• Kosuke Kiyohara, Chika Nishiyama, Tetsuhisa Kitamura, Tasuku Matsuyama, Junya Sado, Tomonari Shimamoto, Daisuke Kobayashi, Takeyuki Kiguchi, Satoe Okabayashi, Takashi Kawamura, and Taku Iwami.
• Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan. Electronic address: kiyosuke0817@hotmail.com.
• Resuscitation. 2019 Jul 1; 140: 93-97.

BackgroundIt is recommended globally that shocks by automated external defibrillators (AEDs) should be delivered immediately when a shockable out-of-hospital cardiac arrest (OHCA) occurs. However, the actual time-interval from collapse to first shock by public-access AED and its impact on subsequent outcome has not been extensively investigated in real-world settings.MethodsOHCA data from 2013 to 2015 were obtained from the All-Japan Utstein Registry. Bystander-witnessed OHCA patients with shockable rhythm who were shocked by public-access AED in public locations were included. The primary endpoint was 1-month survival with favourable neurological outcome, and the association between time-interval from collapse to first shock by public-access AED and subsequent outcome was assessed.ResultsDuring the study period, 28% (2282/8126) of bystander-witnessed OHCA cases with shockable rhythm were shocked by public-access AED in public locations. The proportion of OHCA patients who were shocked by public-access AED within 5 min from collapse was 58% (1323/2282). Among these patients, the proportion of 1-month survival with favourable neurological outcome was 62% (815/1317). The proportion significantly decreased with increased time from collapse to shock by public-access AED (48% for 6-10 min, 38% for 11-15 min, 30% for 16-20 min, and 7% for 21-25 min; p-for-trend <0.001), and no patient survived if shock delivery occurred more than 26 min after OHCA.ConclusionIn Japan, earlier shock by public-access AED led to better outcome after bystander-witnessed OHCA with shockable rhythm in public locations. However, the proportion of OHCA patients who received early shock was still low in public locations.Copyright © 2019 Elsevier B.V. All rights reserved.

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