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JAMA. 2015 Jul 21;314(3):255-64. doi: 10.1001/jama.2015.7938.

Association of Bystander and First-Responder Intervention With Survival After Out-of-Hospital Cardiac Arrest in North Carolina, 2010-2013.

Author information

1
Duke Clinical Research Institute, Durham, North Carolina.
2
Carolinas Medical Center, Charlotte, North Carolina.
3
Duke Clinical Research Institute, Durham, North Carolina3Center for Educational Excellence, Durham, North Carolina.
4
Wake County EMS, Raleigh, North Carolina.
5
WFU Health Sciences, Winston-Salem, North Carolina.
6
Duke Clinical Research Institute, Durham, North Carolina6Department of Community and Family Medicine, Duke University, Durham, North Carolina.
7
Duke Clinical Research Institute, Durham, North Carolina7The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark.
8
Nicholas School of the Environment, Duke University, Durham, North Carolina.
9
Emory University School of Medicine, Atlanta, Georgia10Rollins School of Public Health, Emory University, Atlanta, Georgia.

Abstract

IMPORTANCE:

Out-of-hospital cardiac arrest is associated with low survival, but early cardiopulmonary resuscitation (CPR) and defibrillation can improve outcomes if more widely adopted.

OBJECTIVE:

To examine temporal changes in bystander and first-responder resuscitation efforts before arrival of the emergency medical services (EMS) following statewide initiatives to improve bystander and first-responder efforts in North Carolina from 2010-2013 and to examine the association between bystander and first-responder resuscitation efforts and survival and neurological outcome.

DESIGN, SETTINGS, AND PARTICIPANTS:

We studied 4961 patients with out-of-hospital cardiac arrest for whom resuscitation was attempted and who were identified through the Cardiac Arrest Registry to Enhance Survival (2010-2013). First responders were dispatched police officers, firefighters, rescue squad, or life-saving crew trained to perform basic life support until arrival of the EMS.

EXPOSURES:

Statewide initiatives to improve bystander and first-responder interventions included training members of the general population in CPR and in use of automated external defibrillators (AEDs), training first responders in team-based CPR including AED use and high-performance CPR, and training dispatch centers in recognition of cardiac arrest.

MAIN OUTCOMES AND MEASURES:

The proportion of bystander and first-responder resuscitation efforts, including the combination of efforts between bystanders and first responders, from 2010 through 2013 and the association between these resuscitation efforts and survival and neurological outcome.

RESULTS:

The combination of bystander CPR and first-responder defibrillation increased from 14.1% (51 of 362; 95% CI, 10.9%-18.1%) in 2010 to 23.1% (104 of 451; 95% CI, 19.4%-27.2%) in 2013 (P < .01). Survival with favorable neurological outcome increased from 7.1% (82 of 1149; 95% CI, 5.8%-8.8%) in 2010 to 9.7% (129 of 1334; 95% CI, 8.2%-11.4%) in 2013 (P = .02) and was associated with bystander-initiated CPR. Adjusting for age and sex, bystander and first-responder interventions were associated with higher survival to hospital discharge. Survival following EMS-initiated CPR and defibrillation was 15.2% (30 of 198; 95% CI, 10.8%-20.9%) compared with 33.6% (38 of 113; 95% CI, 25.5%-42.9%) following bystander-initiated CPR and defibrillation (odds ratio [OR], 3.12; 95% CI, 1.78-5.46); 24.2% (83 of 343; 95% CI, 20.0%-29.0%) following bystander CPR and first-responder defibrillation (OR, 1.70; 95% CI, 1.06-2.71); and 25.2% (109 of 432; 95% CI, 21.4%-29.6%) following first-responder CPR and defibrillation (OR, 1.77; 95% CI, 1.13-2.77).

CONCLUSIONS AND RELEVANCE:

Following a statewide educational intervention on rescusitation training, the proportion of patients receiving bystander-initiated CPR and defibrillation by first responders increased and was associated with greater likelihood of survival. Bystander-initiated CPR was associated with greater likelihood of survival with favorable neurological outcome.

PMID:
26197186
DOI:
10.1001/jama.2015.7938
[Indexed for MEDLINE]

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