Automated External Defibrillator Pad Application Before EMS Arrival in Pediatric Out-of-Hospital Cardiac Arrest

Area of Science:

• Pediatric Emergency Medicine
• Cardiovascular Research
• Public Health Interventions

Background:

• Pediatric out-of-hospital cardiac arrest (OHCA) survival rates remain a critical public health concern.
• The utilization rate of automated external defibrillators (AEDs) prior to emergency medical service (EMS) arrival in pediatric OHCA cases in Japan is not well-documented.

Purpose of the Study:

• To determine the current rate of AED pad application in pediatric OHCA patients in Japan.
• To identify factors influencing AED pad application.
• To evaluate the association between AED pad application and survival with favorable neurological outcomes.

Main Methods:

• A nationwide, prospective, population-based cohort study was conducted using the All-Japan Utstein Registry (2021-2023).
• Included were pediatric patients (0-17 years) with OHCA experiencing resuscitation attempts before EMS arrival.
• Multivariable logistic regression analyses were used to assess factors associated with AED application and survival outcomes.

Main Results:

• Out of 3352 pediatric OHCA cases, only 5.5% received AED pad application before EMS arrival.
• Factors associated with reduced AED application included younger age, home arrests, and nighttime arrests.
• Arrests at school and bystander cardiopulmonary resuscitation (CPR) were associated with increased AED application; AED use correlated with improved survival and neurological outcomes.

Conclusions:

• The study highlights a low rate of pre-EMS AED pad application in pediatric OHCA in Japan.
• AED application is associated with significantly better survival and neurological outcomes.
• Increased AED accessibility and utilization in public spaces frequented by children, such as schools, are crucial for improving pediatric OHCA outcomes.