Recent circumstances of out-of-hospital CPA in Yokohama, a typical Japanese urban city

Introduction

In Japan, the out-of-hospital emergency medical service (EMS) system has been established by the ambulance service and an emergency life-saving technician (ELST) belonging to the fire department, and the inhospital Emergency Department has been supporting this system. The licence of ELST was established in 1991 and has been enlarging their activity; defibrillation, infusion of Ringer solution, insertion of a laryngeal mask, EGTA, and laryngeal tube. Moreover, now some of them who have received prearranged education can be permitted to perform endotracheal intubation and infusion therapy of epinephrine. Recently television stations frequently deal with ELST, resulting in enlightenment of many citizens on the importance of immediate CPR and defibrillation. In this study, we examined recent circumstances of out-of-hospital CPA in a Japanese typical urban city.

Methods

Patients' records of our Emergency Department were reviewed for the past year. In our city, Yokohama (3,700,000 people), the CPA patient is transferred to the nearest emergency department of 11 hospitals, which are selected because of their adequate ability of CPR and cerebral resuscitation for CPA patients. In our department, we usually perform echocardiography and abdominal sonography, chest X-ray examination, blood examination including troponin I or T, and cerebral plane CT or chest CT to determine cause of CPA and to treat this pathological condition.

Results

In our Emergency Department, we dealt with 250 CPA patients in the past year, 95 of whom were cardiac aetiology and 155 of whom were noncardiac aetiology. Eleven were SAH and 14 were acute aortic dissection diagnosed by CT or ultrasonography.

In cardiac aetiology patients, 31 were witnessed. Six of them were witnessed by an ELST during transfer and 25 were witnessed by a layperson; 16 were witnessed by patients' families, three by patients' friends, and four by a passenger. Seventeen were witnessed in the patient's home, 13 of whom were witnessed in the patient's private room, two were in the bathroom, and one in the lavatory. Only eight of 25 witnessed CPA patients underwent bystander CPR, who underwent bystander CPR mainly in the patients' homes by the patients' families.

Conclusion

In Japan, we often encountered CPA patients with noncardiac aetiology, including SAH or acute aortic dissection. CPA patients were witnessed mainly in their home, particularly in their private room, bathroom, and lavatory. However, only eight CPA patients underwent bystander CPR. We should enlighten citizens (potential patients' families) on the importance of immediate CPR to save CPA patients.