Location-resolved performance of public-access defibrillation in an urban EMS system: a population-based study in Yokohama, Japan.
Resuscitation Plus · 2026-08-02 · Registry study
Abstract
BACKGROUND: Survival rates after out-of-hospital cardiac arrest (OHCA) in Japan have plateaued despite widespread automated external defibrillator (AED) deployment, suggesting a gap between availability and real-world effectiveness. We aimed to examine the association between public access defibrillation (PAD) shock and neurological outcomes and evaluate location-specific patterns of PAD shock rates. METHODS: We retrospectively analysed data from the Yokohama City OHCA registry from 2021 to 2024. Arrest locations were categorised. PAD shock rates and a composite bystander performance score were calculated to characterise location-level resuscitation performance. The primary outcome was favourable neurological outcome (Cerebral Performance Category score, 1-2) at 30 days. Propensity score matching was performed using age, sex, witnessed arrest, time of arrest, and dispatcher-assisted cardiopulmonary resuscitation to balance baseline characteristics between patients who did and did not receive a PAD shock. Logistic regression models evaluated the association between PAD shock and neurological outcomes before and after matching. RESULTS: Among 15,345 patients, 8828 (57.5%) were male and 272 (1.8%) received a PAD shock. After propensity score matching, PAD shock was significantly associated with favourable neurological outcome (OR 3.3, 95% CI: 1.9-5.7) and 30-day survival (OR 3.7, 95% CI: 2.2-6.1). PAD shock rates varied markedly across arrest locations, ranging from 34.0% (18/53) in sports facilities and 28.0% (30/107) at railway stations to 0.06% (6/10,426) in private residences. Crucially, favourable neurological outcomes across locations were not merely a function of PAD shock rates but were strongly aligned with high composite bystander performance scores. CONCLUSIONS: PAD shock is independently associated with favourable neurological outcomes after OHCA. However, its real-world effectiveness is shaped by urban structural contexts and relies on high-quality, comprehensive bystander interventions. A location-resolved performance framework may serve as a practical tool for guiding targeted resuscitation strategies beyond uniform AED deployment.
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Tags
Automated external defibrillator · Mortality & survival · Quality of life & function · Urban
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