83 For out-of-hospital cardiac arrest (OHCA) at public locations community bystander defibrillation rescue has better impact on patient outcomes compared with dispatcher-assisted telephone CPR (DATCPR)

• Published in: BMJ open 2018-04, Vol.8 (Suppl 1), p.A31-A32
• Main Authors: Ko, PC, Huang, SC, Chen, YW, Hsaio, HY, Shih, CL
• Format: Article
• Language: English
• Subjects: Ambulance services; Cardiac arrest; Cardiopulmonary resuscitation; CPR; Defibrillators; Heart attacks; Patients
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-EMS.83

AimWe compared the outcomes between a community-­wide bystander defibrillation rescue program and a DATCPR program in patients after out-­of-­hospital cardiac arrest at public sites.MethodA prospective 2–year community–wide observational database collected from a metropolitan OHCA Web-based Registry was studied, after a citywide bystander defibrillation rescue program had been launched that public accessed AEDs (automated external defibrillators) were strategically implemented in designated locations and electronically registered; and a DATCPR program had been well run in the dispatch centre. The survival outcomes of OHCA at pubic locations between the two program interventions were compared. Outcomes included 2–hour sustained ROSC (return of spontaneous circulation) at hospital, survival to hospital discharge, and good CPC (Cerebral Performance Category Scale 1 or 2). All patient pre­hospital characteristics and outcome relations were evaluated and adjusted by regression analysis.ResultsThe density of public AEDs distribution increased from 3.96 to 6.24 per square kilometres in the studied 2 years. Among a total of 6,356 OHCA, 627 patients occurred at public locations, including 28 patients (male for 82%, witnessed arrest for 79%) received bystander aid by public AEDs plus CPR rescue and 243 patients (male for 64%, witnessed arrest for 61%) received DATCPR intervention. For these 28 patients, 53.6% (15/28) achieved pre­hospital ROSC at scene or during transport, 71.4% (20/28) achieved sustained ROSC after resuscitation at hospital, 57.1% (16/28) achieved survival–to–discharge and noticeably all those 16 (100%, 16/16) survival-­to-­discharge patients achieved excellent neurological outcome of CPC 1 (CPC Scale 1). Their outcomes were significantly better (71.4 vs 43.6%, OR: 3.2 [95% CI: 1.4 to 7.6] for sustained ROSC; 57.1 vs 25.9%, OR: 3.8 [95% CI: 1.7 to 8.5] for survival of discharge; 57.1 vs 16.9%, OR: 6.6 [95% CI: 2.9 to 14.9] for good CPC; and 100 vs 65.1% for good CPC among survival–to–discharge) compared with those 243 patients by DATCPR rescue. In 28 patients by bystander defibrillation rescue only one man without pre­hospital ROSC still achieved survival–to-­discharge and good CPC.ConclusionFor OHCA patients at public locations, we found that a community­-wide bystander defibrillation program were associated with excellent neurological outcome of CPC 1 and survival to hospital discharge that were significantly higher than those associated with DAT