Louise Kollander Jakobsen
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Sidsel Gamborg Moeller
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Kristian Bundgaard Ringgren
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Amalie Lykkemark Moeller
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Linn Andelius
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...
Introduction:
In Denmark, survival after out-of-hospital cardiac arrest (OHCA) has increased markedly in the past years, from 3.9% in 2001 to 15.8% in 2019. Still, bystander defibrillation remains low, especially for OHCAs in residential areas. To improve bystander defibrillation, smartphone activated Citizen Responder (CR) Programs have expanded to nationwide coverage in Denmark during September 2017 to May 2020.
Hypothesis:
Implementation of CR programs in Denmark was associated with increased bystander CPR and defibrillation.
Methods:
We conducted an observational study of 15,308 OHCAs from the Danish Cardiac Arrest Registry from 2016-2019. App-based CR programs were implemented in four out of five Danish regions during the study period. All OHCAs were divided into two groups according to the date of CR implementation (“before” and “after CR” implementation). The groups were compared focusing on bystander defibrillation, bystander CPR and 30-day survival.
Results:
“Before CR” included 8,819 OHCAs and the “after CR” 6,489 OHCAs. The proportion of bystander CPR was 77.9% and 78.0% (p-value 0.91) for the before -and after CR implementation groups, respectively. The corresponding numbers for bystander defibrillation were 7.4% and 9.5% (p-value < 0.001), respectively. In residential OHCA, bystander defibrillation went from 4.0% to 6.3% (p-value<0.001) in the before -and after group respectively. In public, bystander defibrillation was 19.3% and 22.2% (p-value 0.05) in the groups respectively. 30-day survival was 12.7% before and 13.1% after CR implementation (p-value 0.49).
Conclusion:
We found no changes in bystander CPR or 30-day survival following implementation of CR programs in Denmark, but a significant increase in bystander defibrillation for all OHCAs. Importantly bystander defibrillation also increased significantly in residential locations, where the majority of OHCAs occur and where bystander defibrillation has remained low for decades.
Bystander Defibrillation for Out-of-Hospital Cardiac Arrest in Public vs Residential Locations