Elsevier

Resuscitation

Volume 183, February 2023, 109672
Resuscitation

Clinical paper
Annual improvement trends in resuscitation outcome of patients defibrillated by laypersons after out-of-hospital cardiac arrests and compression-only resuscitation of laypersons

https://doi.org/10.1016/j.resuscitation.2022.12.010Get rights and content

Abstract

Aim

We aimed to investigate the effect of compression-only cardiopulmonary resuscitation (CPR) with conventional CPR in patients who were defibrillated by laypersons.

Methods

This is a population-based, nationwide observational study. Adult and children who sustained a witnessed out-of-hospital cardiac arrest and defibrillated by laypersons between 2005 to 2019 were identified on the national database. The study used trend analyses, multivariate logistic regression, and inverse probability weighting using propensity score to explore changes in one-month survival and survival with a good neurological outcome over time and the influence of compression-only CPR compared with conventional CPR.

Results

In total, 11,402 patients defibrillated by laypersons were enrolled in this study. The percentages of compression-only resuscitation increased dramatically and more than 50% from 2012 (P < 0.001). The percentages of cases with favorable resuscitation outcomes also increased annually (P < 0.001). By regression analysis, favorable outcomes were associated with recent years, male sex, younger age, and shorter resuscitation start time. In addition, the adjusted odds ratio of compression-only CPR to conventional CPR was 1.23 with a 95% confident interval 1.13–1.34. By inverse probability weighting, compression-only CPR was superior to conventional CPR for the favorable outcomes (P < 0.001). The adjusted outcomes in each year were better in compression-only resuscitation in most of the years. The overall relative risk reduction and the number needed to treat for compression-only resuscitation compared with conventional resuscitation were 7.6% and 22.1, respectively.

Conclusions

In Japan, the outcomes of out-of-hospital cardiac arrest patients who were defibrillated by laypersons were considerably better in compression-only resuscitation of laypersons every year.

Introduction

Recent studies report that patients defibrillated by laypeople yielded a larger improvement in survival over the years 1, 2. These reports arouse interest in the performance of laypeople before ambulance arrival. The effect of compression-only CPR has been evaluated varyingly; however, we do not have a consensus yet 3, 4, 5, even after the public recommendation of “hands-only CPR”6. We evaluated the effect of the type of layperson CPR (compression-only CPR or conventional CPR) on patient outcomes amongst patients receiving bystander defibrillation using the large Japanese data registry. This effect was assessed with a good neurological outcome as primary objective and one-month survival as secondary objective. We hypothesize the beneficial effect of compression-only CPR and assessed the clinical therapeutic effect on the outcomes of these patients.

Section snippets

Study design and settings

This was a population-based nationwide observational study covering the whole of Japan. The data of out-of-hospital cardiac arrests transported by ambulances have been registered and reported to the Fire and Disaster Management Agency based on the Utstein style7, 8. The ethics committee of Kyoto Tachibana University approved the study (20–15).

We enrolled out-of-hospital patients who suffered cardiac arrests with cardiac etiology witnessed by bystanders who delivered electrical shock before

Patients

For the 1,804,345 out-of-hospital cardiac arrest patients, resuscitations were attempted during the 15 years of this study period. Of these patients, 1,050,511 were diagnosed with cardiac etiology. Among the patients, 11,402 cases were included in this study (Fig. 1). Data concerning telephone instruction provision were missing in 21 cases (0.2%), CPR start time was missing in 175 cases (1.5%) in these cases.

Annual trends

In the baseline characteristics, sex and age were not much changed annually. In

Discussion

The recommendation for the public “hands-only” CPR of a science advisory statement6 pointed out that most of the reports published before this article showed the noninferiority of compression-only CPR18, 19, and some suggested superiority of the compression-only CPR20. Our annual trend shows that the accelerated increase in the percentage of compression-only CPR demonstrated more than 50% from 2012. Thus, the situation of resuscitation has changed markedly.

At the Cochrane Library, Zhan L et al.

Conflicts of Interest

None.

CRediT authorship contribution statement

Hiroshi Yoshimoto: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Writing – review & editing, Visualization. Kenko Fukui: Software, Validation, Formal analysis, Investigation, Resources, Writing – review & editing, Visualization. Yasuhisa Nishimoto: Validation, Writing – review & editing, Supervision, Project administration. Kazutoshi Kuboyama: Conceptualization, Writing – review & editing, Supervision. Yasuo Oishi: Conceptualization,

Acknowledgments

We thank the Ambulance Service Planning Office, Fire and Disaster Management Agency for maintaining the Utstein database of Japan. This article is dedicated to the EMS personnel, who save the lives of others every day. We would also like to thank Editage (www.editage.com) for English-language editing.

Funding

There were no funding organizations or sponsors for this study.

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