More volunteer responders increase odds for bystander defibrillation before ambulance
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In out-of-hospital cardiac arrest, the number of volunteer responders arriving before an ambulance is associated with increased bystander defibrillation rates, researchers reported.
In Denmark, a nationwide automated external defibrillator registry, holding nearly 21,000 registered publicly accessible AEDs, allows dispatchers to direct bystanders to retrieve an AED before emergency medical service (EMS) arrival when feasible. Despite this, bystander AED usage remains low, especially in residential areas, researchers reported in the Journal of the American College of Cardiology.
Data were derived from Gregers MCT, et al. J Am Coll Cardiol. 2023;doi:10.1016/j.jacc.2022.11.047.
“This indicates that it is reasonable to ensure that when implementing a volunteer responder system, the primary goal is to make sure that a sufficient amount of volunteer responders will arrive before the ambulance,” Mads Christian Tofte Gregers, MD, a doctoral student affiliated with EMS, Capital Region of Denmark, told Healio.
“In our study, we found the highest odds for bystander defibrillation when three or more volunteer responders arrived before the ambulance. To achieve this, a volunteer responder program must ensure a sufficient density of volunteer responders and continued recruitment of volunteers is of high priority, as well as publicly accessible AEDs in the community.”
‘Everyone can help’
Gregers and colleagues analyzed data from 906 out-of-hospital cardiac arrests that were not witnessed by EMS with volunteer responder activation from the Capital Region of Denmark between September 2017 and May 2019, as well as from the Central Region of Denmark between November 2018 and December 2019. Researchers created four groups according to the number of volunteer responders arriving before EMS: none, one, two and three or more volunteer responders. Researchers examined associations between the number of volunteer responders arriving before EMS and bystander CPR and defibrillation.
The adjusted ORs for bystander CPR were 2.4 (95% CI ,1.42-4.05), 3.18 (95% CI, 1.39-7.26), and 2.7 (95% CI, 1.32-5.52) when one, two or three or more volunteer responders arrived before EMS, respectively, compared with none.
For bystander defibrillation, the adjusted ORs increased when there was one volunteer responder (aOR = 1.97; 95% CI, 1.12-3.52), two responders (aOR = 2.88; 95% CI, 1.48-5.58) or three or more responders (aOR = 3.85; 95% CI, 2.11-7.01) arriving on the scene before EMS compared with none.
The adjusted OR of bystander defibrillation was 1.95 (95% CI, 1.18-3.22) when at least three volunteer responders arrived first compared with one responder arriving first.
“Hopefully, our study can help guide decision-makers in similar volunteer responder programs when optimizing their own systems,” Gregers told Healio. “Volunteer responder programs, especially in the United States, United Kingdom, Australia and Canada, dispatch far fewer volunteer responders — and in some settings, only off-duty health care professionals. This study emphasizes that everyone can help in a situation with out-of-hospital cardiac arrest and that the number of arriving volunteer responders is associated with improved bystander interventions.”
Gregers said large, randomized controlled trials are needed in the field of volunteer responder programs.
“To date, only two trials have been performed but without survival as primary outcome,” Gregers told Healio. “Therefore, we do not know how and in which circumstances volunteer responder programs affect survival.”
Denmark data ‘promising’
In a related editorial, Sheldon Cheskes, MD, of the division of emergency medicine at the University of Toronto, wrote that the Denmark study is promising, but more work needs to be done.
“Although volunteer responder programs such as the program in Denmark have shown promising results at targeting the most common sites of cardiac arrest in private locations, one wonders if the concept of ‘home defibrillation’ with new, ultralight, inexpensive disposable defibrillators may be the next step in augmenting volunteer responder programs to further optimize and enhance the community response to out-of-hospital cardiac arrest,” Cheskes wrote. “Time will tell if patient important outcomes can be improved using these community programs, but the sheer high number of volunteer responders willing to act to save a life seems quite promising.”
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For more information:
Mads Christian Tofte Gregers, MD, can be reached at mads.christian.tofte.gregers.01@regionh.dk; Twitter: @mads_tofte.
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