The role of bystanders, first responders, and emergency medical service providers in timely defibrillation and related outcomes after out-of-hospital cardiac arrest: Results from a statewide registry

Different defibrillation strategies in survivors after out-of-hospital cardiac arrest

“…An analysis from 2015 demonstrates variability in time to defibrillation and survival according to who performed defibrillation (bystander, first responder or EMS) 29. This is a plausible explanation to the higher survival rates found in the onsite and first responder group.…”

Survival From Out‐of‐Hospital Cardiac Arrest: Are We Beginning to See Progress?

“…They found that neurologically intact survival at 1 month and discharge increased from 3.3% to 8.2% and attributed this to an increase in bystander CPR from 38.6% to 50.9% during the years of data collection. Using data from the voluntary Cardiac Arrest Registry to Enhance Survival, Hansen et al examined the temporal changes in bystander and first responder CPR and AED use and OHCA survival after state‐wide initiatives to improve resuscitation efforts in North Carolina between 2010 and 2013 4. Specific initiatives included the training of members of the general population in CPR and in the use of AEDs; training first responders in team‐based CPR, including AED use and high‐quality CPR; and training dispatch centers to rapidly recognize cardiac arrest and guide bystanders to perform CPR.…”

Shocking the system: AEDs in military resuscitation

“…While appropriate immediate defibrillation yields a survival rate of 67%,5 this falls precipitously over the first 10 min reaching a survival rate of just 5%. More recent data in non-metropolitan areas6 showed a survival rate of 59% if performed in <2 min, falling to 13% if >10 min. Clearly this puts the onus on immediate access and use of defibrillator devices to maximise the survival rate.…”

“…PAD has been further promoted by the European Resuscitation Council and graphically represented by the ERC’s ‘ Chain of survival ’, which elucidates the role AEDs should play in cardiopulmonary resuscitation (CPR) and early defibrillation 16. Their position has been strengthened as bystander-delivered defibrillation has reduced time to shock,6 and increased use of AEDs prehospitally seems to be associated with favourable neurological outcomes and increased survival 17. Importantly, lack of training was not to be a deterrent to their use, and legally people who try to help should not be sued regardless of outcome 18.…”

“…While Hansen’s research shows a clear temporal relationship between defibrillation and survival,6 Waalewijn20 demonstrated that in a selected population, defibrillation could restore circulation without the need for advanced CPR. With little evidence to support many of the bastions of resuscitation medicine, whether it be pharmacological therapy,21–23 oxygen administration24 25 or airway management,26 defibrillation stands in isolation as possessing a incontrovertibly supportive evidence base.…”