Automated External Defibrillator Pad Application Before EMS Arrival in Pediatric Out-of-Hospital Cardiac Arrest

Importance: The current rate of automated external defibrillator (AED) pad application before emergency medical service (EMS) arrival in pediatric out-of-hospital cardiac arrest (OHCA) in Japan has not been sufficiently investigated. Objective: To describe the current rate of AED pad application and evaluate factors associated with AED pad application as well as factors associated with survival in pediatric patients with OHCA. Design, Setting, and Participants: This was a nationwide, prospective, population-based cohort study using data from the All-Japan Utstein Registry between 2021 and 2023. Pediatric patients with OHCA aged 0 to 17 years in whom resuscitation was attempted before EMS arrival were included. Data analyses were conducted from January to May 2026. Exposure: OHCA stratified by age (infants [<1 year], younger children [1-4 years], older children [5-12 years], and adolescents [13-17 years]). Main Outcomes and Measures: The outcome measures were the application of AED pads before EMS arrival as well as 1-month survival with a favorable neurological outcome, defined as a cerebral performance category scale of 1 or 2. Multivariable logistic regression analyses were performed to estimate adjusted odds ratios (aORs) and 95% CIs for factors associated with each outcome. Results: A total of 3352 pediatric patients with OHCA were analyzed. The median (IQR) age was 3 (1-4) years, 1983 patients (59.2%) were male, and 185 patients (5.5%) received AED pad application before EMS arrival. Arrests among infants (aOR, 0.28; 95% CI, 0.13-0.47) and younger children (aOR, 0.22; 95% CI, 0.10-0.49) vs adolescents, arrests occurring at home vs another public area (aOR, 0.06; 95% CI, 0.03-0.11), and arrests occurring at nighttime vs daytime (aOR, 0.52; 95% CI, 0.33-0.82) were significantly associated with a reduced probability of AED pad application before EMS arrival. In contrast, arrests occurring at school vs another public area (aOR, 6.74; 95% CI, 3.73-12.21) and receipt of bystander CPR (aOR, 28.69; 95% CI, 12.91-63.75) were associated with an increased probability of AED pad application before EMS arrival. Favorable neurological outcome was significantly higher in the AED pad application group than in the non-AED pad application group (aOR, 3.11; 95% CI, 1.30-7.44). Ventricular fibrillation as first documented rhythm had a large magnitude of association with increased favorable neurological outcome (aOR, 27.49; 95% CI, 13.95-54.19). Conclusions and Relevance: In this cohort study from Japan, approximately 5% of pediatric patients with OHCA received AED pad application before EMS arrival, and AED pad application was associated with higher odds of 1-month survival with a favorable neurological outcome. Further efforts are needed to increase AED access and use in public places where children gather, including schools.