MORTALITY RATES OF SUSPECTED OUT-OF-HOSPITAL CARDIAC ARREST PATIENTS AFTER INTRODUCTION OF A

LAY RESCUER PROGRAM

More information:Dr Carine Doggen, PhDwww.utwente.nl/mb/htsr/staffC.J.M.Doggen@utwente.nl

Smid J1, IJzerman MJ1, Van Houwelingen G2, Van Manen JG1, Van der Worp WE3, Doggen CJM1

1 University of Twente, HealthTechnology and Services Research, Enschede, the Netherlands, 2 Medisch Spectrum Twente, Thoraxcentrum Twente, Dept of Cardiology, Enschede, the Netherlands, 3 Ambulance Oost, Hengelo, the Netherlands

OBJECTIVES

Mortality rates of out-of-hospital cardiac arrest (OHCA) patients may be reduced by improving early bystander cardiopulmonary resuscitation (CPR) or automated external defibrillator (AED) use. The aim of this study is to assess mortality rates after introduction of a lay rescuer program (AED-alert) that actively mobilizes lay rescuers alongside emergency care services (EMS).

METHODS

• AED-alert site Twente, introduced April 2008 *

• suspected OHCA patients > 18 yr• 1-day and 90-day mortality rates

compared two years before with two years after introduction

• (adjusted) hazard ratios calculated using Cox-regression

* Resuscitation 2011, Scholten AC et al. Early cardiopulmonary resuscitation and use of automated external defibrillators by laypersons in out-of-hospital cardiac arrest using an SMS alert service

RESULTS

DISCUSSION

The program AED-alert initially appears to be associated with a decreased one-day mortality rate, but may be less effective in the long-term. The effect was mostly noticed in low urbanized areas and in cases where response time was 8 minutes or more. Mobilizing lay rescuers with AED-alert seems to be most effective for those incidents associated with a delayed EMS response, for example due to travel distance. Further in depth analyses is needed.

112 call

suspected OHCA

AED-alertSMS message

2 ambulances

nearest AEDincident

hospital

Before AED‐alert

(N=916)

After AED‐alert

(N=1,022)

Women 34.5 % 31.5 %

Age, median (25‐75th) 69 (57‐78) 68 (56‐78)

<1,000 households/km2 39.6 % 45.6 %

Response time, median 7:21 (5:27‐10:10) 6:43 (4:32‐9:43)

At home 66.5 % 64.5 %

Before 

AED‐

alert

After 

AED‐

alert

HR Crude 

(95% CI)*

HR adjusted 

(95% CI)**

Overall

1‐day 58.8 % 54.9% 0.93 (0.82‐1.04) 0.96 (0.85‐1.08)

90‐day 69.8 % 67.5 % 0.95 (0.86‐1.06) 1.00 (0.89‐1.11)

Low urbanization level

1‐day 63.1 % 55.2 % 0.86 (0.72‐1.03) 0.89 (0.74‐1.06)

90‐day 74.4 % 69.7 % 0.93 (0.79‐1.09) 0.95 (0.80‐1.12)

>8 min response time

1‐day 62.2 % 57.0 % 0.91 (0.74‐1.11) 0.92 (0.75‐1.13)

90‐day 75.3 % 69.9 % 0.94 (0.78‐1.13) 0.92 (0.77‐1.11)

* 95% confidence interval** adjusted for sex, age, urbanization, location of arrest, response and arrival time (when applicable)

Characteristics of suspected OHCA patients and incidents:

1-Day and 90-day mortality before and after introduction of AED alert :