Posted on 08/12/2020
JACC Andelius Figure

Citizen responders who were dispatched through a smartphone app and arrived before emergency medical services increased the odds of the patient receiving bystander CPR and bystander defibrillation, researchers found.

“Several regions and countries are implementing app dispatch of volunteer citizens, and it is of great importance that we follow these implementations with research since we are involving many non-healthcare persons and off-duty health care professionals who devote their time and engagement to attend as a supplement to emergency medical services,” said Linn Andelius, MD, physician and PhD student at Copenhagen Emergency Medical Services at the University of Copenhagen, Denmark. “This study contributes with information about feasibility for a citizen responder program and emphasizes the potential benefit of citizen responders.

Cardiac arrest in Denmark

In this prospective, observational study published in the Journal of the American College of Cardiology, researchers analyzed data from 819 suspected out-of-hospital cardiac arrests that occurred in the Capital Region of Denmark from September 2017 to August 2018. Citizen responders were activated via a smartphone app through which they previously registered to be a volunteer. CPR and/or automated external defibrillator training was highly recommended for people who registered, although it was not mandatory.

When an out-of-hospital cardiac arrest was suspected, citizen responders were activated through the emergency dispatch center in addition to a two-tiered emergency medical services (EMS) system. Up to 20 citizen responders were identified within a maximum radius of 1.8 km. Citizen responders who accepted the alarm were dispatched to go straight to the location of the out-of-hospital cardiac arrest and either start or help with CPR or retrieve the nearest automated external defibrillator.

The primary outcome was bystander CPR and bystander defibrillation. Researchers compared out-of-hospital cardiac arrests when at least one citizen responder arrived before EMS with those when EMS arrived first. Random bystanders could be present in both groups before the citizen responder and EMS arrived.

Of the suspected out-of-hospital cardiac arrests in this study, 53.5% were confirmed cardiac arrests. At least one citizen responder arrived before EMS arrival in 42% of all out-of-hospital cardiac arrests included in this study.

The odds for bystander CPR increased when citizen responders arrived before EMS compared with when EMS arrived first (85.3% vs. 76.8%; OR = 1.76; 95% CI, 1.07-2.91). This also increased the odds for bystander defibrillation (21.2% vs. 6.7%; OR = 3.73; 95% CI, 2.04-6.84).

‘Novel field in resuscitation science’

“This is still a novel field in resuscitation science, and much research is therefore needed,” Andelius said in an interview. “The main question, ‘Can dispatched citizen responders increase survival for patients with out-of-hospital cardiac arrest’ has yet to be answered with solid evidence from randomized trials. Further, studies about how to best adjust citizen responder programs are important to optimize the systems for different settings (eg, urban vs. rural areas). Lastly, it is very important to conduct studies about the well-being of the citizen responders. We need to investigate the potential physical and psychological impact for the responders after attending an alarm and consider this as a ‘side effect’ of a citizen responder program.”

SOURCE: Healio

 

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