Carolina Malta Hansen1, Kristian Kragholm2, Christopher B Granger2, David A Pearson3, Clark Tyson4, Lisa Monk2, Claire Corbett5, R Darrell Nelson6, Matthew E Dupre7, Emil L Fosbøl8, Benjamin Strauss9, Christopher B Fordyce2, Bryan McNally10, James G Jollis2. 1. Duke Clinical Research Institute, Durham, NC, United States. Electronic address: Carolina.hansen@duke.edu. 2. Duke Clinical Research Institute, Durham, NC, United States. 3. Carolinas Medical Center, Charlotte, NC, United States. 4. Duke Clinical Research Institute, Durham, NC, United States; Center for Educational Excellence, Duke Clinical Research Institute, Durham, NC, United States. 5. New Hanover Regional Medical Center, Wilmington, NC, United States. 6. WFU Health Sciences, Winston-Salem, NC, United States. 7. Duke Clinical Research Institute, Durham, NC, United States; Department of Community and Family Medicine, Duke University, Durham, NC, United States. 8. Duke Clinical Research Institute, Durham, NC, United States; The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark. 9. Nicholas School of the Environment, Duke University, Durham, NC, United States. 10. Emory University School of Medicine, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States.
Abstract
AIM: Defibrillation by bystanders and first responders has been associated with increased survival, but limited data are available from non-metropolitan areas. We examined time from 911-call to defibrillation (according to who defibrillated patients) and survival in North Carolina. METHODS: Through the Cardiac Arrest Registry to Enhance Survival, we identified 1732 defibrillated out-of-hospital cardiac arrests from counties with complete case capture (population 2.7 million) from 2010 to 2013. RESULTS: Most patients (60.9%) were defibrillated in > 10 min. A minority (8.0%) was defibrillated < 5 min; most of these patients were defibrillated by first responders (51.8%) and bystanders (33.1%), independent of location of arrest (residential or public). Bystanders initiated cardiopulmonary resuscitation (CPR) in 49.0% of cases and defibrillated 13.4% of those. Survival decreased with increasing time to defibrillation (< 2 min: 59.1%; 2 to < 5 min: 38.5%; 5-10 min: 33.1%; > 10 min: 13.2%). Odds of survival with favorable neurologic outcome adjusted for age, sex, and bystander CPR improved with faster defibrillation (<2 min: OR 7.73 [95% CI 3.19-18.73]; 2 to < 5 min: 3.78 [2.45-5.84]; 5-10 min: 3.16 [2.42-4.12]; > 10 min: reference). CONCLUSION: Bystanders and first responders were mainly responsible for defibrillation within 5 min, independent of location of arrest. Bystanders initiated CPR in half of the cardiac arrest cases but only defibrillated a minority of those. Timely defibrillation and defibrillation by bystanders and/or first responders were strongly associated with increased survival. Strategic efforts to increase bystander and first-responder defibrillation are warranted to increase survival after out-of-hospital cardiac arrest.
AIM: Defibrillation by bystanders and first responders has been associated with increased survival, but limited data are available from non-metropolitan areas. We examined time from 911-call to defibrillation (according to who defibrillated patients) and survival in North Carolina. METHODS: Through the Cardiac Arrest Registry to Enhance Survival, we identified 1732 defibrillated out-of-hospital cardiac arrests from counties with complete case capture (population 2.7 million) from 2010 to 2013. RESULTS: Most patients (60.9%) were defibrillated in > 10 min. A minority (8.0%) was defibrillated < 5 min; most of these patients were defibrillated by first responders (51.8%) and bystanders (33.1%), independent of location of arrest (residential or public). Bystanders initiated cardiopulmonary resuscitation (CPR) in 49.0% of cases and defibrillated 13.4% of those. Survival decreased with increasing time to defibrillation (< 2 min: 59.1%; 2 to < 5 min: 38.5%; 5-10 min: 33.1%; > 10 min: 13.2%). Odds of survival with favorable neurologic outcome adjusted for age, sex, and bystander CPR improved with faster defibrillation (<2 min: OR 7.73 [95% CI 3.19-18.73]; 2 to < 5 min: 3.78 [2.45-5.84]; 5-10 min: 3.16 [2.42-4.12]; > 10 min: reference). CONCLUSION: Bystanders and first responders were mainly responsible for defibrillation within 5 min, independent of location of arrest. Bystanders initiated CPR in half of the cardiac arrest cases but only defibrillated a minority of those. Timely defibrillation and defibrillation by bystanders and/or first responders were strongly associated with increased survival. Strategic efforts to increase bystander and first-responder defibrillation are warranted to increase survival after out-of-hospital cardiac arrest.
Authors: Conor Mackle; Raymond Bond; Hannah Torney; Ronan Mcbride; James Mclaughlin; Dewar Finlay; Pardis Biglarbeigi; Rob Brisk; Adam Harvey; David Mceneaney Journal: IEEE J Transl Eng Health Med Date: 2020-04-21 Impact factor: 3.316
Authors: Christopher B Fordyce; Carolina M Hansen; Kristian Kragholm; Matthew E Dupre; James G Jollis; Mayme L Roettig; Lance B Becker; Steen M Hansen; Tomoya T Hinohara; Claire C Corbett; Lisa Monk; R Darrell Nelson; David A Pearson; Clark Tyson; Sean van Diepen; Monique L Anderson; Bryan McNally; Christopher B Granger Journal: JAMA Cardiol Date: 2017-11-01 Impact factor: 14.676
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