Journal of Epidemiology
Online ISSN : 1349-9092
Print ISSN : 0917-5040
ISSN-L : 0917-5040
Original Article
Epidemiology of Out-of-Hospital Cardiac Arrest Due to Suffocation Focusing on Suffocation Due to Japanese Rice Cake: A Population-Based Observational Study From the Utstein Osaka Project
Kosuke KiyoharaTomohiko SakaiChika NishiyamaTatsuya NishiuchiYasuyuki HayashiTaku IwamiTetsuhisa Kitamura
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2018 Volume 28 Issue 2 Pages 67-74


Background: Japanese rice cake (“mochi”) is a major cause of food-choking accidents in Japan. However, the epidemiology of out-of-hospital cardiac arrests (OHCAs) due to suffocation caused by rice cakes is poorly understood.

Methods: OHCA data from 2005 to 2012 were obtained from the population-based OHCA registry in Osaka Prefecture. Patients aged ≥20 years who experienced OHCA caused by suffocation that occurred before the arrival of emergency-medical-service (EMS) personnel were included. Patient characteristics, prehospital interventions, and outcomes were compared based on the cause of suffocation (rice cake and non-rice-cake). The primary outcome was 1-month survival after OHCA.

Results: In total, 46 911 adult OHCAs were observed during the study period. Of the OHCAs, 7.0% (3,294/46,911) were due to suffocation, with choking due to rice cake as the cause in 9.5% of cases (314/3,294), and of these, 24.5% (77/314) occurred during the first 3 days of the New Year. In crude analysis, 1-month survival was 17.2% (54/314) in those with suffocation caused by rice cake and 13.4% (400/2,980) in those with suffocation due to other causes. In the multivariable analysis for all-cause suffocation, younger age, arrest witnessed by bystanders, and earlier EMS response time were significantly related to better 1-month survival.

Conclusion: Approximately 10% of OHCAs due to suffocation were caused by rice-cake choking, and 25% of these occurred during the first 3 days of the New Year. Further efforts for establishing preventive measures as well as improving the early recognition of choking and encouraging bystanders to call EMS sooner are needed.

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© 2017 Kosuke Kiyohara et al. This is an open access article distributed under the terms of Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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