Dispatching volunteers via mobile alert ups use of bystander CPR for cardiac arrest
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Key takeaways:
- Volunteers registered via mobile app/website were dispatched to cases of out-of-hospital cardiac arrest.
- Cases where volunteers were alerted had increased rates of bystander CPR, AED use and 30-day survival.
Volunteer responders dispatched to assist people experiencing out-of-hospital cardiac arrest may improve rates of bystander CPR, automated external defibrillator use and 30-day survival, researchers reported.
“More densely populated areas/countries may benefit even more as the chance of finding a nearby volunteer increases, together with more nearby automated external defibrillators,” Martin Jonsson, PhD, MsC, postdoctoral researcher at the Center for Resuscitation Science at the Karolinska Institutet in Stockholm, told Healio. “This is of course dependent on the current EMS system. If the response times are very short in densely populated areas, it could be difficult for the volunteers to ‘beat’ the regular EMS.”
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For this retrospective observational study, Jonsson and colleagues used the ESCAPE-NET research network to test whether activation of a volunteer responder system for out-of-hospital cardiac arrest increased bystander CPR, bystander defibrillation and 30-day survival.
The analysis included 9,553 cases of out-of-hospital arrest across sites in the Netherlands, Sweden, Denmark and Sweden.
Adult volunteers registered as bystander responders to out-of-hospital cardiac arrest via website or smartphone app and consented to CPR training, location tracking and dispatch in the event of a nearby cardiac arrest. Volunteer responders were alerted via smartphone app or text message to either fetch a nearby AED or go directly to the person having cardiac arrest.
Outcomes of volunteer response to cardiac arrest
Outcomes of cases exposed to volunteer responders were compared with unexposed cases where resuscitation was dependent on nonregistered bystanders and emergency medical services (EMS) response.
Jonsson and colleagues reported that activation of the volunteer responder system was associated with approximately 30% higher likelihood of bystander CPR across all sites compared with no activation (RR = 1.3; 95% CI, 1.15-1.47).
The pooled estimated likelihood for bystander defibrillation was higher among exposed cases compared with unexposed (RR = 1.89; 95% CI, 1.36-2.63).
Moreover, the likelihood for 30-day survival was also higher among volunteer-activated cases compared with cases where volunteers were not activated (RR = 1.22; 95% CI, 1.07-1.39), according to the study.
“I believe, given the large sample size in our study and the strength of the sites included — all five 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 in the release. “For decades, we have contended with low bystander CPR rates and underuse of AEDs by the public, leading to unnecessary deaths. 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.”
Present comparator group “problematic”
In a related editorial, Janet E. Bray, RN, PHD, professor in the pre-hospital, emergency and trauma unit at the School of Public Health and Preventive Medicine at Monash University in Melbourne, Australia, and colleagues discussed potential issues with the comparator used in the present study.
“Most studies have chosen the approach taken by Jonsson et al, comparing patients receiving an alert to all patients who did not. Even with a propensity score to account for baseline differences, such a comparison is problematic. ... To receive an alert the dispatcher must recognize an out-of-hospital cardiac arrest has occurred. Including patients in whom the dispatcher did not recognize the out-of-hospital cardiac arrest (about 25% of cases) introduces significant bias,” the authors wrote. “Future studies need to consider an appropriate comparator group and examine the impact for cases that receive a volunteer responder attendance rather than an alert or acceptance.
“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,” they wrote.
Jonsson added that “a randomized controlled trial gives us a chance to control for the potential biases that could be difficult to control in observational data. It is however not an easy task … To achieve this I think a multicenter trial is necessary, starting before the system is considered standard care.”
For more information:
Martin Jonsson, PhD, MsC, can be reached at martin.k.jonsson@ki.se.
References:
- Activating volunteer system increases bystander CPR, AED use and improves survival. https://www.acc.org/About-ACC/Press-Releases/2023/07/10/18/48/Activating-Volunteer-System-Increases-Bystander-CPR-AED-Use-and-Improves-Survival. Published July 10, 2023. Accessed July 10, 2023.
- Bray JE, et al. J Am Coll Cardiol. 2023;doi:10.1016/j.jacc.2023.05.018.
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