Exercise-Related Out-of-Hospital Cardiac Arrest Among the General Population in the Era of Public-Access Defibrillation: A Population-Based Observation in Japan

Kosuke Kiyohara; Chika Nishiyama; Takeyuki Kiguchi; Tatsuya Nishiuchi; Yasuyuki Hayashi; Taku Iwami; Tetsuhisa Kitamura

doi:10.1161/JAHA.117.005786

Exercise-Related Out-of-Hospital Cardiac Arrest Among the General Population in the Era of Public-Access Defibrillation: A Population-Based Observation in Japan

J Am Heart Assoc. 2017 Jun 13;6(6):e005786. doi: 10.1161/JAHA.117.005786.

Authors

Kosuke Kiyohara¹, Chika Nishiyama², Takeyuki Kiguchi³, Tatsuya Nishiuchi⁴, Yasuyuki Hayashi⁵, Taku Iwami³, Tetsuhisa Kitamura⁶

Affiliations

¹ Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan [email protected] [email protected].
² Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan.
³ Kyoto University Health Service, Kyoto, Japan.
⁴ Department of Acute Medicine, Kindai University Faculty of Medicine, Osaka, Japan.
⁵ Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Osaka, Japan.
⁶ Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan [email protected] [email protected].

Abstract

Background: Exercise can trigger sudden cardiac arrest. Early initiation of cardiopulmonary resuscitation and automated external defibrillator use by laypersons could maximize the survival rate following exercise-related out-of-hospital cardiac arrest (OHCA).

Methods and results: OHCA data between 2005 and 2012 were obtained from a prospective population-based OHCA registry in Osaka Prefecture. Patients with OHCA of presumed cardiac origin and occurring before emergency medical service personnel arrival were included. The incidence trends of exercise-related OHCA over the 8-year study period were assessed. Among patients with bystander-witnessed, exercise-related OHCA, the trends in the initiation of bystander cardiopulmonary resuscitation, public-access defibrillation, and outcome were evaluated. The primary outcome was 1-month survival with favorable neurological outcome, defined as cerebral performance category 1 or 2. During the study period, 0.7% of OHCAs of cardiac origin (222/31 030) were exercise related. The incidence of exercise-related OHCA increased from 1.8 (per million population per year) in 2005 to 4.3 in 2012. Of these, 83.8% (186/222) were witnessed by bystanders. Among the patients with bystander-witnessed, exercise-related OHCA, the proportion that received bystander cardiopulmonary resuscitation (50.0% in 2005 and 86.2% in 2012) and public-access defibrillation (7.1% in 2005 and 62.1% in 2012) significantly increased during the study period. Furthermore, the rate of 1-month survival with favorable neurological outcome among these patients significantly improved (from 28.6% in 2005 to 58.6% in 2012).

Conclusions: The incidence rate of exercise-related OHCA was low in the study population. The increase in bystander cardiopulmonary resuscitation and public-access defibrillation rates were associated with improved outcome among patients with bystander-witnessed, exercise-related OHCA.

Keywords: automated external defibrillator; cardiac arrest; cardiopulmonary resuscitation; exercise.

Publication types

Multicenter Study
Observational Study

MeSH terms

Aged
Aged, 80 and over
Cardiopulmonary Resuscitation / methods*
Defibrillators*
Emergency Medical Services
Exercise*
Female
Follow-Up Studies
Humans
Incidence
Japan / epidemiology
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / epidemiology
Out-of-Hospital Cardiac Arrest / etiology
Out-of-Hospital Cardiac Arrest / therapy*
Population Surveillance*
Prospective Studies
Registries*
Survival Rate / trends