Alerting nearby volunteers of the need for help when a person in the community goes into cardiac arrest may increase rates of bystander CPR and defibrillation and improve survival rates, according to a study published July 10 in JACC.

Martin Jonsson, PhD, MsC, et al., pooled out-of-hospital cardiac arrests in five sites in four European countries with volunteer responder systems between 2015 to 2019 using available ESCAPE-NET registry data. Overall, more than 9,500 cases of out-of-hospital cardiac arrest were included in the study cohort after exclusion criteria. The volunteer responder systems were activated in 4,969 cases and in the other 4,857 cases they were not.

Volunteer responders registered online or via smartphone application to participate in the responder system, attested to previous CPR training and agreed to be located and dispatched as part of the system. All alert systems were integrated with data on publicly available AEDs, including detailed information on location and accessibility. The alert system would tell volunteers responders whether they were tasked with bringing a nearby AED to the site or going directly to the cardiac arrest to begin CPR. All volunteer responders were dispatched in conjunction with the emergency medical system, including ambulances with trained medical personnel and, in some sites, additional professional first responders such as firefighters or police vehicles equipped with AEDs.

Results showed that the rates were higher for all three outcomes in the alerted vs. non-alerted cases across all the included sites: (bystander CPR: 73.8% vs. 61.9%; bystander defibrillation: 7.9% vs. 4.6%; and 30-day survival: 12.4% vs. 10%).

“I believe, given the large sample size in our study and the strength of the sites included – all five [sites] had up-and-running volunteer systems as well as emergency response systems – our study findings support growing evidence for how new technology can recruit resources to sudden cardiac arrest sites within minutes and increase positive outcomes,” Jonsson said. “We need large, randomized trials to show causal effects of volunteer response systems to determine if this is a replicable model that will help us save lives in communities around the world.”

In an accompanying editorial comment, Janet E. Bray, RN, PhD, et al., write, “Good volunteer first-responder programs are only one part of improving the community response to out-of-hospital cardiac arrest. Ultimately, increasing the rate of timely and equitable access to bystander CPR and defibrillation will have the largest effect on survival.”

Study limitations include the observational nature of the study.

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias

Keywords: Registries, Cardiopulmonary Resuscitation, Out-of-Hospital Cardiac Arrest, Survival Rate

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