Out-of-hospital cardiac arrests: Foreign visitors to Japan tend to have lower survival rates than domestic visitors
A joint study revealed that foreign visitors suffering out-of-hospital cardiac arrests have a significantly lower survival rate than domestic visitors, primarily due to lower rates of bystander CPR caused by language and cultural barriers.
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- 📰 Published: April 7, 2026 at 00:00
- 🔍 Collected: April 6, 2026 at 15:30
- 🤖 AI Analyzed: April 21, 2026 at 00:24 (344h 54m after Collected)
A joint research group consisting of Associate Professor Kentaro Omatsu of the Department of Paramedics at Niigata University of Health and Welfare (NSG Group), Lecturer Tomotaka Ushimoto, and Guest Professor Hideo Inaba of Emergency Medicine at Kanazawa Medical University, conducted a nationwide study on out-of-hospital cardiac arrests occurring in Japan. The study compared the characteristics and outcomes of non-resident visitors, specifically "domestic visitors" and "foreign visitors to Japan". The findings were officially published in the international journal Scientific Reports by Springer Nature on March 13, 2026.
### About the Research
**[Research Background]**
The number of foreign tourists and business travelers visiting Japan has been increasing year by year, significantly exceeding pre-COVID-19 levels since 2023. If these "foreign visitors" suffer an out-of-hospital cardiac arrest, the response from bystanders (citizens present) and emergency services might differ from that for domestic visitors. However, there has been almost no nationwide research comparing the characteristics and survival rates between the two groups.
The research group conducted a retrospective cohort study using national emergency resuscitation and transport data from the Fire and Disaster Management Agency (2018-2023), covering approximately 57,000 emergency transport cases nationwide. They identified the residential status of the patients (residents, domestic visitors, foreign visitors) and compared the characteristics of cardiac arrests, the implementation rate of bystander CPR, and the neurological prognosis (return to society rate) after one month between "domestic visitors" and "foreign visitors."
**[Main Result 1: Difference in Return to Society Rate]**
The rate of return to society after one month was 14.4% for domestic visitors, compared to 8.2% for foreign visitors, showing a difference of about 6 percentage points (adjusted odds ratio 0.61, 95% confidence interval 0.55–0.68). Even after propensity score matching limited to cases with witnessed cardiac arrests, foreign visitors had significantly poorer outcomes (9.1% vs. 14.2%, adjusted odds ratio 0.65).
**[Main Result 2: Difference in Bystander CPR Implementation Rate]**
The implementation rate of bystander CPR was 58.0% for domestic visitors, while it was low at 30.8% for foreign visitors. There were also significant differences in the witness situation. The percentage of cases witnessed by passing strangers was higher for foreign visitors at 49.7% compared to 12.2% for domestic visitors, whereas the percentage witnessed by family or acquaintances tended to be lower. It is suggested that linguistic, cultural, and situational barriers may be affecting bystander actions.
**[Impact of the COVID-19 Pandemic]**
During the COVID-19 pandemic (2020-2021), bystander CPR rates decreased in all groups, but the extent of the decrease was greater for foreign visitors (interaction P-value = 0.02), indicating that the pandemic may have further widened existing disparities.
**[Comments from the Researchers]**
This study indicates that the survival rate of out-of-hospital cardiac arrests in Japan may vary depending on the visitor's attributes. Particularly for foreign visitors, linguistic and cultural differences, as well as weak relationships with surrounding people, may be affecting bystander life-saving procedures.
Moving forward, it is important to create an environment where everyone can receive appropriate life-saving treatment by further developing emergency response information in multiple languages and strengthening CPR and AED education in tourist destinations and public spaces.
### About the Research
**[Research Background]**
The number of foreign tourists and business travelers visiting Japan has been increasing year by year, significantly exceeding pre-COVID-19 levels since 2023. If these "foreign visitors" suffer an out-of-hospital cardiac arrest, the response from bystanders (citizens present) and emergency services might differ from that for domestic visitors. However, there has been almost no nationwide research comparing the characteristics and survival rates between the two groups.
The research group conducted a retrospective cohort study using national emergency resuscitation and transport data from the Fire and Disaster Management Agency (2018-2023), covering approximately 57,000 emergency transport cases nationwide. They identified the residential status of the patients (residents, domestic visitors, foreign visitors) and compared the characteristics of cardiac arrests, the implementation rate of bystander CPR, and the neurological prognosis (return to society rate) after one month between "domestic visitors" and "foreign visitors."
**[Main Result 1: Difference in Return to Society Rate]**
The rate of return to society after one month was 14.4% for domestic visitors, compared to 8.2% for foreign visitors, showing a difference of about 6 percentage points (adjusted odds ratio 0.61, 95% confidence interval 0.55–0.68). Even after propensity score matching limited to cases with witnessed cardiac arrests, foreign visitors had significantly poorer outcomes (9.1% vs. 14.2%, adjusted odds ratio 0.65).
**[Main Result 2: Difference in Bystander CPR Implementation Rate]**
The implementation rate of bystander CPR was 58.0% for domestic visitors, while it was low at 30.8% for foreign visitors. There were also significant differences in the witness situation. The percentage of cases witnessed by passing strangers was higher for foreign visitors at 49.7% compared to 12.2% for domestic visitors, whereas the percentage witnessed by family or acquaintances tended to be lower. It is suggested that linguistic, cultural, and situational barriers may be affecting bystander actions.
**[Impact of the COVID-19 Pandemic]**
During the COVID-19 pandemic (2020-2021), bystander CPR rates decreased in all groups, but the extent of the decrease was greater for foreign visitors (interaction P-value = 0.02), indicating that the pandemic may have further widened existing disparities.
**[Comments from the Researchers]**
This study indicates that the survival rate of out-of-hospital cardiac arrests in Japan may vary depending on the visitor's attributes. Particularly for foreign visitors, linguistic and cultural differences, as well as weak relationships with surrounding people, may be affecting bystander life-saving procedures.
Moving forward, it is important to create an environment where everyone can receive appropriate life-saving treatment by further developing emergency response information in multiple languages and strengthening CPR and AED education in tourist destinations and public spaces.