Abstract
Aim
To investigate the effectiveness of public-access automated external defibrillators
(AEDs) at Tokyo railroad stations.
Methods
We analysed data from a population-based registry of out-of-hospital cardiac arrests
in Tokyo, Japan (2014–2018). We identified patients aged ≥18 years who experienced
bystander-witnessed cardiac arrest due to ventricular fibrillation of presumed cardiac
origin at railroad stations. The primary outcome was survival at 1 month after cardiac
arrest with favourable neurological outcomes (cerebral performance category 1–2).
Results
Among 280 eligible patients who had bystander-witnessed cardiac arrest and received
defibrillation at railroad stations, 245 patients (87.5%) received defibrillation
using public-access AEDs and 35 patients (12.5%) received defibrillation administered
by emergency medical services (EMS). Favourable neurological outcomes at 1 month after
cardiac arrest were significantly more common in the group that received defibrillation
using public-access AEDs (50.2% vs. 8.6%; adjusted odds ratio: 11.2, 95% confidence
interval: 1.43–88.4) than in the group that received defibrillation by EMS. Over a
5-year period, favourable neurological outcomes at 1 month after cardiac arrest of
101.9 cases (95% confidence interval: 74.5–129.4) were calculated to be solely attributable
to public-access AED use. The incremental cost-effectiveness ratio to gain one favourable
neurological outcome obtained from public-access AEDs at railroad stations was lower
than that obtained from nationwide deployment (48.5 vs. 2133.4 AED units).
Conclusion
Deploying public-access AEDs at Tokyo railroad stations presented significant benefits
and cost-effectiveness. Thus, it may be prudent to prioritise metropolitan railroad
stations in public-access defibrillation programs.
Keywords
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Article info
Publication history
Published online: May 05, 2021
Accepted:
April 27,
2021
Received in revised form:
April 17,
2021
Received:
January 27,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
