Activation of Citizen Responders to Out‐of‐Hospital Cardiac Arrest During the COVID‐19 Outbreak in Denmark 2020

Abstract

Background Little is known about how COVID‐19 influenced engagement of citizen responders dispatched to out‐of‐hospital cardiac arrest (OHCA) by a smartphone application. The objective was to describe and analyze the Danish Citizen Responder Program and bystander interventions (both citizen responders and nondispatched bystanders) during the first COVID‐19 lockdown in 2020. Methods and Results All OHCAs from January 1, 2020, to June 30, 2020, with citizen responder activation in 2 regions of Denmark were included. We compared citizen responder engagement for OHCA in the nonlockdown period (January 1, 2020, to March 10, 2020, and April 21, 2020, to June 30, 2020) with the lockdown period (March 11, 2020, to April 20, 2020). Data are displayed in the order lockdown versus nonlockdown period. Bystander cardiopulmonary resuscitation rates did not differ in the 2 periods (99% versus 92%; P =0.07). Bystander defibrillation (9% versus 14%; P =0.4) or return‐of‐spontaneous circulation (23% versus 23%; P =1.0) also did not differ. A similar amount of citizen responders accepted alarms during the lockdown (6 per alarm; interquartile range, 6) compared with the nonlockdown period (5 per alarm; interquartile range, 5) ( P =0.05). More citizen responders reported performing chest‐compression‐only cardiopulmonary resuscitation during lockdown compared with nonlockdown (79% versus 59%; P =0.0029), whereas fewer performed standardized cardiopulmonary resuscitation, including ventilations (19% versus 38%; P =0.0061). Finally, during lockdown, more citizen responders reported being not psychologically affected by attending an OHCA compared with nonlockdown period (68% versus 56%; P <0.0001). Likewise, fewer reported being mildly affected during lockdown (26%) compared with nonlockdown (35%) ( P =0.003). Conclusions The COVID‐19 lockdown in Denmark was not associated with decreased bystander‐initiated resuscitation in OHCAs attended by citizen responders.

No fear: Willingness of smartphone activated first responders to assist with cardiac arrest during the COVID-19 pandemic

“…Our work complements data from other regions where the willingness of bystanders to provide CPR did not waver during the COVID-19 pandemic. [3] , [20] , [21] , [22] …”

院外心停止患者に対するコロナ禍での診療方針変更の転帰への影響(Impact of a change in treatment strategy on outcomes of out–of–hospital cardiac arrest patients during the COVID–19 pandemic)

“…コロナ禍となり3密の回避が推奨され，人との接触をなるべく避けることや外出が制限されたことにより，自宅で孤立していることが多くなるという生活様式に変化がもたらされた。このため，心停止の目撃が減少し 9), 10)，バイスタンダーCPRが減少したと報告されている 6), 11)。しかし，Tanakaら 12)の日本の高齢者での検討やシンガポールの検討 13)では自宅にいることが多く，家族と生活していることが多くなったためか心停止の目撃はむしろ増加したとの報告もある。バイスタンダーCPRの減少に関しては3密を避けるために傷病者に近づかない心理が多く働いたと推測されるが，胸骨圧迫のみの蘇生の普及などのため増加したとの報告もある 12), 14), 15)。Navolokinaら 16)は，小児の報告でバイスタンダーCPRが減っていないのは，胸骨圧迫のみの心肺蘇生法の普及の成果だとしている。今回の検討では，心停止の目撃はコロナ禍でも変わらず，バイスタンダーCPRはより多く実施されていた。当地域では，自宅で家族と暮らしている人も多いため外出自粛により家族で自宅で過ごしていることが多くはなったが，部屋で隔離を意識していたため心停止の目撃は多くならず，バイスタンダーは近親者であることが多いため，CPRは抵抗なくしやすくなり施行率が増加したと考える。…”

Public access defibrillation: challenges and new solutions

“…2). Although several observational studies have found arrival of volunteer responders associated with increased bystander CPR and early defibrillation [27][28][29]30 & ,31-33], only two randomized controlled trials of volunteer responder programmes exist [34,35]. The first trial investigated the effect of adding volunteer responders to the standard EMS response (without AED retrieval) and found increased bystander CPR rates (primary outcome) but no significant improvements in 30-day survival [34].…”