Abstract
Although the rate of survival after an out-of-hospital Cardiac Arrest (CA) has been increasing due to improvement of quality of resuscitation and developments in medical technology, it is still low. This paper describes on a study conducted with the cooperation of the Kobe City Fire Department, the use of Public-Access Defibrillation (PAD) in out-of-hospital CA cases, which occurred in Kobe, a government-ordinance-designated-city with a population of approximately 1.53 million people, and the outcomes of use of PAD. We analyzed the actual status of automated external defibrillator (AED) kits located within Kobe City and the current situation regarding use of PAD in 5,700 CA cases transported to hospital by emergency services, which occurred in Kobe City during the five years between April 2005 and March 2010. In April 2005, there were 90 AED kits installed across Kobe City, the AED installed-base expanded, and as at March 2010, the installation-base was 1,299 kits (according to data by the Kobe City Fire Depatment). During this period, the AED was applied by bystanders in 136 cases (2.6%). AED was applied to witnessed CA in 90 cardiogenic cases and 42 cases (46.7%) were indicated for defibrillation, of which return of spontaneous circulation was recognized in 26 cases (61.9%) and one month survival was obtained in 23 cases (54.8%). AED was also applied to 44 cardiogenic cases without witness, and 6 cases (13.6%) were indicated for defibrillation of which return of spontaneous circulation was recognized in 2 cases (33.3%), and one month survival was seen in 1 case (16.7%). In 2010, Kitamura et al compiled a report on all of the CA cases across Japan using data from the Fire and Disaster Management Agency under the Ministry of Internal Affairs and Communications, which showed the usefulness of PAD. A comparison of the results of our study from Kobe City and the national results for Japan showed that PAD cases in Kobe City have a better prognosis. However, given the low levels of application of AED at 2.3% of all CA cases and only 4.2% for cardiogenic cases alone, further AED promotion initiatives are required.
