How Does Public Access Defibrillation Affect Outcomes When There Is No Return of Spontaneous Circulation?

Public access defibrillation (PAD) improves return of spontaneous circulation (ROSC) and survival after out-of-hospital cardiac arrest (OHCA). But even in the best of circumstances, only a minority of patients with OHCA will have ROSC after PAD. These authors tested whether PAD, with its associated interruptions of cardiopulmonary resuscitation (CPR) and delays in hospital transport, worsens outcomes for patients who do not achieve ROSC.

Using a nationwide Japanese registry of nearly 1.3 million OHCA events from 2005 to 2015, the authors selected approximately 27,300 patients who met the following criteria: (1) witnessed arrest of cardiac origin; (2) initial shockable rhythm; (3) bystander CPR with or without PAD; and (4) no ROSC prior to ar…