European first responder systems and differences in return of spontaneous circulation and survival after out-of-hospital cardiac arrest: A study of registry cohorts

Oving, Iris; Graaf, Corina de; Masterson, Siobhán; Koster, Rudolph W.; Zwinderman, Aeilko H.; Stieglis, Remy; Alihodžić, Hajriz; Baldi, Enrico; Betz, Susanne; Cimpoeşu, Diana; Folke, Fredrik; Rupp, Dennis; Semeraro, Federico; Truhlář, Anatolij; Tan, Hanno L.; Blom, Marieke T.

doi:10.1016/j.lanepe.2020.100004

Cited by 29 publications

(28 citation statements)

References 30 publications

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“…For the professional FRs, the situation is different because they are often equipped with an AED and can bring the defibrillator to the OHCA scene when alerted, resulting in a reduction of the time to the first defibrillation, which is associated with an increased chance of survival [35]. The effectiveness and the capability of the FR system to increase survival is already well-documented [8]. In our survey, we found that only in 11 out of 19 countries were the professional FRs alerted by the EMS equipped with an AED, stressing the need to improve this aspect throughout Europe.…”

Section: Aed Mapping and First Responder Systemsmentioning

confidence: 99%

“…Early defibrillation increases not only the rate of return of spontaneous circulation (ROSC) and survival but also a favorable neurological outcome at the hospital discharge, irrespective of it being a witnessed event, bystander CPR or an initial rhythm [3][4][5]. AED use by a bystander or first responders (FRs; i.e., police officers, firefighters, off-duty medical personnel and trained lay persons alerted when a patient experiences an OHCA nearby) before the arrival of emergency medical service (EMS) personnel is of a primary importance particularly when considering that the earlier the defibrillation, the higher the chance of survival [6][7][8]. This concept was proven in the early 2000s, when the public-access defibrillation (PAD) trial was carried out in the USA involving security officers after cardiac arrests in casinos [9] and has been continuously reinforced by numerous scientific publications subsequently released [10,11].…”

Section: Introductionmentioning

confidence: 99%

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The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study

Baldi

Grieco

Ristagno

et al. 2021

JCM

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Introduction: The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of an AED use. We aimed to verify the situation regarding AED legislation, the AED mapping system and first responders (FRs) equipped with an AED across European countries. Methods: We performed a survey across Europe entitled “European Study about AED Use by Lay Rescuers” (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it. Results: Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12–59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0–7.9%), reflecting the difference in OHCA survival. Conclusions: Our survey highlighted a heterogeneity in AED legislation, AED mapping systems and AED use in Europe, which was reflected in different AED use and survival.

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Section: Aed Mapping and First Responder Systemsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study

Baldi

Grieco

Ristagno

et al. 2021

JCM

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“…SCA is a major public health problem, causing 20% of total mortality in industrialized societies (7,8). SCA most often occurs in the community (out-of-hospital cardiac arrest) where rescuers are most often too late to arrive, resulting in low survival rates, ranging from 4 to 27% across Europe (9). Moreover, those who survive may suffer significant and persistent disabilities due to long-lasting hypoperfusion of the heart and the brain (7,10).…”

Section: Introductionmentioning

confidence: 99%

Anxiety, Mental Stress, and Sudden Cardiac Arrest: Epidemiology, Possible Mechanisms and Future Research

et al. 2022

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Sudden cardiac arrest (SCA) is a leading cause of mortality and morbidity in affluent societies, which underscores the need to identify persons at risk. The etiology of SCA is however complex, with predisposing and precipitating factors interacting. Although anxiety and mental stress have been linked to SCA for decades, their precise role and impact remain unclear and the biological underpinnings are insufficiently understood. In this paper, we systematically reviewed various types of observational studies (total n = 20) examining the association between anxiety or mental stress and SCA. Multiple methodological considerations challenged the summarizing and interpretation of the findings. For anxiety, the overall picture suggests that it predisposes for SCA in physically healthy populations (unadjusted OR = 2.44; 95% CI: 1.06–5.59; n = 3). However, in populations at risk for SCA (n = 4), associations were heterogeneous but not significant. Anxiety may partly predispose to SCA by contributing to other risk factors such as cardiovascular disease and diabetes mellitus via mechanisms such as unhealthy lifestyle and metabolic abnormalities. Mental stress appears to precipitate SCA, presumably by more directly impacting on the cardiac ion channels that control the heart's electrical properties. This may lead to ventricular fibrillation, the arrhythmia that underlies SCA. To advance this field of research, experimental studies that unravel the underlying biological mechanisms are deemed important, and most easily designed for mental stress as a precipitating factor because of the short timeframe. These proof-of-concept studies should examine the whole pathway from the brain to the autonomic nervous system, and eventually to cardiac ion channels. Ultimately, such studies may facilitate the identification of persons at risk and the development of novel preventive strategies.

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“…FR are usually alerted by smartphone and arrive earlier on scene than the EMS, leading to an earlier start of CPR [6,[13][14][15]. Approximately half of all European countries have implemented-to some degree-FR schemes [16] and the number is growing fast. FR schemes are associated with increased survival [7,[17][18][19].…”

Section: Introductionmentioning

confidence: 99%

First responder systems can stay operational under pandemic conditions: results of a European survey during the COVID-19 pandemic

Metelmann

Müller

et al. 2022

Scand J Trauma Resusc Emerg Med

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Background Dispatching first responders (FR) to out-of-hospital cardiac arrest in addition to the emergency medical service has shown to increase survival. The promising development of FR systems over the past years has been challenged by the outbreak of COVID-19. Whilst increased numbers and worse outcomes of cardiac arrests during the pandemic suggest a need for expansion of FR schemes, appropriate risk management is required to protect first responders and patients from contracting COVID-19. This study investigated how European FR schemes were affected by the pandemic and what measures were taken to protect patients and responders from COVID-19. Methods To identify FR schemes in Europe we conducted a literature search and a web search. The schemes were contacted and invited to answer an online questionnaire during the second wave of the pandemic (December 2020/ January 2021) in Europe. Results We have identified 135 FR schemes in 28 countries and included responses from 47 FR schemes in 16 countries. 25 schemes reported deactivation due to COVID-19 at some point, whilst 22 schemes continued to operate throughout the pandemic. 39 schemes communicated a pandemic-specific algorithm to their first responders. Before the COVID-19 outbreak 20 FR systems did not provide any personal protective equipment (PPE). After the outbreak 19 schemes still did not provide any PPE. The majority of schemes experienced falling numbers of accepted call outs and decreasing registrations of new volunteers. Six schemes reported of FR having contracted COVID-19 on a mission. Conclusions European FR schemes were considerably affected by the pandemic and exhibited a range of responses to protect patients and responders. Overall, FR schemes saw a decrease in activity, which was in stark contrast to the high demand caused by the increased incidence and mortality of OHCA during the pandemic. Given the important role FR play in the chain of survival, a balanced approach upholding the safety of patients and responders should be sought to keep FR schemes operational.

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European first responder systems and differences in return of spontaneous circulation and survival after out-of-hospital cardiac arrest: A study of registry cohorts

Cited by 29 publications

References 30 publications

The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study

The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study

Anxiety, Mental Stress, and Sudden Cardiac Arrest: Epidemiology, Possible Mechanisms and Future Research

First responder systems can stay operational under pandemic conditions: results of a European survey during the COVID-19 pandemic

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