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Resuscitation. 2015 Nov;96:303-9. doi: 10.1016/j.resuscitation.2015.09.002. Epub 2015 Sep 16.

The role of bystanders, first responders, and emergency medical service providers in timely defibrillation and related outcomes after out-of-hospital cardiac arrest: Results from a statewide registry.

Author information

1
Duke Clinical Research Institute, Durham, NC, United States. Electronic address: Carolina.hansen@duke.edu.
2
Duke Clinical Research Institute, Durham, NC, United States.
3
Carolinas Medical Center, Charlotte, NC, United States.
4
Duke Clinical Research Institute, Durham, NC, United States; Center for Educational Excellence, Duke Clinical Research Institute, Durham, NC, United States.
5
New Hanover Regional Medical Center, Wilmington, NC, United States.
6
WFU Health Sciences, Winston-Salem, NC, United States.
7
Duke Clinical Research Institute, Durham, NC, United States; Department of Community and Family Medicine, Duke University, Durham, NC, United States.
8
Duke Clinical Research Institute, Durham, NC, United States; The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark.
9
Nicholas School of the Environment, Duke University, Durham, NC, United States.
10
Emory University School of Medicine, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States.

Abstract

AIM:

Defibrillation by bystanders and first responders has been associated with increased survival, but limited data are available from non-metropolitan areas. We examined time from 911-call to defibrillation (according to who defibrillated patients) and survival in North Carolina.

METHODS:

Through the Cardiac Arrest Registry to Enhance Survival, we identified 1732 defibrillated out-of-hospital cardiac arrests from counties with complete case capture (population 2.7 million) from 2010 to 2013.

RESULTS:

Most patients (60.9%) were defibrillated in > 10 min. A minority (8.0%) was defibrillated < 5 min; most of these patients were defibrillated by first responders (51.8%) and bystanders (33.1%), independent of location of arrest (residential or public). Bystanders initiated cardiopulmonary resuscitation (CPR) in 49.0% of cases and defibrillated 13.4% of those. Survival decreased with increasing time to defibrillation (< 2 min: 59.1%; 2 to < 5 min: 38.5%; 5-10 min: 33.1%; > 10 min: 13.2%). Odds of survival with favorable neurologic outcome adjusted for age, sex, and bystander CPR improved with faster defibrillation (<2 min: OR 7.73 [95% CI 3.19-18.73]; 2 to < 5 min: 3.78 [2.45-5.84]; 5-10 min: 3.16 [2.42-4.12]; > 10 min: reference).

CONCLUSION:

Bystanders and first responders were mainly responsible for defibrillation within 5 min, independent of location of arrest. Bystanders initiated CPR in half of the cardiac arrest cases but only defibrillated a minority of those. Timely defibrillation and defibrillation by bystanders and/or first responders were strongly associated with increased survival. Strategic efforts to increase bystander and first-responder defibrillation are warranted to increase survival after out-of-hospital cardiac arrest.

KEYWORDS:

Cardiopulmonary resuscitation; Defibrillation; Heart arrest

[Indexed for MEDLINE]

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