arrest in Goteborg 1994-2002 and Implications for Public Access Defibrillation. Resuscitation, 64, 171-175.
http://dx.doi.org/10.1016/j.resuscitation.2004.08.006 [20] Kim, C., Fahrenbruch, C.E., Cobb, L.A. and Eisenberg, M.S. (2001) Out-of-Hospital Cardiac Arrest in Men and Women. Circulation, 104, 2699-2703.
http://dx.doi.org/10.1161/hc4701.099784 [21] Rea, T.D., Olsufka, M., Bemis, B., White, L., Yin, L., Becker, L., et al. (2010) A Population-Based Investigation of Public Access Defibrillation: Role of Emergency Medical Services Care. Resuscitation, 81, 163-167.
http://dx.doi.org/10.1016/j.resuscitation.2009.10.025 [22] Iwami, T., Hiraide, A., Nakanishi, N., Hayashi, Y., Nishiuchi, T., Uejima, T., et al. (2006) Outcome and Characteristics of Out-of-Hospital Cardiac Arrest According to Location of Arrest: A Report from a Large-Scale,
Population-Based Study in Osaka, Japan. Resuscitation, 69, 221-228.
http://dx.doi.org/10.1016/j.resuscitation.2005.08.018 [23] Morita, H. (2006) Sudden Cardiac Death: Out-of-Hospital Care and Improving Survival. Japanese Journal of Electrocardiology, 26, 134-143. (In Japanese)
http://dx.doi.org/10.5105/jse.26.134 [24] Ministry of Land, Infrastructure, Transport and Tourism (2014) Metropolis Transportation Census. (In Japanese)
http://www.mlit.go.jp/sogoseisaku/transport/daitoshicensus/h22cencus-shuto.pdf [25] Fire and Disaster Management Agency, Ministry of Internal Affairs and Communications (2014). (In Japanese)
http://www.fdma.go.jp/neuter/topics/kyukyukyujo_genkyo/h25/01_kyukyu.pdf [26] Osaka Life Support, Push Project. (In Japanese)
http://osakalifesupport.jp/push/course.html [27] J-PULSE. (In Japanese)
http://j-pulse.umin.jp/push3/index.html [28] Iwami, T., Kawamura, T., Hiraide, A., Berg, R.A., Hayashi, Y., Nishiuchi, T., et al. (2007) Effectiveness of Bystander-Initiated Cardiac-Only Resuscitation for Patients with Out-of-Hospital Cardiac Arrest. Circulation, 116, 2900-2907.
http://dx.doi.org/10.1161/CIRCULATIONAHA.107.723411 [29] SOS-KANTO Study Group (2007) Cardiopulmonary Resuscitation by Bystanders with Chest Compression Only: An Observational Study. The Lancet, 369, 920-926.
http://dx.doi.org/10.1016/S0140-6736(07)60451-6 [30] Ramaraj, R. and Ewy, G.A. (2009) Rationale for Continuous Chest Compression Cardiopulmonary Resuscitation. Heart, 95, 1978-1982.
http://dx.doi.org/10.1136/hrt.2009.174268