Abstract 11295: Out-of-Hospital Cardiac Arrest Characteristics According to Arrest Location in Urban, Suburban, and Rural Areas of Denmark

Introduction: Cardiopulmonary resuscitation (CPR) and early defibrillation are two of the most important factors for survival after out-of-hospital cardiac arrest (OHCA). However, little is known whether bystander interventions and survival are impaired in rural areas compared to more urbanized areas in Denmark. We hypothesized that bystander interventions and survival are lower in rural areas compared to urbanized areas. Methods: We included all non-EMS witnessed OHCAs with known GPS-location in Denmark (January 1, 2016 to December 31, 2019) and geocoded them according to county. All counties in Denmark were classified either as urban, suburban, or rural according to the degree of urbanization tool defined by the European Statistical Agency. Results: A total of 16,670 OHCAs were included, of which 4,555 (27%), 5,457 (33%), and 6,658 (40%) arrests occurred in urban, suburban, and rural areas respectively. The median age (73 vs. 74 vs. 73 years, p=0.003), ambulance response time (6 vs. 7 vs. 8 minutes, p<0.0001), and proportion of arrests occurring in residential areas (77 vs. 79 vs. 78%, p=0.05) differed significantly between degrees of urbanization (from high to low). Fewer OHCAs received bystander CPR in urban and suburban areas compared to rural (76 vs. 77 vs. 79%, p=0.0002). The proportion of patients defibrillated by bystanders remained equal across urbanization. However, return of spontaneous circulation (ROSC) (27 vs. 27 vs. 24%, p<0.0001) and 30-day survival was lower in rural areas (15 vs. 14 vs. 12, p<0.0001) (Figure 1). Conclusion: Degree of urbanization was associated with increased rates of bystander CPR in rural areas. Despite this, ROSC and 30-day survival were higher in urban and suburban areas compared to rural areas which could not be explained by cardiac arrest characteristics.

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Abstract P80: Short-term Outcomes of Vasopressin Administerd with Epinephrine versus Epinephrine Alone in ED for Out-of-hospital Cardiac Arrest

Circulation ◽

10.1161/circ.118.suppl_18.s_1462-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Tae Yun Kim ◽

Sun Woo Lee ◽

Kyuseok Kim ◽

Joong Eui Rhee ◽

Sung Koo Jung

Keyword(s):

Cardiac Arrest ◽

Spontaneous Circulation ◽

National Registry ◽

Controlled Clinical Trial ◽

Emergency Medical Service System ◽

Short Term ◽

Combined Administration ◽

Before And After ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OOHCA) victims are increasing, but emergency medical service system (EMSS) is not ready for them in Korea. A previous randomized, controlled clinical trial has suggested that vasopressin followed epinephrine was superior to epinephrine in patients with asystole. According to the Korean national registry of OOHCA, patients with asystole were more than two thirds of them. In Korean EMSS, no drugs are permitted to administer in the prehospital phase by law. Thereafter epinephrine or vasopressin cannot be administered until patients are transported to emergency departments (EDs). This study was to evaluate whether the combined administration of vasopressin and epinephrine in ED for OOHCA patients would increase the return of spontaneous circulation (ROSC) and survival discharge. Methods: From October 2007 to May 2008, we changed the CPR protocol in adult, nontraumatic OOHCA that 40 U of vasopressin was administered as soon as possible after the first dose of epinephrine (the after group). Cardiac arrest data were collected using the Utstein template. Data from January to September 2007, when vasopressin has not been used, were also collected for comparative analysis (the before group). These two groups were compared in terms of ROSC, and survival discharge Results: There were 45 and 50 patients in the before and after groups, respectively. There was no significant differences in the initial ECG rhythm of asystole (67% vs 78%), witnessed arrest (73% vs 72%), bystander CPR (16% vs 10%), time from collapse to BLS time (6 min vs 8.5 min), and time from collapse to study drugs (23 min vs 26.5 min). The rate of sustained ROSC was similar between the before and after groups (53% vs 48%, P=0.604) as was the survival discharge (27% vs 14%, P=0.123). Conclusions: Vasopressin with administerd with epinephrine does not increase the rate of ROSC nor the survival discharge.

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Abstract 14171: Prehospital Outcomes and Patient Characteristics Associated With PulsePoint Dispatches for Out-of-Hospital Cardiac Arrest in Pittsburgh, Pennsylvania

Circulation ◽

10.1161/circ.144.suppl_2.14171 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

David Salcido ◽

Christian Martin-Gill ◽

LEONARD WEISS ◽

David D Salcido

Keyword(s):

Cardiac Arrest ◽

Response Time ◽

Statistical Significance ◽

Patient Characteristics ◽

The United States ◽

Spontaneous Circulation ◽

Shockable Rhythm ◽

Bystander Cpr ◽

Case Characteristics ◽

Hospital Cardiac Arrest

Background: Mobile phone-based dispatch of volunteers to out-of-hospital cardiac arrest (OHCA) has been shown to increase the likelihood of early chest compressions and AED application. In the United States, limited characterization of patients encountered as a result of such systems exists, including PulsePoint Respond, a smartphone-based volunteer dispatch system. Objective: Examine prehospital case characteristics and outcomes from a multi-year deployment of PulsePoint in Pittsburgh, Pennsylvania. Methods: Case data, including PulsePoint determinant triggers and timing, prehospital electronic health records (EHRs), and computer aided dispatch records were obtained for suspected EMS-treated OHCA cases that did and did not generate PulsePoint alerts within the service area of Pittsburgh EMS for the period July 2016 to October 2020. EHRs were reviewed to determine true OHCA status, and OHCA case characteristics were extracted according to the Utstein template. Key characteristics and the outcome of prehospital return of spontaneous circulation (ROSC) were summarized and compared between cases with and without PulsePoint dispatches. Chi-squared tests were used to determine statistical significance of relationships. Results: There were 1229 OHCA cases overall in the capture period, with an estimated 29.6% occurring in public. Of 840 total PulsePoint dispatches, 68 (8.1%) were for true OHCA. Forty-five (66.2%) of these were witnessed, 43 (63.2%) received bystander CPR, and 17 (25%) had an AED applied prior to first responder arrival. Twenty-seven (39.7%) had an initial shockable rhythm, and 34 (50%) achieved ROSC in the field. Compared to non-PulsePoint dispatch generating OHCA, PulsePoint alert-associated patients were significantly more likely to be male (p=0.024), have bystander CPR/AED application performed (p<0.001), have an initial shockable rhythm (p<0.001), and achieve ROSC (p<0.001). EMS response time, age, ALS response time, and witnessed status were not significantly different. Conclusions: A minority of PulsePoint dispatches in Pittsburgh were triggered by true OHCA. Among cases that did generate a PulsePoint dispatch, case characteristics were prognostically favorable.

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Abstract 11312: Activation of Citizen Responders to Out-of-Hospital Cardiac Arrest: Temporal Changes During the COVID-19 Outbreak in Denmark 2020

Circulation ◽

10.1161/circ.144.suppl_2.11312 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Mads Christian Tofte Gregers ◽

Linn Andelius ◽

Carolina Malta Hansen ◽

Astrid Rolin Kragh ◽

Christian Torp-Pedersen ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Spontaneous Circulation ◽

Acceptance Rate ◽

Smartphone App ◽

Hospital Arrival ◽

Automated External Defibrillators ◽

Return Of Spontaneous Circulation ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: Multiple citizen responder (CR) programs worldwide which dispatch laypersons to out-of-hospital cardiac arrest (OHCA) to perform cardiopulmonary resuscitation (CPR) and use of automated external defibrillators (AEDs) were affected by the COVID-19 outbreak in 2020, but little is known about how the pandemic affected CR activation and initiation of bystander CPR and defibrillation. In Denmark, the CR program continued to run during lockdown but with the recommendation to perform chest-compression-only CPR in contrast to standard CPR including ventilations. We hypothesized that bystander interventions as CPR and AED usage decreased during the first COVID-19 lockdown in two regions of Denmark in the spring of 2020. Methods: All OHCAs from January 1, 2020 to June 30, 2020 with CR activation from the Danish Cardiac Arrest Registry and the National Citizen Responder database. Bystander CPR, AED usage, and CRs’ alarm acceptance rate during the national lockdown from March 11, 2020 to April 20, 2020 were compared with the non-lockdown period from January 1, 2020 to March 10, 2020 and from April 21 to June 30, 2020. Results: A total of 6,120 CRs were alerted in 443 (23/100.000 inhabitants) cases of presumed OHCA of which 256 (58%) were confirmed cardiac arrests. Bystander CPR remained equally high in the lockdown period compared with non-lockdown period (99% vs. 92%, p=0.07). Likewise, there was no change in bystander defibrillation (9% vs. 14%, p=0.4). There was a slight increase in the number of CRs who accepted an alarm (7 per alarm, IQR 4) during lockdown compared with non-lockdown period (6 per alarm, IQR 4), p=0.0001. The proportion of patients achieving return of spontaneous circulation at hospital arrival was also unchanged (lockdown 23% vs non-lockdown 23%, p=1.0) (Table 1). Conclusion: Bystander initiated resuscitation rates did not change during the first COVID-19 lockdown in Denmark for OHCAs where CRs were activated through a smartphone app.

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Abstract 18304: Are Prolonged Resuscitation Efforts Worthwhile? Patient Outcomes by Time to Restoration of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest Patients

Circulation ◽

10.1161/circ.132.suppl_3.18304 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Kristian Kragholm ◽

Monique Anderson ◽

Carolina Malta Hansen ◽

Phillip J. Schulte ◽

Michael C. Kurz ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Survival Rates ◽

Spontaneous Circulation ◽

Significant Survival ◽

Bystander Cardiopulmonary Resuscitation ◽

Bystander Cpr ◽

Using Data ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Introduction: How long resuscitation attempts should be continued before termination of efforts is not clear in patients with out-of-hospital cardiac arrest (OHCA). We studied outcomes in patients with return of spontaneous circulation (ROSC) across quartiles of time from 9-1-1 call to ROSC. Hypothesis: Survival with favorable neurological outcome is seen in all time intervals from 9-1-1 call to ROSC. Methods: Using data from Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation clinical trials: IMpedance valve and an Early vs. Delayed analysis (PRIMED) available via National Institute of Health, patients with ROSC not witnessed by the emergency medical service (EMS) were identified and grouped by quartiles of time from 9-1-1 call to ROSC. We defined favorable neurological outcome as modified Rankin Scale (mRS) scores of ≤3. Results: Included were 3,431 OHCA patients with ROSC. Median time from 9-1-1 call to ROSC was 22.8 min (25%-75% 17 min–29.2 min); 953 (27.8%) survived to discharge (20.4% mRS ≤3). Significant survival and favorable neurological outcome were seen in each quartile (Figure). In patients who received bystander cardiopulmonary resuscitation (CPR), survival rates were 60.9%, 33.2%, 18.3% and 11.1% across quartiles of time to ROSC versus (vs.) 51.5%, 25.6%, 13.3% and 8.9% in patients without bystander CPR; corresponding rates of favorable neurological outcome were 50.7%, 23.8%, 12.2% and 9.1% vs. 40.1%, 16.6%, 8% and 4.8%. Correspondingly, survival rates in defibrillated patients were 70.1%, 45.9%, 25.5% and 16.4% vs. 36.3%, 9.5%, 6% and 3.4% in non-defibrillated patients; corresponding rates of favorable neurological outcome were 59.8%, 33.4%, 18.3% and 11.4% vs. 24.4%, 4.1%, 1.9% and 1.8%. Conclusions: Survival with favorable neurological outcome was seen in all quartiles of time to ROSC, even in cases without bystander CPR or shocks delivered. This suggests that EMS personnel should not terminate resuscitation efforts too early.

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Factors Affecting a Successful Out-Of-Hospital Cardiopulmonary Resuscitation / Pirmsslimnīcas Etapa Kardiopulmonālo Reanimāciju Rezultātus Ietekmējošie Faktori

Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences ◽

10.2478/prolas-2014-0028 ◽

2014 ◽

Vol 68 (5-6) ◽

pp. 228-231

Author(s):

Kaspars Setlers ◽

Indulis Vanags ◽

Anita Kalēja

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Hospital Admission ◽

Heart Rhythm ◽

Patient Characteristics ◽

Spontaneous Circulation ◽

Factors Affecting ◽

Bystander Cpr ◽

And Gender ◽

Hospital Cardiac Arrest

Abstract A retrospective patient record analysis of the Emergency Medial Service’s Rîga City Regional Centre was provided from January 2012 through December 2013. 1359 adult patients were CPR treated for out-of-hospital cardiac arrest according to ERC Guidelines 2010. A total of 490 patients were excluded from the study. The main outcome measure was survival to hospital admission. Of 869 CPR-treated patients, 60% (n = 521) were men. The mean age of patients was 66.68 ± 15.28 years. The survival rate to hospital admission was 12.9% (n = 112). 54 of survived patients were women. Mean patient age of successful CPR was 63.22 ± 16.21 and unsuccessful CPR 67.20 ± 15.09. At least one related illness was recorded with 63.4% (n = 551) patients. There were 61 survivors in bystander witnessed OHCA and nine survivors in unwitnessed OHCA. The rate of bystander CPR when CA (cardiac arrest) was witnessed was 24.8%. Ventricular fibrillation (VF) as initial heart rhythm was significantly associated with survival to hospital admission in 54 cases (p < 0.0001). Age and gender affected return of spontaneous circulation. Survival to hospital admission had rhythm-specific outcome. Presence of OHCA witnesses improved outcome compared to bystander CPR. The objective of this study was to report patient characteristics, the role of witnesses in out-of-hospital cardiac arrest (OHCA) and outcome of adult cardiopulmonary resuscitation

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Abstract 20: Intraosseous vs. Intravenously Administered Advanced Life Support Drugs in Patients With Out-of-Hospital Cardiac Arrest: Insights From the Resuscitation Outcomes Consortium Continuous Chest Compression Trial

Circulation ◽

10.1161/circ.138.suppl_2.20 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Purav Mody ◽

Siobhan Brown ◽

Rohan Khera ◽

Ambarish Pandey ◽

Colby Ayers ◽

...

Keyword(s):

Cardiac Arrest ◽

Chest Compression ◽

Life Support ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Neurological Function ◽

Access Route ◽

Epinephrine Administration ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Background: There is an urgent need to identify strategies which improve outcomes for out-of-hospital cardiac arrest (OHCA). Determining the optimal access route to deliver medications during resuscitation from OHCA may be one such strategy. Methods: Using data from the Continuous Chest compression trial between 2011 and 2016, we examined rates of sustained return of spontaneous circulation (ROSC) i.e. ROSC on ER arrival, survival to discharge and survival with favorable neurological function (modified Rankin scale ≤3) among patients with attempted IV and IO access. Results: Among 19,731 patients with available access information, IO or IV access was attempted in 3,068 (15.5%) and 16,663 (84.5%) patients, respectively and was successful in 2,975 (97%) and 15,485 (92%) of these patients. Overall, patients with attempted IO access were younger, more likely female, received less bystander CPR, had lower proportions of shockable and witnessed arrests, marginally faster times to access and to epinephrine administration, and less frequently received therapeutic hypothermia and coronary angiography as compared with patients with IV access ( Table ) . Unadjusted rates of sustained ROSC, discharge survival and survival with favorable neurological function were significantly lower in patients with attempted IO access ( Table) . After adjustment for age, sex, initial rhythm, bystander CPR, public location, witnessed status, EMS response time and trial cluster, attempted IO access was associated with lower sustained ROSC rates (OR 0.79, 95% CI 0.71-0.89, p<0.001) but not with discharge survival (OR 0.88, 95% CI 0.71-1.08, p=0.21) or survival with favorable neurological function (OR 0.86, 95% CI 0.67-1.1, p=0.26). Conclusions: Among patients with OHCA, intraosseous access was attempted in 1 in 7 OHCA patients and associated with worse ROSC rates but no difference in survival. Further studies are necessary to elucidate the optimal access route among OHCA patients.

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Dispatcher-assisted cardiopulmonary resuscitation for traumatic patients with out-of-hospital cardiac arrest

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-019-0679-2 ◽

2019 ◽

Vol 27 (1) ◽

Cited By ~ 2

Author(s):

Chien-Hsin Lu ◽

Pin-Hui Fang ◽

Chih-Hao Lin

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Statistical Significance ◽

Spontaneous Circulation ◽

Stepwise Logistic Regression ◽

Population Database ◽

Stepwise Logistic Regression Analysis ◽

Emergency Calls ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Abstract Background Resuscitation efforts for traumatic patients with out-of-hospital cardiac arrest (OHCA) are not always futile. Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) during emergency calls could increase the rate of bystander cardiopulmonary resuscitation (CPR) and thus may enhance survival and neurologic outcomes of non-traumatic OHCA. This study aimed to examine the effectiveness of DA-CPR for traumatic OHCA. Methods A retrospective cohort study was conducted using an Utstein-style population database with data from January 1, 2014, to December 31, 2016, in Tainan City, Taiwan. Voice recordings of emergency calls were retrospectively retrieved and reviewed. The primary outcome was an achievement of sustained (≥2 h) return of spontaneous circulation (ROSC); the secondary outcomes were prehospital ROSC, ever ROSC, survival at discharge and favourable neurologic status at discharge. Statistical significance was set at a p-value of less than 0.05. Results A total of 4526 OHCA cases were enrolled. Traumatic OHCA cases (n = 560, 12.4%), compared to medical OHCA cases (n = 3966, 87.6%), were less likely to have bystander CPR (10.7% vs. 31.7%, p < 0.001) and initially shockable rhythms (7.1% vs. 12.5%, p < 0.001). Regarding DA-CPR performance, traumatic OHCA cases were less likely to have dispatcher recognition of cardiac arrest (6.3% vs. 42.0%, p < 0.001), dispatcher initiation of bystander CPR (5.4% vs. 37.6%, p < 0.001), or any dispatcher delivery of CPR instructions (2.7% vs. 20.3%, p < 0.001). Stepwise logistic regression analysis showed that witnessed cardiac arrests (aOR 1.70, 95% CI 1.10–2.62; p = 0.017) and transportation to level 1 centers (aOR 1.99, 95% CI 1.27–3.13; p = 0.003) were significantly associated with achievement of sustained ROSC in traumatic OHCA cases, while DA-CPR-related variables were not (All p > 0.05). Conclusions DA-CPR was not associated with better outcomes for traumatic OHCA in achieving a sustained ROSC. The DA-CPR program for traumatic OHCAs needs further studies to validate its effectiveness and practicability, especially in the communities where rules for the termination of resuscitation in prehospital settings do not exist.

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Abstract MP73: Emergency Call First Strategy versus Bystander Cardiopulmonary Resuscitation First Strategy for Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.137.suppl_1.mp73 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Tatsuma Fukuda ◽

Naoko Ohashi-Fukuda ◽

Yutaka Kondo ◽

Kei Hayashida ◽

Ichiro Kukita

Keyword(s):

Overall Survival ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cerebral Performance Category ◽

Population Based ◽

Spontaneous Circulation ◽

Emergency Call ◽

Bystander Cardiopulmonary Resuscitation ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: Lay rescuers have a crucial role in successful cardiopulmonary resuscitation (CPR), specifically the first three links in the chain of survival, for out-of-hospital cardiac arrest (OHCA). However, randomized controlled trials on the priority of emergency call (Call first) versus bystander CPR (CPR first) do not exist, and comparative data are very limited. We aimed to assess the association between the priority of bystander’s action (Call first vs. CPR first) and neurologic outcome after OHCA. Methods: This nationwide population-based study of patients who experienced OHCA from January 2005 to December 2014 was based on the data from the Japanese government-managed registry of OHCA. Patients provided bystander’s action (both emergency call and bystander CPR) within 1 minute of witness were included, and Call first strategy was compared with CPR first strategy. The primary outcome was one-month neurologically favorable survival, defined as a Glasgow-Pittsburgh cerebral performance category (CPC) score of 1(good performance) or 2(moderate disability). The secondary outcomes were prehospital return of spontaneous circulation (ROSC) and one-month overall survival. Results: A total of 25,840 patients were included; 4,430 (17.1%) were treated with Call first approach, and 21,410 (82.9%) were treated with CPR first approach. Among total cohort, 2,696 (10.4%) survived with neurologically favorable status one month after OHCA. In the propensity score-matched cohort, one-month neurologically favorable survival was lower among Call first group compared with CPR first group: 364 of 4,430 patients (8.2%) vs. 457 of 4,430 patients (10.3%), respectively (Risk ratio [RR], 0.80; 95% confidence interval [CI], 0.70-0.91). Similar associations were observed for one-month overall survival (RR, 0.90; 95%CI, 0.82-0.99), although there were no significant differences in prehospital ROSC (RR, 0.94; 95%CI, 0.86-1.02) between the Call first and CPR first groups. In subgroup analyses, the association between delayed bystander CPR and worse neurological outcome did not change regardless of subgroup characteristics. Conclusions: In witnessed OHCA, Call first approach was associated with a decreased chance of one-month neurologically favorable survival compared with CPR first approach. These observational findings warrant a randomized clinical trial to determine the priority of emergency call or bystander CPR for OHCA.

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Abstract 109: Automated External Defibrillators Are Rarely Used for In-Hospital Cardiac Arrest in Denmark

Circulation ◽

10.1161/circ.140.suppl_2.109 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Mathilde Staerk ◽

Kasper G Lauridsen ◽

Kristian Krogh ◽

Hans Kirkegaard ◽

Bo Løfgren

Keyword(s):

Cardiac Arrest ◽

Hospital Setting ◽

Spontaneous Circulation ◽

Early Defibrillation ◽

Automated External Defibrillators ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Rhythm Analysis ◽

Hospital Cardiac Arrest ◽

Cardiac Arrest Team

Introduction: Automated External Defibrillators (AEDs) are widely distributed in the pre-hospital setting and reported to reduce time to defibrillation and increase survival from out-of-hospital cardiac arrest. During in-hospital cardiac arrest (IHCA), AEDs may allow for early defibrillation before the cardiac arrest team arrives with a manual defibrillator. However, the effect of AEDs for IHCA remains unclear. This study aimed to investigate AED usage and contribution to defibrillation before cardiac arrest team arrival during IHCA. Methods: We obtained data on IHCAs in 2016 and 2017 from the Danish nationwide registry on IHCA (DANARREST). Data included information on initial rhythm, type of defibrillator, time to first rhythm analysis, time to arrival of the cardiac arrest team, time to first defibrillation, and return of spontaneous circulation (ROSC). Results: Of 4,496 IHCAs, AEDs were used in 421 resuscitation attempts (9%). Time registrations were excluded for 6 non-shockable IHCAs due to errors in registration. Of the 421 IHCAs, 82% (n=347) were non-shockable and 16% (n=68) were shockable (data missing for 6 IHCAs). ROSC was achieved in 46% (n=158) of patients with non-shockable rhythms and 59% (n=40) of patients with shockable rhythms. For IHCAs with a shockable rhythm and usage of an AED, rhythm analysis was performed before arrival of the cardiac arrest team in 50% (n=34) of cases and defibrillation with an AED were performed in 46% (n=27) of the cases. Patients with shockable rhythms defibrillated before arrival of the cardiac team, more often achieved ROSC compared to patients defibrillated after cardiac arrest team arrival (p=0.0024). Data regarding time registration are shown in the table. Conclusion: AEDs are used in approximately 1 of 10 resuscitation attempts in Danish hospitals and contribute to defibrillation before arrival of the cardiac arrest team in 1 of 14 cardiac arrest patients.

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Abstract 13249: Temporal Trends in Out-of-Hospital Cardiac Arrest Bystander CPR and Defibrillation Following Implementation of Citizen Responder Programs

Circulation ◽

10.1161/circ.144.suppl_2.13249 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Louise Kollander Jakobsen ◽

Sidsel Gamborg Moeller ◽

Kristian Bundgaard Ringgren ◽

Amalie Lykkemark Moeller ◽

Linn Andelius ◽

...

Keyword(s):

Cardiac Arrest ◽

Observational Study ◽

Temporal Trends ◽

P Value ◽

Residential Areas ◽

The Past ◽

Residential Locations ◽

Before And After ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

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.

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