Ziad Nehme1, Emily Andrew2, Stephen Bernard3, Brian Haskins4, Karen Smith5. 1. Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia; NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ), Monash University, Melbourne, Victoria, Australia. Electronic address: ziad.nehme@ambulance.vic.gov.au. 2. Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 3. Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ), Monash University, Melbourne, Victoria, Australia; Alfred Hospital, Prahran, Victoria, Australia. 4. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia; NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ), Monash University, Melbourne, Victoria, Australia. 5. Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia; NHMRC Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ), Monash University, Melbourne, Victoria, Australia; Discipline of Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia.
Abstract
BACKGROUND: Although survival from out-of-hospital cardiac arrest (OHCA) is increasing, little is known about the long-term trends in survival for patients defibrillated by first responders and bystanders. METHODS: Between 2000 and 2017, we included adult non-traumatic OHCA with an initial shockable rhythm from the Victorian Ambulance Cardiac Arrest Registry. Adjusted logistic regression analyses were used to assess trends in survival to hospital discharge according to whether the patient was initially shocked by paramedics, first responders or bystanders. RESULTS: Of the 10,451 initial shockable arrests, 796 (7.6%) and 526 (5.0%) were initially shocked by first responders and bystanders, respectively. Between 2000-02 and 2015-17, the proportion of cases initially shocked by first responders and bystanders increased from 3.8% to 8.2% and from 2.0% to 11.2%, respectively. Over the same period, survival to hospital discharge increased from 11.6% to 28.8% for cases initially shocked by paramedics, from 10.5% to 37.8% for cases initially shocked by first responders, and from 6.7% to 55.5% for cases initially shocked by bystanders (p trend <0.001 for all). In the adjusted analyses, patients initially shocked by first responders (AOR 1.40, 95% CI: 1.18, 1.67; p < 0.001) and bystanders (AOR 2.11, 95% CI: 1.72, 2.59; p < 0.001) were more likely to survive to hospital discharge than those initially shocked by paramedics. The odds of survival increased year-on-year by 8.1% for patients shocked by paramedics (p < 0.001), 6.1% for patients shocked by first responders (p = 0.004), and 11.8% for patients shocked by bystanders (p < 0.001). CONCLUSION: OHCA patients initially defibrillated by bystanders yielded the largest improvements in survival over time.
BACKGROUND: Although survival from out-of-hospital cardiac arrest (OHCA) is increasing, little is known about the long-term trends in survival for patients defibrillated by first responders and bystanders. METHODS: Between 2000 and 2017, we included adult non-traumatic OHCA with an initial shockable rhythm from the Victorian Ambulance Cardiac Arrest Registry. Adjusted logistic regression analyses were used to assess trends in survival to hospital discharge according to whether the patient was initially shocked by paramedics, first responders or bystanders. RESULTS: Of the 10,451 initial shockable arrests, 796 (7.6%) and 526 (5.0%) were initially shocked by first responders and bystanders, respectively. Between 2000-02 and 2015-17, the proportion of cases initially shocked by first responders and bystanders increased from 3.8% to 8.2% and from 2.0% to 11.2%, respectively. Over the same period, survival to hospital discharge increased from 11.6% to 28.8% for cases initially shocked by paramedics, from 10.5% to 37.8% for cases initially shocked by first responders, and from 6.7% to 55.5% for cases initially shocked by bystanders (p trend <0.001 for all). In the adjusted analyses, patients initially shocked by first responders (AOR 1.40, 95% CI: 1.18, 1.67; p < 0.001) and bystanders (AOR 2.11, 95% CI: 1.72, 2.59; p < 0.001) were more likely to survive to hospital discharge than those initially shocked by paramedics. The odds of survival increased year-on-year by 8.1% for patients shocked by paramedics (p < 0.001), 6.1% for patients shocked by first responders (p = 0.004), and 11.8% for patients shocked by bystanders (p < 0.001). CONCLUSION: OHCA patients initially defibrillated by bystanders yielded the largest improvements in survival over time.
Authors: Jessica K Zègre-Hemsey; Mary E Grewe; Anna M Johnson; Evan Arnold; Christopher J Cunningham; Brittany M Bogle; Wayne D Rosamond Journal: Resuscitation Date: 2020-10-17 Impact factor: 5.262
Authors: Theresa M Olasveengen; Mary E Mancini; Gavin D Perkins; Suzanne Avis; Steven Brooks; Maaret Castrén; Sung Phil Chung; Julie Considine; Keith Couper; Raffo Escalante; Tetsuo Hatanaka; Kevin K C Hung; Peter Kudenchuk; Swee Han Lim; Chika Nishiyama; Giuseppe Ristagno; Federico Semeraro; Christopher M Smith; Michael A Smyth; Christian Vaillancourt; Jerry P Nolan; Mary Fran Hazinski; Peter T Morley Journal: Resuscitation Date: 2020-10-21 Impact factor: 5.262