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Impact of dual dispatch system implementation on response times and survival outcomes in out-of-hospital cardiac arrest in rural areas
1Center for Emergency Medicine, Prehospital unit, Community healthcare center, 2000 Maribor, Slovenia
2Emergency department, University Clinical Centre Maribor, 2000 Maribor, Slovenia
3Department of Emergency Medicine, Medical faculty, University of Maribor, 2000 Maribor, Slovenia
4Community healthcare center, 2360 Radlje ob Dravi, Slovenia
DOI: 10.22514/sv.2021.134 Vol.18,Issue 1,January 2022 pp.76-83
Submitted: 12 May 2021 Accepted: 17 July 2021
Published: 08 January 2022
*Corresponding Author(s): Matej Strnad E-mail: strnad.matej78@gmail.com
Objectives: Dual dispatch early defibrillation in out-of-hospital cardiac arrest (OHCA) victims provided by firefighters in addition to Emergency medical services (EMS) has proven to increase rate of return of spontaneous circulation (ROSC) and thus survival in the metropolitan or suburban areas whereas the data in rural areas are scarce.
Methods: This was a retrospective observational cohort study of EMS resuscitated OHCA victims in regions with dual dispatch of volunteer firefighters as first responders (intervention group). Historical group was based on all OHCAs occurring in these regions before the implementation of first responders (EMS response only). Multivariate logistic regression with following variables: intervention, age, gender, witnessed status, bystander cardiopulmonary resuscitation (CPR), first rhythm and etiology were used to control for confounding factors affecting ROSC.
Results: A total of 312 OHCAs were included in the study (historical group, n = 115 and intervention group, n = 197). Median time to arrival of first help shortened significantly for all patients, patients with ROSC and patients with Cerebral Performance Category 1/2 (CPC 1/2) in intervention vs historical group (8 vs 12 min, p < 0.001; 7.5 vs 11 min, p = 0.002; 7 vs 10 min, p = 0.011; respectively). The proportion of patients with ROSC, 30-day survival and CPC 1/2 at hospital discharge remained unchanged in intervention vs historical group (21% vs 23%, p = 0.808; 7% vs 6%, p = 0.914; 6% vs 3%, p = 0.442; respectively). The logistic regression model of adjustment confirms the absence of improvement in the ROSC rate after the implementation of first responders.
Conclusions: Introduction of a dual dispatch of local first responders in addition to EMS in cases of OHCA significantly shortened response times. However, reduced response times were not associated with better survival outcomes.
Out-of-hospital cardiac arrest; First responder; Survival rate; Sudden cardiac death; Automated external defibrillator; Cardiopulmonary resuscitation; Firefighters
Matej Strnad,Pia Jerot,Vesna Borovnik Lesjak. Impact of dual dispatch system implementation on response times and survival outcomes in out-of-hospital cardiac arrest in rural areas. Signa Vitae. 2022. 18(1);76-83.
[1] Atwood C, Eisenberg MS, Herlitz J, Rea TD. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation. 2005; 67: 75–80.
[2] Gräsner JT, Lefering R, Koster RW, Masterson S, Böttiger BW, Herlitz J, et al. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation. 2016; 105: 188–195.
[3] Hasselqvist-Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. New England Journal of Medicine. 2015; 372: 2307–2315.
[4] Malta Hansen C, Kragholm K, Pearson DA, Tyson C, Monk L, Myers B, et al. Association of Bystander and first-Responder Intervention with Survival after out-of-Hospital Cardiac Arrest in North Carolina, 2010–2013. Journal of the American Medical Association. 2015; 314: 255–264.
[5] Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. New England Journal of Medicine. 2000; 343: 1206–1209.
[6] Hallstrom AP, Ornato JP, Weisfeldt M, Travers A, Christenson J, McBurnie MA, et al. Public-access defibrillation and survival after out-of-hospital cardiac arrest. New England Journal of Medicine. 2004; 351: 637–646.
[7] Capucci A, Aschieri D. Results of early defibrillation program in Piacenza. Minerva Anestesiologica. 2003; 69: 353–356.
[8] Myerburg RJ, Fenster J, Velez M, Rosenberg D, Lai S, Kurlansky P, et al. Impact of community-wide police car deployment of automated external defibrillators on survival from out-of-hospital cardiac arrest. Circulation. 2002; 106: 1058–1064.
[9] Groh WJ, Newman MM, Beal PE, Fineberg NS, Zipes DP. Limited response to cardiac arrest by police equipped with automated external defibrillators: lack of survival benefit in suburban and rural Indiana—the police as responder automated defibrillation evaluation (PARADE). Academic Emergency Medicine. 2001; 8: 324–330.
[10] Kooij FO, van Alem AP, Koster RW, de Vos R. Training of police officers as first responders with an automated external defibrillator. Resuscitation. 2004; 63: 33–41.
[11] Nordberg P, Hollenberg J, Rosenqvist M, Herlitz J, Jonsson M, Järnbert-Petterson H, et al. The implementation of a dual dispatch system in out-of-hospital cardiac arrest is associated with improved short and long term survival. European Heart Journal. 2014; 3: 293–303.
[12] Nordberg P, Jonsson M, Forsberg S, Ringh M, Fredman D, Riva G, et al. The survival benefit of dual dispatch of EMS and fire-fighters in out-of-hospital cardiac arrest may differ depending on population density—a prospective cohort study. Resuscitation. 2015; 90: 143–149.
[13] Saner H, Morger C, Eser P, von Planta M. Dual dispatch early defibrillation in out-of-hospital cardiac arrest in a mixed urban-rural population. Resuscitation. 2013; 84: 1197–1202.
[14] Hollenberg J, Riva G, Bohm K, Nordberg P, Larsen R, Herlitz J, et al. Dual dispatch early defibrillation in out-of-hospital cardiac arrest: the SALSA-pilot. European Heart Journal. 2009; 30: 1781–1789.
[15] 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.
[16] Hansen SM, Brøndum S, Thomas G, Rasmussen SR, Kvist B, Christensen A, et al. Home Care Providers to the Rescue: a Novel first-Responder Programme. PLoS ONE. 2015; 10: e0141352.
[17] White RD, Bunch TJ, Hankins DG. Evolution of a community-wide early defibrillation programme: Experience over 13 years using police/fire personnel and paramedics as responders. Resuscitation. 2005; 65: 279–283.
[18] Hasselqvist-Ax I, Nordberg P, Herlitz J, Svensson L, Jonsson M, Lindqvist J, et al. Dispatch of Firefighters and Police Officers in out-of-Hospital Cardiac Arrest: a Nationwide Prospective Cohort Trial Using Propensity Score Analysis. Journal of the American Heart Association. 2017; 6: e005873.
[19] van Alem AP, Vrenken RH, de Vos R, Tijssen JGP, Koster RW. Use of automated external defibrillator by first responders in out of hospital cardiac arrest: prospective controlled trial. British Medical Journal. 2003; 327: 1312.
[20] Waalewijn RA, Nijpels MA, Tijssen JG, Koster RW. Prevention of deterioration of ventricular fibrillation by basic life support during out-of-hospital cardiac arrest. Resuscitation. 2002; 54: 31–36.
[21] Hansen SM, Hansen CM, Fordyce CB, Dupre ME, Monk L, Tyson C, et al. Association Between Driving Distance From Nearest Fire Station and Survival of Out-of-Hospital Cardiac Arrest. Journal of the American Heart Association. 2018; 7: e008771
[22] Rajan S, Wissenberg M, Folke F, Hansen SM, Gerds TA, Kragholm K, et al. Association of Bystander Cardiopulmonary Resuscitation and Survival According to Ambulance Response Times after out-of-Hospital Cardiac Arrest. Circulation. 2016; 134: 2095–2104.
[23] Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation. 2010; 81: 1219–1276.
[24] Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015; 95: 1–80.
[25] Moore MJ, Hamilton AJ, Cairns KJ, Marshall A, Glover BM, McCann CJ, et al. The Northern Ireland Public Access Defibrillation (NIPAD) study: effectiveness in urban and rural populations. Heart. 2008; 94: 1614–1619.
[26] Zijlstra JA, Koster RW, Blom MT, Lippert FK, Svensson L, Herlitz J, et al. Different defibrillation strategies in survivors after out-of-hospital cardiac arrest. Heart. 2018; 104: 1929–1936.
[27] Renkiewicz GK, Hubble MW, Wesley DR, Dorian PA, Losh MJ, Swain R, et al. Probability of a shockable presenting rhythm as a function of EMS response time. Prehospital Emergency Care. 2014; 18: 224–230.
[28] Beesems SG, Blom MT, van der Pas MHA, Hulleman M, van de Glind EMM, van Munster BC, et al. Comorbidity and favorable neurologic outcome after out-of-hospital cardiac arrest in patients of 70 years and older. Resuscitation. 2015; 94: 33–39.
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