Automated external defibrillator use and outcomes after out-of-hospital cardiac arrest: an Israeli cohort study.
Aged
Cognitive Dysfunction
/ epidemiology
Cohort Studies
Coronary Care Units
Defibrillators
/ statistics & numerical data
Electric Countershock
/ statistics & numerical data
Emergency Medical Services
Female
Hospital Mortality
Humans
Israel
Male
Middle Aged
Mortality
Myocardial Infarction
Out-of-Hospital Cardiac Arrest
/ therapy
Public Policy
Retrospective Studies
Tachycardia, Ventricular
/ therapy
Ventricular Fibrillation
/ therapy
Journal
Coronary artery disease
ISSN: 1473-5830
Titre abrégé: Coron Artery Dis
Pays: England
ID NLM: 9011445
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
pubmed:
29
10
2019
medline:
29
6
2021
entrez:
29
10
2019
Statut:
ppublish
Résumé
Out-of-hospital cardiac arrests (OHCA) are a serious healthcare situation with low survival rates. Application of an automated external defibrillator (AED) by bystanders shortens time to defibrillation and increases survival. In Israel, a regulation ensuring the presence of AED in public places was issued and implemented since 2014. We investigated whether this regulation had an impact on the outcomes of OHCA patients. We performed a retrospective, single-center observational study. Included in the cohort were patients who were admitted to the department of intensive care cardiac unit with OHCA. Patients were stratified into two groups according to the year the regulation was introduced: group 1 (2009-2013) and group 2 (2014-2018). A total of 77 patients were included in group 1 and 61 in group 2. The utilization of AED was significantly higher in group 2 compared to group 1 (42% vs. 27%; P = 0.04). Compared to group 1 patients, group 2 had lower 48 h (0% vs. 8%; P = 0.02) and 30-day mortality (28% vs. 42%; P = 0.02). Cognitive damage following recovery was less frequent in group 2 (55% vs. 81%; P = 0.01). Deployment of AEDs in public places by mandatory regulations increased utilization for OHCA and may improve outcomes.
Sections du résumé
BACKGROUND
Out-of-hospital cardiac arrests (OHCA) are a serious healthcare situation with low survival rates. Application of an automated external defibrillator (AED) by bystanders shortens time to defibrillation and increases survival. In Israel, a regulation ensuring the presence of AED in public places was issued and implemented since 2014. We investigated whether this regulation had an impact on the outcomes of OHCA patients.
METHODS
We performed a retrospective, single-center observational study. Included in the cohort were patients who were admitted to the department of intensive care cardiac unit with OHCA. Patients were stratified into two groups according to the year the regulation was introduced: group 1 (2009-2013) and group 2 (2014-2018).
RESULTS
A total of 77 patients were included in group 1 and 61 in group 2. The utilization of AED was significantly higher in group 2 compared to group 1 (42% vs. 27%; P = 0.04). Compared to group 1 patients, group 2 had lower 48 h (0% vs. 8%; P = 0.02) and 30-day mortality (28% vs. 42%; P = 0.02). Cognitive damage following recovery was less frequent in group 2 (55% vs. 81%; P = 0.01).
CONCLUSION
Deployment of AEDs in public places by mandatory regulations increased utilization for OHCA and may improve outcomes.
Identifiants
pubmed: 31658139
doi: 10.1097/MCA.0000000000000807
pii: 00019501-202005000-00016
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
289-292Références
Atwood C, Eisenberg MS, Herlitz J, Rea TD. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation. 2005; 67:75–80
Hirlekar G, Jonsson M, Karlsson T, Hollenberg J, Albertsson P, Herlitz J. Comorbidity and survival in out-of-hospital cardiac arrest. Resuscitation. 2018; 133:118–123
Shin SM, Kim KS, Suh GJ, Kim K, Kwon WY, Shin J, et al. Prediction of neurological outcomes following the return of spontaneous circulation in patients with out-of-hospital cardiac arrest: retrospective fast-and-frugal tree analysis. Resuscitation. 2018; 133:65–70
Gregers E, Kjærgaard J, Lippert F, Thomsen JH, Køber L, Wanscher M, et al. Refractory out-of-hospital cardiac arrest with ongoing cardiopulmonary resuscitation at hospital arrival - survival and neurological outcome without extracorporeal cardiopulmonary resuscitation. Crit Care. 2018; 22:242
Nguyen P, Alreshaid L, Poblete R, Konye G, Marehbian J, Sung G. Targeted temperature management and multimodality monitoring of comatose patients after cardiac arrest. Front Neurol. 2018; 9:768
Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010; 81:1479–1487
Drezner JA, Peterson DF, Siebert DM, Thomas LC, Lopez-Anderson M, Suchsland MZ, et al. Survival after exercise-related sudden cardiac arrest in young athletes: can we do better? Sports Health. 2019; 11:91–98
Berdowski J, Kuiper MJ, Dijkgraaf MG, Tijssen JG, Koster RW. Survival and health care costs until hospital discharge of patients treated with onsite, dispatched or without automated external defibrillator. Resuscitation. 2010; 81:962–967
Nolan JP, Deakin CD, Soar J, Böttiger BW, Smith G; European Resuscitation Council. European resuscitation council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation. 2005; 67Suppl 1S39–S86
Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, et al.; Adult advanced life support section Collaborators. European resuscitation council guidelines for resuscitation 2015: section 3. Adult advanced life support. Resuscitation. 2015; 95:100–147
Fredman D, Ringh M, Svensson L, Hollenberg J, Nordberg P, Djärv T, et al. Experiences and outcome from the implementation of a national Swedish automated external defibrillator registry. Resuscitation. 2018; 130:73–80
. http://main.knesset.gov.il/Activity/committees/Labor/Regulation/calcala021213.pdf)Hebrew). Accessed January 23, 2018
Holmberg MJ, Vognsen M, Andersen MS, Donnino MW, Andersen LW. Bystander automated external defibrillator use and clinical outcomes after out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2017; 120:77–87
Spaite DW. Lay responder defibrillation, pancake breakfasts, and survival from out-of-hospital cardiac arrest. Ann Emerg Med. 2009; 54:236–238
Nichol G, Elrod JA, Becker LB. Treatment for out-of-hospital cardiac arrest: is the glass half empty or half full? Circulation. 2014; 130:1844–1846
Nas J, Thannhauser J, Herrmann JJ, van der Wulp K, van Grunsven PM, van Royen N, et al. Changes in automated external defibrillator use and survival after out-of-hospital cardiac arrest in the nijmegen area. Neth Heart J. 2018; 26:600–605
Hasselqvist-Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 2015; 372:2307–2315
Folke F, Lippert FK, Nielsen SL, Gislason GH, Hansen ML, Schramm TK, et al. Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations. Circulation. 2009; 120:510–517
Fredman D, Haas J, Ban Y, Jonsson M, Svensson L, Djarv T, et al. Use of a geographic information system to identify differences in automated external defibrillator installation in urban areas with similar incidence of public out-of-hospital cardiac arrest: a retrospective registry-based study. BMJ Open. 2017; 7:e014801
Zijlstra JA, Stieglis R, Riedijk F, Smeekes M, van der Worp WE, Koster RW. Local lay rescuers with AEDs, alerted by text messages, contribute to early defibrillation in a Dutch out-of-hospital cardiac arrest dispatch system. Resuscitation. 2014; 85:1444–1449
Demidova MM, Smith JG, Höijer CJ, Holmqvist F, Erlinge D, Platonov PG. Prognostic impact of early ventricular fibrillation in patients with ST-elevation myocardial infarction treated with primary PCI. Eur Heart J Acute Cardiovasc Care. 2012; 1:302–311
Rittenberger JC, Callaway CW. Temperature management and modern post-cardiac arrest care. N Engl J Med. 2013; 369:2262–2263
Blom MT, Beesems SG, Homma PC, Zijlstra JA, Hulleman M, van Hoeijen DA, et al. Improved survival after out-of-hospital cardiac arrest and use of automated external defibrillators. Circulation. 2014; 130:1868–1875
HasselqvistAx I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 2015; 372:2307–2315
Fredman D, Svensson L, Ban Y, Jonsson M, Hollenberg J, Nordberg P, et al. Expanding the first link in the chain of survival - experiences from dispatcher referral of callers to AED locations. Resuscitation. 2016; 107:129–134
Ringh M, Rosenqvist M, Hollenberg J, Jonsson M, Fredman D, Nordberg P, et al. Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest. N Engl J Med. 2015; 372:2316–2325
Deakin CD, Shewry E, Gray HH. Public access defibrillation remains out of reach for most victims of out-of-hospital sudden cardiac arrest. Heart. 2014; 100:619–623