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Abstract
Aim We examined the effect of governmental implementation of community-wide bystander defibrillation program on good neurological outcome in patients after OHCA during a four-year prospective follow-up period.
Method A prospective 4 year community-wide observational database collected from an OHCA e–Registry in a metropolitan was studied, after a citywide bystander defibrillation rescue program had been launched by the government that legitimised the strategic provision of AEDs (automated external defibrillators) in certain public locations and electronically registered the devices. Outcomes included 2–hour sustained ROSC (return of spontaneous circulation) at hospital, survival to hospital discharge, and good CPC (Cerebral Performance Category Scale 1 or 2). All patient prehospital characteristics and outcome relations were evaluated and adjusted by regression analysis.
Results The density of public AEDs distribution increased from 0.85 to 6.24 per square kilometres in the studied 4 years. Among a total of 12,368 OHCA, 1210 occurred in public locations, and 52 patients (male for 83%, witnessed arrest for 77%) received bystander aid by public accessed AED and CPR rescue. For these 52 patients, 44.2% (23/52) achieved prehospital ROSC at scene or during transport, 67.3% (35/52) achieved sustained ROSC after resuscitation at hospital, 44.2% (23/52) achieved survival–to–discharge and noticeably all those 23 (100%, 23/23) survival-to-discharge patients achieved excellent neurological outcome of CPC 1. Their outcomes were significantly better (67.3 vs 26.5%, OR: 5.7 [95% CI: 3.2 to 10.4] for sustained ROSC; 44.2 vs 10.1%, OR: 7.0 [95% CI: 3.9 to 12.6] for survival-to-discharge; 44.2 vs 6.6%, OR: 11.6 [95% CI: 6.4 to 21.2] for good CPC 1or2, and 100 vs 62.9% for good CPC among survival-to–discharge) compared with those without public accessed AED plus CPR rescue. In all 52 patients, there was one man without prehospital ROSC still achieved survival-to-discharge and good CPC.
Conclusion In our study, we found that governmental implementation of bystander defibrillation rescue program was significantly associated with excellent neurological outcome of CPC 1 and higher survival to hospital discharge. It would be noticeably in our community that by this rescue program all patients achieving survival–to–discharge could achieve excellent CPC1.
Conflict of interest None
Funding None
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