Impact of bystander automated external defibrillator use on survival and functional outcomes in shockable observed public cardiac arrests

Ross A. Pollack, Siobhan P. Brown, Thomas Rea, Tom Aufderheide, David Barbic, Jason E. Buick, Jim Christenson, Ahamed H Idris, Jamie Jasti, Michael Kampp, Peter Kudenchuk, Susanne May, Marc Muhr, Graham Nichol, Joseph P. Ornato, George Sopko, Christian Vaillancourt, Laurie Morrison, Myron Weisfeldt

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

BACKGROUND: Survival following out-of-hospital cardiac arrest (OHCA) with shockable rhythms can be improved with early defibrillation. Although shockable OHCA accounts for only ≈25% of overall arrests, ≈60% of public OHCAs are shockable, offering the possibility of restoring thousands of individuals to full recovery with early defibrillation by bystanders. We sought to determine the association of bystander automated external defibrillator use with survival and functional outcomes in shockable observed public OHCA. METHODS: From 2011 to 2015, the Resuscitation Outcomes Consortium prospectively collected detailed information on all cardiac arrests at 9 regional centers. The exposures were shock administration by a bystander-applied automated external defibrillator in comparison with initial defibrillation by emergency medical services. The primary outcome measure was discharge with normal or near-normal (favorable) functional status defined as a modified Rankin Score ≤2. Survival to hospital discharge was the secondary outcome measure. RESULTS: Among 49 555 OHCAs, 4115 (8.3%) observed public OHCAs were analyzed, of which 2500 (60.8%) were shockable. A bystander shock was applied in 18.8% of the shockable arrests. Patients shocked by a bystander were significantly more likely to survive to discharge (66.5% versus 43.0%) and be discharged with favorable functional outcome (57.1% versus 32.7%) than patients initially shocked by emergency medical services. After adjusting for known predictors of outcome, the odds ratio associated with a bystander shock was 2.62 (95% confidence interval, 2.07-3.31) for survival to hospital discharge and 2.73 (95% confidence interval, 2.17-3.44) for discharge with favorable functional outcome. The benefit of bystander shock increased progressively as emergency medical services response time became longer. CONCLUSIONS: Bystander automated external defibrillator use before emergency medical services arrival in shockable observed public OHCA was associated with better survival and functional outcomes. Continued emphasis on public automated external defibrillator utilization programs may further improve outcomes of OHCA.

Original languageEnglish (US)
Pages (from-to)2104-2113
Number of pages10
JournalCirculation
Volume137
Issue number20
DOIs
StatePublished - Jan 1 2018

Fingerprint

Out-of-Hospital Cardiac Arrest
Defibrillators
Heart Arrest
Emergency Medical Services
Shock
Survival
Public Hospitals
Outcome Assessment (Health Care)
Confidence Intervals
Resuscitation
Reaction Time
Odds Ratio

Keywords

  • cardiac arrest
  • cardiopulmonary resuscitation
  • defibrillators
  • mortality
  • public policy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Pollack, R. A., Brown, S. P., Rea, T., Aufderheide, T., Barbic, D., Buick, J. E., ... Weisfeldt, M. (2018). Impact of bystander automated external defibrillator use on survival and functional outcomes in shockable observed public cardiac arrests. Circulation, 137(20), 2104-2113. https://doi.org/10.1161/CIRCULATIONAHA.117.030700

Impact of bystander automated external defibrillator use on survival and functional outcomes in shockable observed public cardiac arrests. / Pollack, Ross A.; Brown, Siobhan P.; Rea, Thomas; Aufderheide, Tom; Barbic, David; Buick, Jason E.; Christenson, Jim; Idris, Ahamed H; Jasti, Jamie; Kampp, Michael; Kudenchuk, Peter; May, Susanne; Muhr, Marc; Nichol, Graham; Ornato, Joseph P.; Sopko, George; Vaillancourt, Christian; Morrison, Laurie; Weisfeldt, Myron.

In: Circulation, Vol. 137, No. 20, 01.01.2018, p. 2104-2113.

Research output: Contribution to journalArticle

Pollack, RA, Brown, SP, Rea, T, Aufderheide, T, Barbic, D, Buick, JE, Christenson, J, Idris, AH, Jasti, J, Kampp, M, Kudenchuk, P, May, S, Muhr, M, Nichol, G, Ornato, JP, Sopko, G, Vaillancourt, C, Morrison, L & Weisfeldt, M 2018, 'Impact of bystander automated external defibrillator use on survival and functional outcomes in shockable observed public cardiac arrests', Circulation, vol. 137, no. 20, pp. 2104-2113. https://doi.org/10.1161/CIRCULATIONAHA.117.030700
Pollack, Ross A. ; Brown, Siobhan P. ; Rea, Thomas ; Aufderheide, Tom ; Barbic, David ; Buick, Jason E. ; Christenson, Jim ; Idris, Ahamed H ; Jasti, Jamie ; Kampp, Michael ; Kudenchuk, Peter ; May, Susanne ; Muhr, Marc ; Nichol, Graham ; Ornato, Joseph P. ; Sopko, George ; Vaillancourt, Christian ; Morrison, Laurie ; Weisfeldt, Myron. / Impact of bystander automated external defibrillator use on survival and functional outcomes in shockable observed public cardiac arrests. In: Circulation. 2018 ; Vol. 137, No. 20. pp. 2104-2113.
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AU - Pollack, Ross A.

AU - Brown, Siobhan P.

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AU - Aufderheide, Tom

AU - Barbic, David

AU - Buick, Jason E.

AU - Christenson, Jim

AU - Idris, Ahamed H

AU - Jasti, Jamie

AU - Kampp, Michael

AU - Kudenchuk, Peter

AU - May, Susanne

AU - Muhr, Marc

AU - Nichol, Graham

AU - Ornato, Joseph P.

AU - Sopko, George

AU - Vaillancourt, Christian

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N2 - BACKGROUND: Survival following out-of-hospital cardiac arrest (OHCA) with shockable rhythms can be improved with early defibrillation. Although shockable OHCA accounts for only ≈25% of overall arrests, ≈60% of public OHCAs are shockable, offering the possibility of restoring thousands of individuals to full recovery with early defibrillation by bystanders. We sought to determine the association of bystander automated external defibrillator use with survival and functional outcomes in shockable observed public OHCA. METHODS: From 2011 to 2015, the Resuscitation Outcomes Consortium prospectively collected detailed information on all cardiac arrests at 9 regional centers. The exposures were shock administration by a bystander-applied automated external defibrillator in comparison with initial defibrillation by emergency medical services. The primary outcome measure was discharge with normal or near-normal (favorable) functional status defined as a modified Rankin Score ≤2. Survival to hospital discharge was the secondary outcome measure. RESULTS: Among 49 555 OHCAs, 4115 (8.3%) observed public OHCAs were analyzed, of which 2500 (60.8%) were shockable. A bystander shock was applied in 18.8% of the shockable arrests. Patients shocked by a bystander were significantly more likely to survive to discharge (66.5% versus 43.0%) and be discharged with favorable functional outcome (57.1% versus 32.7%) than patients initially shocked by emergency medical services. After adjusting for known predictors of outcome, the odds ratio associated with a bystander shock was 2.62 (95% confidence interval, 2.07-3.31) for survival to hospital discharge and 2.73 (95% confidence interval, 2.17-3.44) for discharge with favorable functional outcome. The benefit of bystander shock increased progressively as emergency medical services response time became longer. CONCLUSIONS: Bystander automated external defibrillator use before emergency medical services arrival in shockable observed public OHCA was associated with better survival and functional outcomes. Continued emphasis on public automated external defibrillator utilization programs may further improve outcomes of OHCA.

AB - BACKGROUND: Survival following out-of-hospital cardiac arrest (OHCA) with shockable rhythms can be improved with early defibrillation. Although shockable OHCA accounts for only ≈25% of overall arrests, ≈60% of public OHCAs are shockable, offering the possibility of restoring thousands of individuals to full recovery with early defibrillation by bystanders. We sought to determine the association of bystander automated external defibrillator use with survival and functional outcomes in shockable observed public OHCA. METHODS: From 2011 to 2015, the Resuscitation Outcomes Consortium prospectively collected detailed information on all cardiac arrests at 9 regional centers. The exposures were shock administration by a bystander-applied automated external defibrillator in comparison with initial defibrillation by emergency medical services. The primary outcome measure was discharge with normal or near-normal (favorable) functional status defined as a modified Rankin Score ≤2. Survival to hospital discharge was the secondary outcome measure. RESULTS: Among 49 555 OHCAs, 4115 (8.3%) observed public OHCAs were analyzed, of which 2500 (60.8%) were shockable. A bystander shock was applied in 18.8% of the shockable arrests. Patients shocked by a bystander were significantly more likely to survive to discharge (66.5% versus 43.0%) and be discharged with favorable functional outcome (57.1% versus 32.7%) than patients initially shocked by emergency medical services. After adjusting for known predictors of outcome, the odds ratio associated with a bystander shock was 2.62 (95% confidence interval, 2.07-3.31) for survival to hospital discharge and 2.73 (95% confidence interval, 2.17-3.44) for discharge with favorable functional outcome. The benefit of bystander shock increased progressively as emergency medical services response time became longer. CONCLUSIONS: Bystander automated external defibrillator use before emergency medical services arrival in shockable observed public OHCA was associated with better survival and functional outcomes. Continued emphasis on public automated external defibrillator utilization programs may further improve outcomes of OHCA.

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