Cardiopulmonary Resuscitation and Public Access Defibrillation in the Current Era—Can We Do Better Yet?
چکیده
T he paper in this edition of JAHA by Iwami, et al. entitled “Outcomes of Out-of-Hospital Cardiac Arrest by Public Location in the Public-Access Defibrillation Era” offers very encouraging data with regard to the improving outcomes of out-of-hospital cardiac arrest. The information solidifies and emphasizes strategies in our attempts at the continued improvement in survival with good neurologic outcomes in this condition. In this population-based observational study in Osaka, Japan, consecutive OHCA patients who had resuscitation attempts during a 7-year period from January 2005 to December 2011 were assessed. The public use of automated external defibrillator (AED) was legalized in Japan in July 2004, just before the time period of this study. One of the intents of this paper was to better delineate the outcomes of out-ofhospital-cardiac arrest (OHCA), specifically by location. Trends in public access AED use and 1-month survival with good neurologic outcome were therefore evaluated by location in this study. A total of 9453 episodes of bystander-witnessed OHCA of cardiac origin were documented during the 7-year prospective period, 894 (9.5%) occurred in public places. Interestingly and importantly the proportion of public access AED use increased significantly from 0% (0/20) in 2005 to 41.2% (7/17) in 2011 at railway stations and from 0% (0/7) in 2005 to 56.5% (13/23) in 2011 at sports facilities, for example. Among all who received shocks with public access AEDs the mean time from collapse to shock was 5.0 minutes. In this study it was also very exciting to note that the proportion of patients with good neurologic outcome was 28% (33/118) at railway stations, 51.6% (48/93) at sports facilities, 23.3% (20/86) at public buildings, and 41.9% (13/31) at schools. A multivariate analysis of the data in this study showed that early defibrillation, whether by bystander lay rescuer or emergency medical personnel, was associated with neurologically favorable outcomes to a significant degree. This paper along with much additional evidence demonstrates that the institution of the “chain of survival” early in the setting of OHCA will result in increased survival and improved neurologic outcomes. The chain of survival includes: (1) immediate recognition of cardiac arrest and activation of the emergency response system, (2) early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions, (3) rapid defibrillation, (4) effective advanced life support, and (5) integrated post-cardiac arrest care. Several important aspects of the institution of this chain of survival especially with regard to lay rescuer involvement are important to emphasize. Those critical aspects include the actual recognition of the cardiac arrest, the institution of lay rescuer CPR as well as the proper use of public access defibrillation. The findings of the Iwami paper are indeed outstanding and show some very important new information. Most critically it highlights the importance of lay rescuer impact on OHCA and it provides an encouraging model for continued work in the United States as well as the rest of the world. Several important aspects of public education with regard to lay rescuer institution of the chain of survival should be emphasized.