Location of arrest and survival from out-of-hospital cardiac arrest among children in the public-access defibrillation era in Japan.

BACKGROUND: Our objective was to assess the characteristics such as public-access defibrillation by laypersons and the outcomes after pediatric out-of-hospital cardiac arrest by location in the public-access defibrillation era.

METHODS: From a nationwide, prospective, population-based registry of out-of-hospital cardiac arrest patients in Japan, we enrolled consecutive pediatric patients aged ≤17 years before emergency-medical-service arrival between 2013 and 2015. The primary outcome measure was 1-month survival with favorable neurologic outcome defined as cerebral performance category 1 or 2. Factors associated with favorable neurologic outcome were assessed using multivariable logistic regression analysis.

RESULTS: Among 3,991 eligible pediatric out-of-hospital cardiac arrests, the proportion of public-access defibrillation was 0.2% (5/2,888) at residences, 1.6% (2/125) in public areas, 0.9% (3/321) on streets/highways, 21.6% (11/51) at recreation/sports event areas, 46.1% (82/178) at education institutions, and 1.2% (5/428) in others. In the multivariable analysis, arrest witnessed by family members (adjusted odds ratio [AOR], 5.25; 95% confidence interval [CI], 3.22-8.58) and non-family members (AOR, 2.45; 95% CI, 1.26-4.77), first documented ventricular fibrillation (AOR, 12.29; 95% CI, 7.08-21.35), PAD (AOR, 2.63; 95% CI, 1.23-5.62), and earlier EMS response time (AOR for 1-minute increment, 0.88; 95% CI, 0.81-0.94) were associated with improving outcome. As for locations, recreation/sports event areas (AOR, 3.43; 95% CI, 1.17-10.07) and education institutions (AOR, 3.03; 95% CI, 1.39-6.63) were also associated with favorable neurologic outcome.

CONCLUSIONS: In Japan, where public-access automated external defibrillators are well disseminated, characteristics such as public-access defibrillation and outcomes for pediatric out-of-hospital cardiac arrest before emergency-medical-service arrival differed substantially by location.