Epidemiology of out-of-hospital cardiac arrest due to suffocation focusing on suffocation due to Japanese rice cake: A population-based observational study from the Utstein Osaka project

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Abstract

Background: Japanese rice cake (“mochi”) is a major cause of food-choking accidents in Japan. However, the epidemiology of out-of-hospital cardiac arrests (OHCAs) due to suffocation caused by rice cakes is poorly understood. Methods: OHCA data from 2005 to 2012 were obtained from the population-based OHCA registry in Osaka Prefecture. Patients aged ≥20 years who experienced OHCA caused by suffocation that occurred before the arrival of emergency-medical-service (EMS) personnel were included. Patient characteristics, prehospital interventions, and outcomes were compared based on the cause of suffocation (rice cake and non-rice-cake). The primary outcome was 1-month survival after OHCA. Results: In total, 46 911 adult OHCAs were observed during the study period. Of the OHCAs, 7.0% (3,294=46,911) were due to suffocation, with choking due to rice cake as the cause in 9.5% of cases (314=3,294), and of these, 24.5% (77=314) occurred during the first 3 days of the New Year. In crude analysis, 1-month survival was 17.2% (54=314) in those with suffocation caused by rice cake and 13.4% (400=2,980) in those with suffocation due to other causes. In the multivariable analysis for allcause suffocation, younger age, arrest witnessed by bystanders, and earlier EMS response time were significantly related to better 1-month survival. Conclusion: Approximately 10% of OHCAs due to suffocation were caused by rice-cake choking, and 25% of these occurred during the first 3 days of the New Year. Further efforts for establishing preventive measures as well as improving the early recognition of choking and encouraging bystanders to call EMS sooner are needed.

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Kitamura, T., Sakai, T., Nishiyama, C., Nishiuchi, T., Hayashi, Y., & Iwami, T. (2018). Epidemiology of out-of-hospital cardiac arrest due to suffocation focusing on suffocation due to Japanese rice cake: A population-based observational study from the Utstein Osaka project. Journal of Epidemiology, 28(2), 67–74. https://doi.org/10.2188/jea.JE20160179

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