Abstract
PurposeOut-of-hospital cardiac arrests (OHCAs) are a major healthcare problem. Over the years, several initiatives have contributed to more lay volunteers providing cardiopulmonary resuscitation (CPR) and increased use of automated external defibrillators (AEDs) in the Netherlands. As part of a quality and outcomes program, we registered bystander CPR, AED use and outcome in the Nijmegen area.MethodsProspective resuscitation registry with a study cohort of non-traumatic OHCA cases from 2013–2016 and historical controls from 2008–2011. In line with previous reports, we studied patients transported to the hospital (Radboudumc, Nijmegen, the Netherlands) and excluded arrests witnessed by the emergency medical service (EMS). Primary outcomes were return of spontaneous circulation (ROSC) and survival to discharge.ResultsIn the study cohort (n = 349) the AED was attached more often than in the historical cohort (n = 180): 46% vs. 23% and the proportion of bystander CPR was higher: 78% vs. 63% (both p < 0.001). A higher proportion of patients received an AED shock (39% vs. 15%, p < 0.001) and the number of required shocks by the EMS was lower (2 vs. 4, p = 0.004). Survival to discharge was higher (47% vs. 33%, p = 0.002) without differences in ROSC. The survival benefit was restricted to patients with a shockable initial rhythm. In both cohorts, bystander CPR and AED use were independently associated with survival.ConclusionIn patients admitted after OHCA, survival to discharge has markedly improved to 40–50%, comparable with other Dutch registries. As increased bystander CPR and the doubled use of AEDs seem to have contributed, all civilian-based resuscitation initiatives should be encouraged.
Highlights
Out-of-hospital cardiac arrests (OHCAs) are a major healthcare problem with dismal survival rates [1]
● We found higher rates of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs) use in our current cohort of cardiac arrest patients than in a historical cohort, as well as higher survival
A higher proportion of patients received a shock by the AED (39% vs. 15%, p < 0.001), less patients received a shock by the emergency medical service (EMS) (59% vs. 76%, p < 0.001) and the median number of EMS shocks was lower in the study cohort (2 vs. 4, p = 0.004)
Summary
Out-of-hospital cardiac arrests (OHCAs) are a major healthcare problem with dismal survival rates [1]. There have been many initiatives to improve survival [7, 8], which are summarised in a framework called. In the pre-hospital setting, interventions are mainly aimed towards improving bystander cardiopulmonary resuscitation (CPR) and facilitating earlier defibrillation [10,11,12]. AEDs were mainly used by first responder units, such as fire and police services, which are dispatched alongside the ambulance to a suspected OHCA [17]. More recent developments involve dispatching lay responders to find and bring the nearest AED to the scene of the OHCA, using a text message based alert system [18,19,20,21]. Recruitment of lay responders may facilitate early defibrillation, a key determinant of survival in case of a shockable initial rhythm [22]
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