ArticleResuscitation plus2026
Location-resolved performance of public-access defibrillation in an urban EMS system: a population-based study in Yokohama, Japan.
Article in Resuscitation plus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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5 authors.
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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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