Better Procedures Raised SCA Survival in Japan

Researchers evaluating 8,782 bystander-witnessed cardiac events in Osaka, Japan from May 1998 to December 2006 say procedural changes during that period increased victims’ survival rate, lowered the median time from collapse to first shock, and raised bystander-initiated CPR from 19 percent to 36 percent. The results, reported in Circulation: Journal of the American Heart Association, were posted Tuesday by the American Heart Association.

The article says about 120,000 of Osaka's 8.8 million residents were trained in conventional CPR per year. During the study period, Japanese citizens received training in cardiopulmonary resuscitation and several other changes took place. Dispatcher instruction in CPR was introduced, and EMS personnel were permitted to deliver AED shocks without online physician oversight and to intubate patients in the field. Improvements included:

  • One-month survival of witnessed cardiac arrests improved from 5 percent to 12 percent.
  • Median time from collapse to CPR decreased from 9 to 7 minutes because of the citizen training, and bystander-initiated CPR climbed from 19 percent to 36 percent.
  • Median time from collapse to calling EMS dropped from 4 to 2 minutes, and the median time from collapse to first shock went from 19 to 9 minutes.

"This study proves that improvement in the 'chain of survival' results in increased survival from out-of-hospital cardiac arrest in the real world," said Taku Iwami, M.D., lead author of the study and an assistant professor at the Kyoto University Health Service. "The improvement is mainly due to the improvement in the first three links of the chain, but there was some incremental benefit in the fourth link of advanced life support."

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