An Utstein-style Examination of Out-of-hospital Cardiac Arrest Patients in Saga Prefecture, Japan

Introduction: The Utstein-style guidelines have been used in various countries around the world, because they are suitable for evaluating regional emergency medical systems (EMSs) for patients who have an out-of-hospital cardiac arrest (OHCA). This report examined the present status of treating OHCA in Saga Prefecture and examined policies that can contribute to improving the rate of the return of spontaneous circulation (ROSC). Methods: This study examined 800 cases of OHCA by means of the Utstein-style guidelines submitted for medical control verification by firefighting organizations in Saga Prefecture from July 1, 2010, to June 30, 2011. The firefighting organizations were divided into 5 areas (A-E) according to each medical classification. The 5 areas were compared in terms of the ROSC rate and background factors (patient age and sex, cardiac arrest cause, place, witnesses, initial electrocardiogram [ECG], hospital ECG, prehospital medical treatment, transfer time, oral instruction, and bystander cardiopulmonary resuscitation [CPR]). Results: The ROSC rate was significantly lower in areas D (24.2%) and E (26.8%). Age, sex, cardiac arrest cause, place, witnesses, initial ECG, hospital ECG, shock, and adrenaline administration did not differ significantly among the 5 areas. The response time was significantly shorter in areas A (8: 25), D (8: 07), and E (8: 12). There were significantly fewer examples of oral CPR instruction in area E (42.1%), and there were fewer examples of CPR in areas A (44.0%), D (41.9%), and E (37.9%). CPR was performed by lay person in approximately 70% of the cases in which oral instructions were provided, but it was not performed in 90% of cases in which no oral instructions were provided. Conclusions: The Utstein-style guidelines were used to clarify differences in the ROSC rate in Saga Prefecture, thus making improvements in regional EMSs possible. Improvements in the quality of oral instruction and a reexamination of the oral instruction manual are expected to improve the ROSC rate, in parallel with education in basic life support for lay person and in advanced cardiac life support for medical personnel. In addition, it is important to reaffirm the effectiveness of CPR and encourage the participation of lay person by providing instructions by telephone from an ambulance that is en route to the scene.