The role of bystanders, first responders, and emergency medical service providers in timely defibrillation and related outcomes after out-of-hospital cardiac arrest: Results from a statewide registry.

Defibrillation by bystanders and first responders has been associated with increased survival, but limited data are available from non-metropolitan areas. We examined time from 911-call to defibrillation (according to who defibrillated patients) and survival in North Carolina. Through the Cardiac Arrest Registry to Enhance Survival, we identified 1732 defibrillated out-of-hospital cardiac arrests from counties with complete case capture (population 2.7 million) from 2010 to 2013. Most patients (60.9%) were defibrillated in > 10 min. A minority (8.0%) was defibrillated < 5 min; most of these patients were defibrillated by first responders (51.8%) and bystanders (33.1%), independent of location of arrest (residential or public). Bystanders initiated cardiopulmonary resuscitation (CPR) in 49.0% of cases and defibrillated 13.4% of those. Survival decreased with increasing time to defibrillation (< 2 min: 59.1%; 2 to < 5 min: 38.5%; 5-10 min: 33.1%; > 10 min: 13.2%). Odds of survival with favorable neurologic outcome adjusted for age, sex, and bystander CPR improved with faster defibrillation (<2 min: OR 7.73 [95% CI 3.19-18.73]; 2 to < 5 min: 3.78 [2.45-5.84]; 5-10 min: 3.16 [2.42-4.12]; > 10 min: reference). Bystanders and first responders were mainly responsible for defibrillation within 5 min, independent of location of arrest. Bystanders initiated CPR in half of the cardiac arrest cases but only defibrillated a minority of those. Timely defibrillation and defibrillation by bystanders and/or first responders were strongly associated with increased survival. Strategic efforts to increase bystander and first-responder defibrillation are warranted to increase survival after out-of-hospital cardiac arrest.

Hansen CM ，Kragholm K ，Granger CB ，Pearson DA ，Tyson C ，Monk L ，Corbett C ，Nelson RD ，Dupre ME ，Fosbøl EL ，Strauss B ，Fordyce CB ，McNally B ，Jollis JG ... -  《-》

Association of Bystander and First-Responder Intervention With Survival After Out-of-Hospital Cardiac Arrest in North Carolina, 2010-2013.

Malta Hansen C ，Kragholm K ，Pearson DA ，Tyson C ，Monk L ，Myers B ，Nelson D ，Dupre ME ，Fosbøl EL ，Jollis JG ，Strauss B ，Anderson ML ，McNally B ，Granger CB ... -  《-》

Trends in survival from out-of-hospital cardiac arrests defibrillated by paramedics, first responders and bystanders.

Although survival from out-of-hospital cardiac arrest (OHCA) is increasing, little is known about the long-term trends in survival for patients defibrillated by first responders and bystanders. Between 2000 and 2017, we included adult non-traumatic OHCA with an initial shockable rhythm from the Victorian Ambulance Cardiac Arrest Registry. Adjusted logistic regression analyses were used to assess trends in survival to hospital discharge according to whether the patient was initially shocked by paramedics, first responders or bystanders. Of the 10,451 initial shockable arrests, 796 (7.6%) and 526 (5.0%) were initially shocked by first responders and bystanders, respectively. Between 2000-02 and 2015-17, the proportion of cases initially shocked by first responders and bystanders increased from 3.8% to 8.2% and from 2.0% to 11.2%, respectively. Over the same period, survival to hospital discharge increased from 11.6% to 28.8% for cases initially shocked by paramedics, from 10.5% to 37.8% for cases initially shocked by first responders, and from 6.7% to 55.5% for cases initially shocked by bystanders (p trend <0.001 for all). In the adjusted analyses, patients initially shocked by first responders (AOR 1.40, 95% CI: 1.18, 1.67; p < 0.001) and bystanders (AOR 2.11, 95% CI: 1.72, 2.59; p < 0.001) were more likely to survive to hospital discharge than those initially shocked by paramedics. The odds of survival increased year-on-year by 8.1% for patients shocked by paramedics (p < 0.001), 6.1% for patients shocked by first responders (p = 0.004), and 11.8% for patients shocked by bystanders (p < 0.001). OHCA patients initially defibrillated by bystanders yielded the largest improvements in survival over time.

Nehme Z ，Andrew E ，Bernard S ，Haskins B ，Smith K ... -  《-》

Out-of-hospital cardiac arrest surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010.

McNally B ，Robb R ，Mehta M ，Vellano K ，Valderrama AL ，Yoon PW ，Sasson C ，Crouch A ，Perez AB ，Merritt R ，Kellermann A ，Centers for Disease Control and Prevention ... -  《MMWR SURVEILLANCE SUMMARIES》

Association of Public Health Initiatives With Outcomes for Out-of-Hospital Cardiac Arrest at Home and in Public Locations.

Fordyce CB ，Hansen CM ，Kragholm K ，Dupre ME ，Jollis JG ，Roettig ML ，Becker LB ，Hansen SM ，Hinohara TT ，Corbett CC ，Monk L ，Nelson RD ，Pearson DA ，Tyson C ，van Diepen S ，Anderson ML ，McNally B ，Granger CB ... -  《-》