The rates of bystander CPR and defibrillation for out-of-hospital cardiac arrest (OHCA) were higher when one or more volunteer responders (VR) arrive before EMS, with rates of defibrillation increasing with the increasing number of responding VRs, according to a study published Feb. 13 in JACC.

Mads Christian Tofte Gregers, MD, et al., conducted a retrospective observational study of VR activation to OHCAs not witnessed by EMS in the Capital and the Central Regions of Denmark to determine the association between the number of responding VRs and the use of CPR and defibrillation to help inform decision-making about the optimal number of VRs to dispatch.

The analysis included 906 OHCAs. The number of VRs arriving before EMS was classified into four groups (zero, one, two, and three or more) and a logistic regression model was used to adjust for EMS response time.

Results showed that at least one VR arrived before EMS in 58% of all OHCAs, with an increase in CPR and a statistically significant trend for defibrillation with an increasing number of VRs onsite. The adjusted odds ratio (OR) for bystander CPR was 2.40, 3.18 and 2.70 when one, two, or three or more VRs arrived before EMS. Meanwhile, for bystander defibrillation, there was an increase in the adjusted OR as the number of VRs increased: 1.97 for one VR, 2.88 for two VRs and 3.85 for three or more VRs. Notably, when three or more VRs, compared with one, arrived before EMS, the adjusted OR increased to 1.95 for bystander defibrillation.

The authors note that the chances of CPR and defibrillation increase with more VRs arriving on the scene before EMS and write that “VR activation might be especially important in areas with expected long EMS response time.”

In an accompanying editorial comment, Sheldon Cheskes, MD, states that although early CPR and defibrillation can improve survival for OHCA, successful VR programs require integration with dispatch systems and a “critical mass of responders who are willing to be trained and will actually respond to save a life.”

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

Keywords: ACC International, Cardiopulmonary Resuscitation, Out-of-Hospital Cardiac Arrest

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