Background: Since 2004, the number of installed Automated External Defibrillator (AED) has been increased in Japan annually, the cumulative number of sold AED more than 600,000 units by 2016. Despite there have been a...Background: Since 2004, the number of installed Automated External Defibrillator (AED) has been increased in Japan annually, the cumulative number of sold AED more than 600,000 units by 2016. Despite there have been about 130,000 out of hospital cardiac arrest annually, there have only 1302 cases delivered defibrillation by bystanders at the scene. Therefore, we investigate that number of AED installation and usage rate for Out of Hospital Cardiac Arrest (OHCA) patients. Methods: Retrospective metropolitan wide cohort study. Subject: Total 13,364 OHCA patients in the Tokyo Metropolitan area from Jan. 1 through Dec. 31 in 2012 were eligible for theses analyses. Also, OHCA occurrence place and AED usage rate were studied. Results: 82.8% of OHCA occurred at residences, 10% at outdoors, 6.4% at indoors, only 0.7% at schools. In the other hand, highest bystander’s CPR rates were found in sports facilities and schools (71.4%). The installation rate of AEDs in residences was 9.6%, instead of highest incidence for OHCA patients, school and sports institute made up 21.4% of AED installations, but only 1.0% of the incidences of cardiac arrest. We found that there is a mismatch between incidence sites of cardiac arrest and locations of installed AED. Discussion: It is essential to increase the number of AED installations. Furthermore, it is desirable to install AEDs in locations where cardiac arrest is liable to occur following guidelines for the proper placement of AEDs, and important to further spread BLS education among the general citizens.展开更多
Background The choice of a defibrillation or a cardiopulmonary resuscitation （CPR）-first strategy in the treatment of prolonged cardiac arrest （CA） is still controversial. The purpose of this study was to compare ...Background The choice of a defibrillation or a cardiopulmonary resuscitation （CPR）-first strategy in the treatment of prolonged cardiac arrest （CA） is still controversial. The purpose of this study was to compare the effects of defibrillation or CPR administered first on neurological prognostic markers in a porcine model of prolonged CA. Methods After 8 minutes of untreated ventricular fibrillation （VF）, 24 inbred Chinese Wuzhishan minipigs were randomized to receive either defibrillation first （ID group, n=12） or chest compression first （IC group, n=12）. In the ID group, a shock was delivered immediately. If defibrillation failed to attain restoration of spontaneous circulation （ROSC）, manual chest compressions were rapidly initiated at a rate of 100 compressions/min and a compression-to-ventilation ratio of 30：2. If VF persisted after five cycles of CPR, a second defibrillation attempt was made. In the IC group, chest compressions were delivered first, followed by a shock. After successful ROSC, hemodynamic status and blood samples were obtained at 0.5, 1, 2, 4, 6, and 24 hours after ROSC. Porcine-specific neuron-specific enolase （NSE） and S100B were measured from sera using enzyme-linked immunosorbent assays. Porcine cerebral performance category scores were used to evaluate preliminary neurological function following 24 hours recovery. Surviving pigs were sacrificed at 24 hours after ROSC and brains were removed for electron microscopy analysis. Results The number of shocks, total defibrillation energy, and time to ROSC were significantly lower in the ID group compared with the IC group. Compared with the IC group, S100B expression was decreased at 2 and 4 hours after ROSC, and NSE expression decreased at 6 and 24 hours after ROSC in the ID group. Brain tissue analysis showed that injury was attenuated in the ID group compared with the IC group. There were no significant differences between 6 and 24 hours survival rates. Conclusion Defibrillation first may result in a shorter tim展开更多
文摘Background: Since 2004, the number of installed Automated External Defibrillator (AED) has been increased in Japan annually, the cumulative number of sold AED more than 600,000 units by 2016. Despite there have been about 130,000 out of hospital cardiac arrest annually, there have only 1302 cases delivered defibrillation by bystanders at the scene. Therefore, we investigate that number of AED installation and usage rate for Out of Hospital Cardiac Arrest (OHCA) patients. Methods: Retrospective metropolitan wide cohort study. Subject: Total 13,364 OHCA patients in the Tokyo Metropolitan area from Jan. 1 through Dec. 31 in 2012 were eligible for theses analyses. Also, OHCA occurrence place and AED usage rate were studied. Results: 82.8% of OHCA occurred at residences, 10% at outdoors, 6.4% at indoors, only 0.7% at schools. In the other hand, highest bystander’s CPR rates were found in sports facilities and schools (71.4%). The installation rate of AEDs in residences was 9.6%, instead of highest incidence for OHCA patients, school and sports institute made up 21.4% of AED installations, but only 1.0% of the incidences of cardiac arrest. We found that there is a mismatch between incidence sites of cardiac arrest and locations of installed AED. Discussion: It is essential to increase the number of AED installations. Furthermore, it is desirable to install AEDs in locations where cardiac arrest is liable to occur following guidelines for the proper placement of AEDs, and important to further spread BLS education among the general citizens.
基金This research was supported by a grant from the Beijing Natural Science Foundation （No. 7132092）.
文摘Background The choice of a defibrillation or a cardiopulmonary resuscitation （CPR）-first strategy in the treatment of prolonged cardiac arrest （CA） is still controversial. The purpose of this study was to compare the effects of defibrillation or CPR administered first on neurological prognostic markers in a porcine model of prolonged CA. Methods After 8 minutes of untreated ventricular fibrillation （VF）, 24 inbred Chinese Wuzhishan minipigs were randomized to receive either defibrillation first （ID group, n=12） or chest compression first （IC group, n=12）. In the ID group, a shock was delivered immediately. If defibrillation failed to attain restoration of spontaneous circulation （ROSC）, manual chest compressions were rapidly initiated at a rate of 100 compressions/min and a compression-to-ventilation ratio of 30：2. If VF persisted after five cycles of CPR, a second defibrillation attempt was made. In the IC group, chest compressions were delivered first, followed by a shock. After successful ROSC, hemodynamic status and blood samples were obtained at 0.5, 1, 2, 4, 6, and 24 hours after ROSC. Porcine-specific neuron-specific enolase （NSE） and S100B were measured from sera using enzyme-linked immunosorbent assays. Porcine cerebral performance category scores were used to evaluate preliminary neurological function following 24 hours recovery. Surviving pigs were sacrificed at 24 hours after ROSC and brains were removed for electron microscopy analysis. Results The number of shocks, total defibrillation energy, and time to ROSC were significantly lower in the ID group compared with the IC group. Compared with the IC group, S100B expression was decreased at 2 and 4 hours after ROSC, and NSE expression decreased at 6 and 24 hours after ROSC in the ID group. Brain tissue analysis showed that injury was attenuated in the ID group compared with the IC group. There were no significant differences between 6 and 24 hours survival rates. Conclusion Defibrillation first may result in a shorter tim
