Hiroshi Taku, Professor, Graduate School of Emergency Medicine, Kokushikan University Ryo Sagisaka, Faculty of Science and Engineering, Chuo University
[Purpose] In cases of out-of-hospital cardiac arrest occurring at home, we examined whether the initial electrocardiogram waveform was a shockable rhythm that could be saved with an AED, adjusting for the time of detection contact, age, and gender, and whether verbal instructions by the communications commander on chest compressions could improve the outcome.
[Subjects and Methods] We extracted Utstein-style data from 2015 for patients aged 15-84 years, witnessed, reported by general informants, and with a one-month brain function prognosis of CPC1-5, and sought 19,062 cases in which events occurred in the order of purpose-awareness-contact, and the awareness-contact time was within the 99th percentile. We then used a Cox proportional hazards model to calculate the hazard ratio for the presence or absence of shockable rhythm, adjusted for age and 119-contact time, for 15,500 cases that could be linked to the location of CPA occurrence in the emergency transport data.
Results: Of 15,500 cases, excluding defibrillation by citizens, 9,091 (58.6%) occurred in the home and involved family bystanders. The hazard ratios for verbal CPR compared with spontaneous CPR performance were 1.44 (1.06-1.97) in 15-64 year olds, 1.08 (0.78-1.54) in 65-74 year olds, and 0.76 (0.56-1.05) in 75-84 year olds.
[Conclusion] In out-of-hospital cardiac arrests occurring at home and treated by family members, shockable rhythms were significantly increased in the 15-64 year old group by verbal instructions from dispatchers compared to independent CPR. We believe that proactive verbal instructions to families will lead to an increase in the number of cardiac arrest patients returning to society in the future.
[Additional Information] The analysis and report will take into account newly released data from 2016 onwards.
