for the Japanese Circulation Society Resuscitation Science Study ...

2846 Circulation December 11, 2012Figure. Study flow of out-of-hospital cardiac arrest patients using an abridged Utstein template from January 1, 2005, to December 31,2009. EMS indicates emergency medical service; CPR, cardiopulmonary resuscitation; PEA, pulseless electric activity; VF, ventricularfibrillation; VT, ventricular tachycardia; and AED, automated external defibrillator.All of those who survived OHCA were followed up for up to 1month after the event by the EMS personnel in charge. Theneurological status after 1 month was determined by the physiciancaring for the patients using the Cerebral Performance CategoryScale: category 1, good cerebral performance; category 2, moderatecerebral disability; category 3, severe cerebral disability; category 4,coma or vegetative state; and category 5, death. 28,29 Neurologicallyfavorable survival was defined as a Cerebral Performance CategoryScale score of 1 or 2. 28,29The data form was filled out by the EMS personnel in cooperationwith the physicians in charge of the patients, and the data wereintegrated into the registry system on the Fire and Disaster ManagementAgency database server and then logically checked by thecomputer system. If the data form was incomplete, the Fire andDisaster Management Agency returned it to the respective firestation for data completion.Statistical AnalysisOutcomes after bystander-witnessed OHCA of cardiac origin withPAD were compared by type of bystander-initiated CPR. Bothbystander-initiated CCCPR and conventional CPR with rescuebreathing were included as bystander CPR. Patient characteristicsand outcomes by type of bystander-initiated CPR were evaluatedwith the use of the t test for numeric variables and the 2 test orFisher exact test for categorical variables. Trends were tested withunivariate regression models. Multivariable analysis was used toassess the contribution of bystander-initiated CPR to 1-monthsurvival with favorable neurological outcome; odds ratios and their95% confidence intervals were calculated. Potential confoundingfactors based on biological plausibility and previous studies wereincluded in the multivariable analysis. These variables included age(17, 18–74, 75 years), sex (male, female), bystander witnessstatus (family member, other), time interval from collapse to thepublic-access AED shock or the initiation of CPR by bystanders (for1-minute increment), and year of arrest (for 1-year increment). Allstatistical analyses were performed with SPSS statistical packageversion 16.0J (SPSS, Inc, Chicago, IL). All tests were 2 tailed, andvalues of P0.05 were considered statistically significant.The authors had full access to and take full responsibility for theintegrity of the data. All authors have read and agree to themanuscript as written.ResultsA total of 547 153 confirmed OHCAs were documentedduring these 5 years (the Figure). Of 539 758 OHCA patientswith resuscitation attempts, 297 444 were presumed to be ofcardiac origin. Of them, OHCA was witnessed in 97 053patients (32.6%) by bystanders, 43 436 (14.6%) receivedbystander-initiated CPR, and 11 932 (4.0%) had ventricularfibrillation or pulseless ventricular tachycardia as the firstdocumented rhythm. Among the bystander-witnessed OHCAwith bystander CPR, 1376 patients (3.2%) who received theirfirst shock by public-access AEDs before EMS arrival wereeligible for our analyses. Among them, 506 (36.8%) receivedCCCPR and 870 (63.2%) received conventional CPR withrescue breathing.Downloaded from http://circ.ahajournals.org/ by guest on January 21, 2013