Ross A Pollack1, Siobhan P Brown2, Thomas Rea3,4, Tom Aufderheide5, David Barbic6, Jason E Buick7, Jim Christenson6, Ahamed H Idris8, Jamie Jasti5, Michael Kampp9, Peter Kudenchuk3,4, Susanne May1, Marc Muhr10, Graham Nichol11, Joseph P Ornato12, George Sopko13, Christian Vaillancourt14, Laurie Morrison7,15, Myron Weisfeldt16. 1. Johns Hopkins University School of Medicine, Baltimore, MD (R.A.P., M.W.). 2. Department of Biostatistics (S.P.B.). 3. University of Washington, Seattle (T.R., P.K.). 4. King County Emergency Medical Services, Public Health, Seattle, WA (T.R., P.K.). 5. Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee (T.A., J.J.). 6. Department of Emergency Medicine, University of British Columbia, Vancouver, Canada (D.B., J.C.). 7. Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Canada (J.E.B, L.M.). 8. Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.H.I.). 9. Department of Emergency Medicine, Oregon Health and Science University, Portland (M.K.). 10. Clark County Emergency Medical Services, Vancouver, WA (M.M.). 11. University of Washington-Harborview Center for Prehospital Emergency Care, Seattle (G.N.). 12. Department of Emergency Medicine, Virginia Commonwealth University, Richmond (J.P.O.). 13. National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.S.). 14. Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Canada (C.V.). 15. Division of Emergency Medicine, Department of Medicine, University of Toronto, Ottawa, Canada (L.M.). 16. Johns Hopkins University School of Medicine, Baltimore, MD (R.A.P., M.W.) mlw5@jhmi.edu.
Abstract
BACKGROUND: Survival following out-of-hospital cardiac arrest (OHCA) with shockable rhythms can be improved with early defibrillation. Although shockable OHCA accounts for only ≈25% of overall arrests, ≈60% of public OHCAs are shockable, offering the possibility of restoring thousands of individuals to full recovery with early defibrillation by bystanders. We sought to determine the association of bystander automated external defibrillator use with survival and functional outcomes in shockable observed public OHCA. METHODS: From 2011 to 2015, the Resuscitation Outcomes Consortium prospectively collected detailed information on all cardiac arrests at 9 regional centers. The exposures were shock administration by a bystander-applied automated external defibrillator in comparison with initial defibrillation by emergency medical services. The primary outcome measure was discharge with normal or near-normal (favorable) functional status defined as a modified Rankin Score ≤2. Survival to hospital discharge was the secondary outcome measure. RESULTS: Among 49 555 OHCAs, 4115 (8.3%) observed public OHCAs were analyzed, of which 2500 (60.8%) were shockable. A bystander shock was applied in 18.8% of the shockable arrests. Patients shocked by a bystander were significantly more likely to survive to discharge (66.5% versus 43.0%) and be discharged with favorable functional outcome (57.1% versus 32.7%) than patients initially shocked by emergency medical services. After adjusting for known predictors of outcome, the odds ratio associated with a bystander shock was 2.62 (95% confidence interval, 2.07-3.31) for survival to hospital discharge and 2.73 (95% confidence interval, 2.17-3.44) for discharge with favorable functional outcome. The benefit of bystander shock increased progressively as emergency medical services response time became longer. CONCLUSIONS: Bystander automated external defibrillator use before emergency medical services arrival in shockable observed public OHCA was associated with better survival and functional outcomes. Continued emphasis on public automated external defibrillator utilization programs may further improve outcomes of OHCA.
BACKGROUND: Survival following out-of-hospital cardiac arrest (OHCA) with shockable rhythms can be improved with early defibrillation. Although shockable OHCA accounts for only ≈25% of overall arrests, ≈60% of public OHCAs are shockable, offering the possibility of restoring thousands of individuals to full recovery with early defibrillation by bystanders. We sought to determine the association of bystander automated external defibrillator use with survival and functional outcomes in shockable observed public OHCA. METHODS: From 2011 to 2015, the Resuscitation Outcomes Consortium prospectively collected detailed information on all cardiac arrests at 9 regional centers. The exposures were shock administration by a bystander-applied automated external defibrillator in comparison with initial defibrillation by emergency medical services. The primary outcome measure was discharge with normal or near-normal (favorable) functional status defined as a modified Rankin Score ≤2. Survival to hospital discharge was the secondary outcome measure. RESULTS: Among 49 555 OHCAs, 4115 (8.3%) observed public OHCAs were analyzed, of which 2500 (60.8%) were shockable. A bystander shock was applied in 18.8% of the shockable arrests. Patients shocked by a bystander were significantly more likely to survive to discharge (66.5% versus 43.0%) and be discharged with favorable functional outcome (57.1% versus 32.7%) than patients initially shocked by emergency medical services. After adjusting for known predictors of outcome, the odds ratio associated with a bystander shock was 2.62 (95% confidence interval, 2.07-3.31) for survival to hospital discharge and 2.73 (95% confidence interval, 2.17-3.44) for discharge with favorable functional outcome. The benefit of bystander shock increased progressively as emergency medical services response time became longer. CONCLUSIONS: Bystander automated external defibrillator use before emergency medical services arrival in shockable observed public OHCA was associated with better survival and functional outcomes. Continued emphasis on public automated external defibrillator utilization programs may further improve outcomes of OHCA.
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