AED and text message responders density in residential areas for rapid response in out-of-hospital cardiac arrest

Remy Stieglis; Jolande A Zijlstra; Frank Riedijk; Martin Smeekes; Wim E van der Worp; Rudolph W Koster

doi:10.1016/j.resuscitation.2020.01.031

AED and text message responders density in residential areas for rapid response in out-of-hospital cardiac arrest

Resuscitation. 2020 May:150:170-177. doi: 10.1016/j.resuscitation.2020.01.031. Epub 2020 Feb 8.

Authors

Remy Stieglis¹, Jolande A Zijlstra², Frank Riedijk³, Martin Smeekes³, Wim E van der Worp⁴, Rudolph W Koster²

Affiliations

¹ Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands. Electronic address: r.stieglis@amsterdamumc.nl.
² Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands.
³ Veiligheidsregio Noord-Holland Noord, Alkmaar, The Netherlands.
⁴ Ambulance Oost, Hengelo, The Netherlands.

PMID: 32045663
DOI: 10.1016/j.resuscitation.2020.01.031

Abstract

Background: For out-of-hospital cardiac arrest (OHCA) in residential areas, a dispatcher driven alert-system using text messages (TM-system) directing local rescuers (TM-responders) to OHCA patients was implemented and the desired density of automated external defibrillators (AEDs) or TM-responders investigated.

Methods: We included OHCA cases with the TM-system activated in residential areas between 2010-2017. For each case, densities/km² of activated AEDs and TM-responders within a 1000 m circle were calculated. Time intervals between 112-call and first defibrillation were calculated.

Results: In total, 813 patients (45%) had a shockable initial rhythm. In 17% a TM-system AED delivered the first shock. With increasing AED density, the median time to shock decreased from 10:59 to 08:17 min. (p < 0.001) and shocks <6 min increased from 6% to 12% (p = 0.024). Increasing density of TM-responders was associated with a decrease in median time to shock from 10:59 to 08:20 min. (p < 0.001) and increase of shocks <6 min from 6% to 13% (p = 0.005). Increasing density of AEDs and TM-responders resulted in a decline of ambulance first defibrillation by 19% (p = 0.016) and 22% (p = 0.001), respectively. First responder AED defibrillation did not change significantly. Densities of >2 AEDs/km² did not result in further decrease of time to first shock but >10 TM-responders/km² resulted in more defibrillations <6 min.

Conclusion: With increasing AED and TM-responder density within a TM-system, time to defibrillation in residential areas decreased. AED and TM-responders only competed with ambulances, not with first responders. The recommended density of AEDs and TM-responders for earliest defibrillation is 2 AEDs/km² and >10 TM-responders/km².

Keywords: AED; Automated external defibrillator; Cardiopulmonary resuscitation; Defibrillation; Dispatch; Emergency medical service; First responder; Heart arrest; Lay rescuer; Text message; Ventricular fibrillation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiopulmonary Resuscitation*
Defibrillators
Electric Countershock
Emergency Medical Services*
Emergency Responders*
Humans
Out-of-Hospital Cardiac Arrest* / therapy
Text Messaging*