Changes in automated external defibrillator use and survival after out-of-hospital cardiac arrest in the Nijmegen area

PurposeOut-of-hospital cardiac arrests (OHCAs) are amajor healthcare problem. Over the years, several initiatives have contributed to more lay volunteers providing cardiopulmonary resuscitation (CPR) and increased use of automated external defibrillators (AEDs) in the Netherlands. As part of aquality and outcomes program, we registered bystander CPR, AED use and outcome in the Nijmegen area.MethodsProspective resuscitation registry with astudy cohort of non-traumatic OHCA cases from 2013-2016 and historical controls from 2008-2011. In line with previous reports, we studied patients transported to the hospital (Radboudumc, Nijmegen, the Netherlands) and excluded arrests witnessed by the emergency medical service (EMS). Primary outcomes were return of spontaneous circulation (ROSC) and survival to discharge.ResultsIn the study cohort (n=349) the AED was attached more often than in the historical cohort (n=180): 46% vs. 23% and the proportion of bystander CPR was higher: 78% vs. 63% (both p<0.001). Ahigher proportion of patients received an AED shock (39% vs. 15%, p<0.001) and the number of required shocks by the EMS was lower (2 vs. 4, p=0.004). Survival to discharge was higher (47% vs. 33%, p=0.002) without differences in ROSC. The survival benefit was restricted to patients with ashockable initial rhythm. In both cohorts, bystander CPR and AED use were independently associated with survival.ConclusionIn patients admitted after OHCA, survival to discharge has markedly improved to 40-50%, comparable with other Dutch registries. As increased bystander CPR and the doubled use of AEDs seem to have contributed, all civilian-based resuscitation initiatives should be encouraged.