Alert system-supported lay defibrillation and basic life-support for cardiac arrest at home

Abstract

Background Automated external defibrillators (AEDs) are placed in public, but the majority of out-of-hospital cardiac arrests (OHCA) occur at home. Methods In residential areas 785 AEDs were placed and 5735 volunteer responders recruited. For suspected OHCA, dispatchers activated nearby volunteer responders with text messages, directing two-thirds to an AED first and one-third directly to the patient. We analyzed survival (primary outcome) and neurologically favorable survival to discharge, time to first defibrillation shock and cardiopulmonary resuscitation (CPR) before Emergency Medical Service (EMS) arrival of patients in residences found with ventricular fibrillation (VF), before and after introduction of this text-message alert system. Results Survival from OHCAs in residences increased from 26% to 39% [adjusted relative risk (RR) 1.5 (95% CI 1.03–2.0)]. RR for neurologically favorable survival was 1.4 (95% CI 0.99 - 2.0). No CPR before ambulance arrival decreased from 22% to 9% (RR 0.5, 95% CI 0.3 - 0.7). Text-message-responders with AED administered shocks to 16% of all patients in VF in residences, while defibrillation by EMS decreased from 73% to 39% in residences (p < 0.001). Defibrillation by first responders in residences increased from 22% to 40% (p < 0.001). Use of public AEDs in residences remained unchanged (6% and 5%) (p = 0.81). Time from emergency call to defibrillation decreased from median 11.7 min to 9.3 min; mean difference -2.6 (95% CI -3.5 - -1.6). Conclusion Introducing volunteer responders directed to AEDs, dispatched by text-message was associated with significantly reduced time to first defibrillation, increased bystander CPR and increased overall survival for OHCA patients in residences found with VF.

Dispatching citizens as first responders to out-of-hospital cardiac arrests: a systematic review and meta-analysis

“…Details of studies excluded are displayed in the Supplementary Table 1, Supplemental digital content 1, http://links.lww.com/EJEM/A327. All included studies were published between 2015 and 2021, seven in Europe [12,15,17,21,[28][29][30], two in Asia [31,32], and one in the USA [33]. Four of the included studies adopted a text message-based alert system [21,28,30,31], whereas the remaining six studies implemented a smartphone app to alert citizen first responders [12,15,17,29,32,33].…”

“…Three studies compared activation versus no activation of citizen first responders activation [17,21,29], three studies compared before and after the implementation of a network of citizen first responders [30][31][32]. The remaining three studies compared OHCAs where citizen first responders were activated and at least one responded versus no one responded [28], OHCAs where citizen first responders arrived first with those where EMS arrived first [15], and OHCAs where CPR was initiated by citizen first responders with those with CPR initiated by EMS [12].…”

The year in cardiovascular medicine 2021: arrhythmias

“…A novel strategy of alert system-supported lay defibrillation and basic life-support was superior to usual resuscitation in a randomized study from the Netherlands with improved out-of-hospital cardiac arrest survival from 26 to 39% and 50% more patients with neurologically favourable outcome. 18 A spectacular new concept from Sweden concerned drone delivery of an AED to the out-of-hospital cardiac arrest scene integrated in the standard emergency medical services, showing that delivery was feasible with earlier arrival of AED by 2 min. 19 Both papers illustrate that the chain-of-survival for cardiac arrest is boosted significantly by novel technologies and implicitly they provide an example for regions with less advanced resuscitation infrastructure.…”

Increased bystander intervention when volunteer responders attend out-of-hospital cardiac arrest

“…During the last decade, a strategy of activating volunteer responders to increase bystander cardiopulmonary resuscitation (CPR) and early defibrillation with automated external defibrillators (AEDs) has been implemented world-wide with positive results and increasing interest from both the general public and professionals (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Globally, survival following out-of-hospital cardiac arrest (OHCA) ranges from 2 to 11% with great variations (12,13).…”