Analysis of Prehospital Care for Cardiac Arrest in an Urban Setting in Japan

Background: In Japan, the management of prehospital care for cardiopulmonary arrest (CPA) has recently changed. Study Objectives: The characteristics of prehospital care for CPA were analyzed to identify predictors of prehospital return of spontaneous circulation (PROSC) and good recovery. Methods: The characteristics of prehospital management of 713 out-of-hospital CPA patients in the First Western District of Saitama Prefecture, Japan, were retrospectively analyzed. Results: Overall, PROSC rate was 9.5% (n = 68), and 2.2% of patients (n = 16) made a good recovery. Significant positive predictors of PROSC were: duration from the first call to hospital arrival, witnessed collapse, ventricular fibrillation at scene, and epinephrine administration. Establishment of supraglottic airway was a significant negative predictor of PROSC. Significant positive predictors of good recovery were younger age, ventricular fibrillation at scene, and PROSC. Changes to the life support protocol based on 2005 guidelines did not affect the outcome. Conclusions: Epinephrine was effective in increasing PROSC; however, it did not improve recovery of such patients. The findings also suggest that out-of-hospital care providers should not try to establish a supraglottic airway.