Copenhagen University Hospital, Copenhagen Emergency Medical Services, Telegrafvej 5, opgang 2, 2750 Ballerup, Denmark.
Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
Eur Heart J Acute Cardiovasc Care. 2023 Feb 9;12(2):87-95. doi: 10.1093/ehjacc/zuac165.
To investigate the association between the arrival of smartphone-activated volunteer responders before the Emergency Medical Services (EMS) and bystander defibrillation in out-of-hospital cardiac arrest (OHCA) at home and public locations.
This is a retrospective study (1 September 2017-14 May 2019) from the Stockholm Region of Sweden and the Capital Region of Denmark. We included 1271 OHCAs, of which 1029 (81.0%) occurred in private homes and 242 (19.0%) in public locations. The main outcome was bystander defibrillation. At least one volunteer responder arrived before EMS in 381 (37.0%) of OHCAs at home and 84 (34.7%) in public. More patients received bystander defibrillation when a volunteer responder arrived before EMS at home (15.5 vs. 2.2%, P < 0.001) and in public locations (32.1 vs. 19.6%, P = 0.030). Similar results were found among the 361 patients with an initial shockable heart rhythm (52.7 vs. 11.5%, P < 0.001 at home and 60.0 vs. 37.8%, P = 0.025 in public). The standardized probability of receiving bystander defibrillation increased with longer EMS response times in private homes. The 30-day survival was not significantly higher when volunteer responders arrived before EMS (9.2 vs. 7.7% in private homes, P = 0.41; and 40.5 vs. 35.4% in public locations, P = 0.44).
Bystander defibrillation was significantly more common in private homes and public locations when a volunteer responder arrived before the EMS. The standardized probability of bystander defibrillation increased with longer EMS response times in private homes. Our findings support the activation of volunteer responders and suggest that volunteer responders could increase bystander defibrillation, particularly in private homes.
调查智能手机激活的志愿者响应者在紧急医疗服务（EMS）之前到达与院外心脏骤停（OHCA）在家中和公共场所旁观者除颤之间的关联。
这是一项来自瑞典斯德哥尔摩地区和丹麦首都地区的回顾性研究（2017 年 9 月 1 日至 2019 年 5 月 14 日）。我们纳入了 1271 例 OHCA，其中 1029 例（81.0%）发生在私人住宅，242 例（19.0%）发生在公共场所。主要结局是旁观者除颤。在家中，至少有一名志愿者响应者在 EMS 之前到达的 OHCA 为 381 例（37.0%），在公共场所为 84 例（34.7%）。当志愿者响应者在 EMS 之前到达时，更多的患者接受了旁观者除颤在家中（15.5%对 2.2%，P<0.001）和在公共场所（32.1%对 19.6%，P=0.030）。在初始可除颤心律的 361 例患者中也发现了类似的结果（52.7%对 11.5%，在家中 P<0.001；60.0%对 37.8%，P=0.025 在公共场所）。在家中，随着 EMS 反应时间的延长，接受旁观者除颤的标准化概率增加。当志愿者响应者在 EMS 之前到达时，30 天生存率并没有显著提高（在家中为 9.2%对 7.7%，P=0.41；在公共场所为 40.5%对 35.4%，P=0.44）。
当志愿者响应者在 EMS 之前到达时，在家中和公共场所旁观者除颤更为常见。在家中，随着 EMS 反应时间的延长，接受旁观者除颤的标准化概率增加。我们的发现支持激活志愿者响应者，并表明志愿者响应者可以增加旁观者除颤，特别是在私人住宅中。
