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Bystander CPR for out-of-hospital cardiac arrest in Japan

Background and aims

The aim of this study is to clarify how Japanese citizens are interested in the importance of immediate cardiopulmonary resuscitation (CPR) and defibrillation, and how they understand that importance. In Japan, the out-of-hospital emergency medical service system has been established with the ambulance service and an emergency life saving technician (ELST) belonging to the fire department.

Subjects and methods

Patients' records were reviewed for the past 2 years. In Yokohama (3,700,000 people), the cardiopulmonary arrest (CPA) patient is transferred to the nearest ED of the selected 11 hospitals with adequate ability of CPR and cerebral resuscitation. We perform ultrasound, chest X-ray, and blood examination including Troponin in all CPA patients, and cerebral plane CT (40%) or chest CT (7%). CT was not performed in patients with a clearly known aetiology.

Results and discussion

We treated 624 CPA patients in the past 2 years, 38% were cardiac and 62% were noncardiac aetiology (3% subarachnoid haemorrhage and 5% acute aortic dissection). Restricted in cardiac aetiology patients, 13% showed a ventricular fibrillation (VF) as a first monitored rhythm and 33% showed a VF during resuscitation. In all patients, 50% of VF were witnessed. In witnessed patients, 17% were witnessed by the ELST during transfer and 81% by a layperson, most of whom are patients' families and patients' friends. Fifty-three per cent were witnessed in the patients' home (35% in patients' private room, 1% in bathroom and 7% in lavatory), 4% in an aged people's residence, 1% in a hotel, restaurant, office, and 3% on the road. Only 48% of CPA patients underwent bystander CPR, and 51% of witnessed CPA patients (24% of all CPA patients) underwent bystander CPR by the witness; most patients underwent bystander CPR in the patients' home by the patients' families.

Conclusion

In Japan, CPA patients were witnessed mainly in their home by their families or their friends. The aetiology of some CPA patients is noncardiac (subarachnoid haemorrhage or acute aortic dissection, etc.). However, only 24% CPA patients underwent bystander CPR by the witness.

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Moriwaki, Y., Sugiyama, M., Toyoda, H. et al. Bystander CPR for out-of-hospital cardiac arrest in Japan. Crit Care 11, P321 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5481

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Keywords

  • Subarachnoid Haemorrhage
  • Ventricular Fibrillation
  • Emergency Medical Service
  • Acute Aortic Dissection
  • Fire Department