Citizen Responder Activation in Out-of-Hospital Cardiac Arrest by Time of Day and Day of Week

Katarina Høgh Mottlau, Linn Charlotte Andelius, Rasmus Gregersen, Carolina Malta Hansen, Fredrik Folke, Katarina Høgh Mottlau, Linn Charlotte Andelius, Rasmus Gregersen, Carolina Malta Hansen, Fredrik Folke

Abstract

Background We aim to examine diurnal and weekday variations in citizen responder availability and intervention at out-of-hospital cardiac arrest (OHCA) resuscitation. Methods and Results We included confirmed OHCAs where citizen responders were activated by a smartphone application in the Capital Region of Denmark between September 1, 2017 and August 31, 2018. OHCAs were analyzed by time of day (daytime: 07:00 am-03:59 pm, evening: 4:00-11:59 pm, and nighttime: 12:00-06:59 am) and day of week (Monday-Friday or Saturday-Sunday/public holidays). We included 438 OHCAs where 6836 citizen responders were activated. More citizen responders accepted alarms in the evening (mean 4.8 [95% CI, 4.4-5.3]) compared with daytime (3.7 [95% CI, 3.4-4.4]) and nighttime (1.8 [95% CI, 1.5-2.2]) (P<0.001), and more accepted alarms during weekends (4.3 [95% CI, 3.8-4.9]) compared with weekdays (3.4 [95% CI, 3.2-3.7]) (P<0.001). Proportion of OHCAs where at least 1 citizen responder arrived before Emergency Medical Services were significantly different between day (42.9%), evening (50.3%), and night (26.1%) (P<0.001), and between weekdays (37.2%) and weekends (53.5%) (P=0.002). When responders arrived before Emergency Medical Services, there was no difference of bystander cardiopulmonary resuscitation or defibrillation between daytime, evening, and nighttime (P=0.75 and P=0.22, respectively) or between weekend and weekdays (P=0.29 and P=0.12, respectively). Conclusions Citizen responders were more likely to accept OHCA alarms during evening and weekends, with the highest proportion of responders arriving before Emergency Medical Services in the evening. However, there was no significant difference in delivering cardiopulmonary resuscitation or early defibrillation among cases where citizen responders arrived before Emergency Medical Services. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03835403.

Keywords: defibrillation; emergency medical services; out‐of‐hospital cardiac arrest; resuscitation.

Figures

Figure 1. Flowchart of cardiac arrest cases…
Figure 1. Flowchart of cardiac arrest cases in the study period.
EMS indicates emergency medical services; and OHCA, out‐of‐hospital cardiac arrest.
Figure 2. Mean number of citizen responders’…
Figure 2. Mean number of citizen responders’ interaction with alarms according to time of day and day of week.
Black markers indicate 95% CIs. Alerted: number of citizen responders who were located within 1800 m from the OHCA location. Responded: number of citizen responders who have accepted, declined, or rejected the alert. Accepted: number of citizen responders who accepted the alarm. Daytime: 07:00 am to 03:59 pm. Evening: 4:00 to 11:59 pm. Nighttime: 12:00 to 06:59 am. Weekday: Monday to Friday. Weekend: Saturday and Sunday incl. public holidays. AED indicates automated external defibrillators; CPR, cardiopulmonary resuscitation; and OHCA, out‐of‐hospital cardiac arrest.
Figure 3. Proportion of performed cardiopulmonary resuscitation,…
Figure 3. Proportion of performed cardiopulmonary resuscitation, automated external defibrillator attachment, and performed defibrillation in out‐of‐hospital cardiac arrest where at least 1 citizen responders arrived before EMS according to time of day and day of week.
AED indicates automated external defibrillators; and CPR, cardiopulmonary resuscitation. Black markers indicate 95% CIs. Daytime: 07:00 am to 03:59 pm. Evening: 4:00 to 11:59 pm. Nighttime: 12:00 to 06:59 am. Weekday: Monday to Friday. Weekend: Saturday and Sunday including public holidays. AED indicates automated external defibrillators; and CPR, cardiopulmonary resuscitation.

References

    1. Rajan S, Wissenberg M, Folke F, Hansen SM, Gerds TA, Kragholm K, Hansen CM, Karlsson L, Lippert FK, Køber L, et al. Association of bystander cardiopulmonary resuscitation and survival according to ambulance response times after out‐of‐hospital cardiac arrest. Circulation. 2016;134:2095–2104. doi: 10.1161/CIRCULATIONAHA.116.024400
    1. Hasselqvist‐Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P, Ringh M, Jonsson M, Axelsson C, Lindqvist J, et al. Early cardiopulmonary resuscitation in out‐of‐hospital cardiac arrest. N Engl J Med. 2015;372:2307–2315. doi: 10.1056/NEJMoa1405796
    1. Blom MT, Beesems SG, Homma PC, Zijlstra JA, Hulleman M, van Hoeijen DA, Bardai A, Tijssen JG, Tan HL, Koster RW. Improved survival after out‐of‐hospital cardiac arrest and use of automated external defibrillators. Circulation. 2014;130:1868–1875. doi: 10.1161/CIRCULATIONAHA.114.010905
    1. Hallstrom AP, Ornato JP, Weisfeldt M, Travers A, Christenson J, McBurnie MA, Zalenski R, Becker LB, Schron EB, Proschan M, et al. Public‐access defibrillation and survival after out‐of‐hospital cardiac arrest. N Engl J Med. 2004;351:637–646. doi: 10.1056/NEJMoa040566
    1. Hansen SM, Hansen CM, Folke F, Rajan S, Kragholm K, Ejlskov L, Gislason G, Køber L, Gerds TA, Hjortshøj S, et al. Bystander defibrillation for out‐of‐hospital cardiac arrest in public vs residential locations. JAMA Cardiol. 2017;2:507–514. doi: 10.1001/jamacardio.2017.0008
    1. Perkins GD, Handley AJ, Koster RW, Castren M, Smyth MA, Olasveengen T, Monsieurs KG, Raffay V, Gräsner JT, Wenzel V, et al.; Adult basic life support and automated external defibrillation section Collaborators . European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation. 2015;95:81–99. doi: 10.1016/j.resuscitation.2015.07.015
    1. Ringgren KB, Christensen HC, Schønau L, Lippert FK, Folke F, Christensen EF, Hendriksen OM, Nielsen PS, Hansen PA, Mikkelsen S, et al. Dansk Hjertestopregister 2018. 2019:35.
    1. Wissenberg M, Lippert FK, Folke F, Weeke P, Hansen CM, Christensen EF, Jans H, Hansen PA, Lang‐Jensen T, Olesen JB, et al. Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out‐of‐hospital cardiac arrest. JAMA. 2013;310:1377–1384. doi: 10.1001/jama.2013.278483
    1. Karlsson L, Malta Hansen C, Wissenberg M, Møller Hansen S, Lippert FK, Rajan S, Kragholm K, Møller SG, Bach Søndergaard K, Gislason GH, et al. Automated external defibrillator accessibility is crucial for bystander defibrillation and survival: a registry‐based study. Resuscitation. 2019;136:30–37. doi: 10.1016/j.resuscitation.2019.01.014
    1. Ringh M, Fredman D, Nordberg P, Stark T, Hollenberg J. Mobile phone technology identifies and recruits trained citizens to perform CPR on out‐of‐hospital cardiac arrest victims prior to ambulance arrival. Resuscitation. 2011;82:1514–1518. doi: 10.1016/j.resuscitation.2011.07.033
    1. Lee SY, Shin SD, Lee YJ, Song KJ, Hong KJ, Ro YS, Lee EJ, Kong SY. Text message alert system and resuscitation outcomes after out‐of‐hospital cardiac arrest: a before‐and‐after population‐based study. Resuscitation. 2019;138:198–207. doi: 10.1016/j.resuscitation.2019.01.045
    1. Ringh M, Rosenqvist M, Hollenberg J, Jonsson M, Fredman D, Nordberg P, Järnbert‐Pettersson H, Hasselqvist‐Ax I, Riva G, Svensson L, et al. Mobile‐phone dispatch of laypersons for CPR in out‐of‐hospital cardiac arrest. N Engl J Med. 2015;372:2316–2325. doi: 10.1056/NEJMoa1406038
    1. Pijls RW, Nelemans PJ, Rahel BM, Gorgels AP. A text message alert system for trained volunteers improves out‐of‐hospital cardiac arrest survival. Resuscitation. 2016;105:182–187. doi: 10.1016/j.resuscitation.2016.06.006
    1. Zijlstra JA, Stieglis R, Riedijk F, Smeekes M, van der Worp WE, Koster RW. Local lay rescuers with AEDs, alerted by text messages, contribute to early defibrillation in a Dutch out‐of‐hospital cardiac arrest dispatch system. Resuscitation. 2014;85:1444–1449. doi: 10.1016/j.resuscitation.2014.07.020
    1. Caputo ML, Muschietti S, Burkart R, Benvenuti C, Conte G, Regoli F, Mauri R, Klersy C, Moccetti T, Auricchio A. Lay persons alerted by mobile application system initiate earlier cardio‐pulmonary resuscitation: a comparison with SMS‐based system notification. Resuscitation. 2017;114:73–78. doi: 10.1016/j.resuscitation.2017.03.003
    1. Andelius L, Malta Hansen C, Lippert FK, Karlsson L, Torp‐Pedersen C, Kjær Ersbøll A, Køber L, Collatz Christensen H, Blomberg SN, Gislason GH, et al. Smartphone activation of citizen responders to facilitate defibrillation in out‐of‐hospital cardiac arrest. J Am Coll Cardiol. 2020;76:43–53. doi: 10.1016/j.jacc.2020.04.073
    1. Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, et al. Education, implementation, and teams: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2020;142:S222–S283. doi: 10.1161/CIR.0000000000000896
    1. Valeriano A, Van Heer S, de Champlain F, C Brooks S. Crowdsourcing to save lives: a scoping review of bystander alert technologies for out‐of‐hospital cardiac arrest. Resuscitation. 2021;158:94–121. doi: 10.1016/j.resuscitation.2020.10.035
    1. Lin P, Shi F, Wang L, Liang ZA. Nighttime is associated with decreased survival for out of hospital cardiac arrests: a meta‐analysis of observational studies. Am J Emerg Med. 2019;37:524–529. doi: 10.1016/j.ajem.2019.01.004
    1. Berglund E, Claesson A, Nordberg P, Djarv T, Lundgren P, Folke F, Forsberg S, Riva G, Ringh M. A smartphone application for dispatch of lay responders to out‐of‐hospital cardiac arrests. Resuscitation. 2018;126:160–165. doi: 10.1016/j.resuscitation.2018.01.039
    1. Folke F. The HeartRunner trial. ; 2019. Available at: . Accessed October 1, 2019.
    1. Danmarks Statistik . Befolkningstal, folketal 2019. Available at: . Accessed October 1, 2019.
    1. Heartrunner Sweden AB . Heartrunner. Available at: . Accessed October 1, 2019.
    1. Andelius L, Hansen CM, Lippert FK, Karlsson L, Torp‐Pedersen C, Ersbøll AK, Køber L, Christensen HC, Blomberg SN, Gislason GH, et al. Smartphone activation of citizen responders to facilitate defibrillation in out‐of‐hospital cardiac arrest. J Am Coll Cardiol. 2020;76:43–53.
    1. Coxe S, West SG, Aiken LS. The analysis of count data: a gentle introduction to Poisson regression and its alternatives. J Pers Assess. 2009;91:121–136. doi: 10.1080/00223890802634175
    1. Pijls RW, Nelemans PJ, Rahel BM, Gorgels AP. Factors modifying performance of a novel citizen text message alert system in improving survival of out‐of‐hospital cardiac arrest. Eur Heart J Acute Cardiovasc Care. 2018;7:397–404. doi: 10.1177/2048872617694675
    1. Hansen CM, Wissenberg M, Weeke P, Ruwald MH, Lamberts M, Lippert FK, Gislason GH, Nielsen SL, Køber L, Torp‐Pedersen C, et al. Automated external defibrillators inaccessible to more than half of nearby cardiac arrests in public locations during evening, nighttime, and weekends. Circulation. 2013;128:2224–2231. doi: 10.1161/CIRCULATIONAHA.113.003066
    1. Dainty KN, Vaid H, Brooks SC. North American public opinion survey on the acceptability of crowdsourcing basic life support for out‐of‐hospital cardiac arrest with the PulsePoint mobile phone app. JMIR Mhealth Uhealth. 2017;5:e63. doi: 10.2196/mhealth.6926

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi