National AED registries and coordinated AED systems as a system-level intervention to improve outcomes after out-of-hospital cardiac arrest: lessons from Japan for Poland

Background: Out-of-hospital cardiac arrest (OHCA) survival depends critically on early defibrillation. Coordinated automated external defibrillator (AED) systems, including registries, mapping initiatives, and integration with emergency medical services (EMS), enable real-time device location, strategic placement, and system-level quality improvement. However, implementation varies widely between countries. Objective: To synthesize evidence on the impact of coordinated AED systems, including registries and public-access defibrillation programs, on OHCA outcomes and to identify lessons from Japan applicable to Poland. Methods: A systematic review was conducted according to PRISMA guidelines. PubMed/MEDLINE, EMBASE, Cochrane Library, and Scopus were searched (January 2015-June 2025) for studies evaluating AED registries, mapping systems, and public-access defibrillation programs. Eligible designs included randomized trials, observational registry studies, economic evaluations, and policy analyses. Inclusion criteria comprised studies evaluating AED registries, mapping systems, or public-access defibrillation in OHCA settings with reported clinical, operational, or economic outcomes. Exclusion criteria included studies without primary data, conference abstracts without full text, animal studies, and studies focused solely on in-hospital cardiac arrest. Study quality was assessed using the Newcastle-Ottawa Scale, AMSTAR 2, and CHEERS 2022. Results: Seventeen studies met inclusion criteria. Japan's coordinated system, combining nationwide OHCA surveillance, public-access defibrillation programs, AED mapping initiatives, and EMS integration, has been associated in observational studies with increased bystander AED use among patients with bystander-witnessed OHCA with shockable rhythm (from 1.1 to 16.5%), reduced time to defibrillation, and improved neurological outcomes. In contrast, Poland currently lacks a fully coordinated national system, resulting in fragmented AED data and limited integration with emergency response. Modeling studies suggest that implementing a national system incorporating an AED registry, dispatcher integration, and community responder networks would be cost-effective. Conclusion: Coordinated AED systems, rather than standalone registries, represent an effective system-level approach to improving OHCA outcomes. Japan's experience highlights the importance of integrating AED mapping, OHCA surveillance, EMS systems, and public training. Implementing such a coordinated approach in Poland could substantially improve survival and neurological outcomes after cardiac arrest. However, the observed benefits are likely multifactorial and reflect the combined effect of system-level interventions rather than a single component.