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Resuscitation. 2018 May;126:72-79. doi: 10.1016/j.resuscitation.2018.02.021. Epub 2018 Mar 2.

Neighborhood characteristics, bystander automated external defibrillator use, and patient outcomes in public out-of-hospital cardiac arrest.

Author information

1
Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 02115, Boston, MA, USA. Electronic address: lwandersen@clin.au.dk.
2
Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 02115, Boston, MA, USA.
3
Department of Anesthesiology, Aarhus University Hospital, 8000, Aarhus, Denmark.
4
Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000, Aarhus, Denmark; Department of Internal Medicine, Regional Hospital of Randers, 8900, Randers, Denmark.
5
Department of Emergency Medicine, Emory University, 30322, Atlanta, Georgia, USA.
6
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany; Institute of Public Health, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany.
7
Institute of Public Health, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany.
8
Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 02115, Boston, MA, USA; Department of Internal Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, 02115, Boston, MA, USA.

Abstract

BACKGROUND:

Automated external defibrillators (AEDs) can be used by bystanders to provide rapid defibrillation for patients with out-of-hospital cardiac arrest (OHCA). Whether neighborhood characteristics are associated with AED use is unknown. Furthermore, the association between AED use and outcomes has not been well characterized for all (i.e. shockable and non-shockable) public OHCAs.

METHODS:

We included public, non-911-responder witnessed OHCAs registered in the Cardiac Arrest Registry to Enhance Survival (CARES) between 2013 and 2016. The primary patient outcome was survival to hospital discharge with a favorable functional outcome. We first assessed the association between neighborhood characteristics and bystander AED use using logistic regression and then assessed the association between bystander AED use and patient outcomes in a propensity score matched cohort.

RESULTS:

25,182 OHCAs were included. Several neighborhood characteristics, including the proportion of people living alone, the proportion of white people, and the proportion with a high-school degree or higher, were associated with bystander AED use. 5132 OHCAs were included in the propensity score-matched cohort. Bystander AED use was associated with an increased risk of a favorable functional outcome (35% vs. 25%, risk difference: 9.7% [95% confidence interval: 7.2%, 12.2%], risk ratio: 1.38 [95% confidence interval: 1.27, 1.50]). This was driven by increased favorable functional outcomes with AED use in patients with shockable rhythms (58% vs. 39%) but not in patients with non-shockable rhythms (10% vs. 10%).

CONCLUSIONS:

Specific neighborhood characteristics were associated with bystander AED use in OHCA. Bystander AED use was associated with an increase in favorable functional outcome.

KEYWORDS:

Automated external defibrillator; Cardiac arrest; Neighborhood; Outcomes

[Indexed for MEDLINE]

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