Improved Survival After Out-of-Hospital Cardiac Arrest and Use of Automated External Defibrillators

Study Questions:

Has survival with favorable neurologic outcome after out-of-hospital cardiac arrest (OHCA) significantly increased over time, and, if so, was this attributable to automated external defibrillator (AED) use?

Methods:

This was a population-based cohort study in the Netherlands of patients with OHCA between 2006 and 2012. Survival status at each stage (to emergency department, to admission, and to discharge) was determined, and temporal trends using logistic regression analysis with year of resuscitation as an independent variable were examined. By adding each covariable subsequently to the regression model, the authors investigated the covariates’ impact on the odds ratio of year of resuscitation. Analyses were performed according to initial rhythm (shockable vs. nonshockable) and AED use.

Results:

Rates of survival with favorable neurologic outcome after OHCA increased significantly (n = 6,133, 16.2%-19.7%; p for trend = 0.021), although solely in patients presenting with a shockable initial rhythm (n = 2,823; 29.1%-41.4%; p for trend < 0.001). In this group, survival increased at each stage, but was strongest in the prehospital phase (odds ratio, 1.11; 95% confidence interval, 1.06-1.16). Rates of AED use almost tripled during the study period (21.4%-59.3%; p for trend < 0.001), thereby decreasing time from emergency call to defibrillation-device connection (median, 9.9-8.0 minutes; p < 0.001). AED use statistically explained increased survival with favorable neurologic outcome by decreasing the odds ratio of year of resuscitation to a nonsignificant 1.04.

Conclusions:

The authors concluded that increased AED use is associated with increased survival in patients with a shockable initial rhythm, and recommend continuous efforts to introduce or extend AED programs.

Perspective:

This study confirms that increased AED use (both “on site” as well as “dispatched”) results in increased survival with favorable neurologic outcome in victims of OHCA. There was an impressive threefold increase in AED use during the study period of 7 years. Widespread use of AEDs has the potential to dramatically reduce mortality of OHCA. The present study provides further support for ongoing efforts to raise public awareness of AEDs and to increase resuscitation attempts in which defibrillation is provided without delay.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias

Keywords: Defibrillators, Resuscitation, Out-of-Hospital Cardiac Arrest, Survival Rate, Electric Countershock, Netherlands, Emergency Service, Hospital, AHA Annual Scientific Sessions


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