BACKGROUND: In Europe, survival-rates after out-of-hospital cardiac arrest (OHCA) vary widely between regions. Whether a system dispatching First Responders (FRs; main FR-types: firefighters, police officers, citizen-responders) is present or not may be associated with survival-rates. This study aimed to assess the association between having a dispatched FR-system and rates of return of spontaneous circulation (ROSC) and survival across Europe. METHODS: Results of an inventory of dispatched FR-systems for OHCA in Europe were combined with aggregate ROSC and survival data from the EuReCa-TWO study and additionally collected data. Regression analysis (weighted on number of patients included per region) was performed to study the association between having a dispatched FR-system and ROSC and survival-rates to hospital discharge in the total population and in patients with shockable initial rhythm, witnessed OHCA and bystander cardiopulmonary resuscitation (CPR; Utstein comparator group). For regions without a dispatched FR-system, the theoretical survival-rate if a dispatched FR-system would have existed was estimated. FINDINGS: We included 27 European regions. There were 15,859 OHCAs in the total group and 2,326 OHCAs in the Utstein comparator group. Aggregate ROSC and survival-rates were significantly higher in regions with an FR-system compared to regions without (ROSC: 36% [95%CI 35%-37%] vs. 24% [95%CI 23%-25%]; P<0.001; survival in total population [N=15.859]: 13% [95%CI 12%-15%] vs. 5% [95%CI 4%-6%]; P<0.001; survival in Utstein comparator group [N=2326]: 33% [95%CI 30%-36%] vs. 18% [95%CI 16%-20%]; P<0.001), and in regions with more than one FR-type compared to regions with only one FR-type. All main FR-types were associated with higher survival-rates (all P<0.050). INTERPRETATION: European regions with dispatched FRs showed higher ROSC and survival-rates than regions without. FUNDING: This project/work has received funding from the European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381 (IO, HLT and MTB) and the European Union's COST programme under acronym PARQ, registered under grant agreement No CA19137 (IO, DC, HLT, MTB). HLT and MTB were supported by a grant from the Netherlands CardioVascular Research Initiative, Dutch Heart Foundation, Dutch Federation of University Medical Centres, Netherlands Organization for Health Research and Development, Royal Netherlands Academy of Sciences - CVON2017-15 RESCUED (HLT), and CVON2018-30 Predict2 (HLT and MTB).

Department of Anaesthesia Intensive Care and Emergency Medical Services Ospedale Maggiore Bologna Italy

Department of Cardiology Copenhagen University Hospital Gentofte Hellerup Denmark; Emergency Medical Services Copenhagen University of Copenhagen Denmark

Department of Clinical and Experimental Cardiology Amsterdam UMC Academic Medical Centre University of Amsterdam Amsterdam The Netherlands

Department of Clinical Epidemiologic Biostatics Academic Amsterdam UMC Academic Medical Centre University of Amsterdam Amsterdam The Netherlands

Department of Emergency Medicine Grigore T Popa University of Medicine and Pharmacy Iasi Romania

Department of Emergency Medicine University Hospital Giessen and Marburg Marburg Germany

Department of General Practice National University of Ireland Galway and National Ambulance Service Dublin Ireland

Department of Molecular Medicine Section of Cardiology University of Pavia Pavia Italy; Cardiac Intensive Care Unit Arrhythmia and Electrophysiology and Experimental Cardiology Fondazione IRCCS Policlinico San Matteo Pavia Italy

Emergency Medical Service Public Institution Health Centre 'Dr Mustafa Šehović' Tuzla and Faculty of Medicine University of Tuzla Tuzla Bosnia and Herzegovina

Emergency Medical Services Mittelhessen German Red Cross Marburg Germany

Emergency Medical Services of the Hradec Kralove Region and Department of Anaesthesiology and Intensive Care Charles University Prague Faculty of Medicine in Hradec Kralove University Hospital Hradec Kralove Hradec Kralove Czech Republic

Netherlands Heart Institute Utrecht The Netherlands

Zobrazit více v PubMed

Holmgren C, Bergfeldt L, Edvardsson N. Analysis of initial rhythm, witnessed status and delay to treatment among survivors of out-of-hospital cardiac arrest in Sweden. Heart (British Cardiac Society) 2010;96(22):1826–1830. PubMed

Rajan S, Folke F, Hansen SM. Incidence and survival outcome according to heart rhythm during resuscitation attempt in out-of-hospital cardiac arrest patients with presumed cardiac etiology. Resuscitation. 2017;114:157–163. PubMed

Hansen CM, Kragholm K, Granger CB. 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. Resuscitation. 2015;96:303–309. PubMed

Berdowski J, Blom MT, Bardai A, Tan HL, Tijssen JG, Koster RW. Impact of onsite or dispatched automated external defibrillator use on survival after out-of-hospital cardiac arrest. Circulation. 2011;124(20):2225–2232. PubMed

Oving I, Masterson S, Tjelmeland IBM. First-response treatment after out-of-hospital cardiac arrest: a survey of current practices across 29 countries in Europe. Scand J Trauma Resusc Emerg Med. 2019;27(1):112. PubMed PMC

Grasner JT, Wnent J, Herlitz J. Survival after out-of-hospital cardiac arrest in Europe - results of the EuReCa-TWO study. Resuscitation. 2020;148:218–226. PubMed

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(11):1444–1449. PubMed

Sayre MR, Evans J, White LJ, Brennan TD. Providing automated external defibrillators to urban police officers in addition to a fire department rapid defibrillation program is not effective. Resuscitation. 2005;66(2):189–196. PubMed

Empana JP, Blom MT, Bttiger BW. Determinants of occurrence and survival after sudden cardiac arrest-A European perspective: the ESCAPE-NET project. Resuscitation. 2018;124:7–13. PubMed

Perkins GD, Jacobs IG, Nadkarni VM. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Circulation. 2015;132(13):1286–1300. PubMed

Fletcher D, Chamberlain D, Handley A. Utstein-style audit of Protocol C: a non-standard resuscitation protocol for healthcare professionals. Resuscitation. 2011;82(10):1265–1272. PubMed

van Alem AP, Vrenken RH, de Vos R, Tijssen JG, Koster RW. Use of automated external defibrillator by first responders in out of hospital cardiac arrest: prospective controlled trial. Bmj. 2003;327(7427):1312. PubMed PMC

Hasselqvist-Ax I, Nordberg P, Herlitz J. Dispatch of firefighters and police officers in out-of-hospital cardiac arrest: a nationwide prospective cohort trial using propensity score analysis. J Am Heart Ass. 2017;6(10) PubMed PMC

Nichol G, Detsky AS, Stiell IG, O'Rourke K, Wells G, Laupacis A. Effectiveness of emergency medical services for victims of out-of-hospital cardiac arrest: a metaanalysis. Ann Emerg Med. 1996;27(6):700–710. PubMed

Nichol G, Laupacis A, Stiell IG. Cost-effectiveness analysis of potential improvements to emergency medical services for victims of out-of-hospital cardiac arrest. Ann Emerg Med. 1996;27(6):711–720. PubMed

Berdowski J, Kuiper MJ, Dijkgraaf MG, Tijssen JG, Koster RW. Survival and health care costs until hospital discharge of patients treated with onsite, dispatched or without automated external defibrillator. Resuscitation. 2010;81(8):962–967. PubMed

Moran PS, Teljeur C, Masterson S, O'Neill M, Harrington P, Ryan M. Cost-effectiveness of a national public access defibrillation programme. Resuscitation. 2015;91:48–55. PubMed

Nordberg P, Hollenberg J, Rosenqvist M. The implementation of a dual dispatch system in out-of-hospital cardiac arrest is associated with improved short and long term survival. Eu Heart J Acute Cardiovas Care. 2014;3(4):293–303. PubMed

Shuster M, Keller JL. Effect of fire department first-responder automated defibrillation. Ann Emerg Med. 1993;22(4):721–727. PubMed

Smith KL, Peeters A, McNeil JJ. Results from the first 12 months of a fire first-responder program in Australia. Resuscitation. 2001;49(2):143–150. PubMed

Baekgaard JS, Viereck S, Moller TP, Ersboll AK, Lippert F, Folke F. The effects of public access defibrillation on survival after out-of-hospital cardiac arrest: a systematic review of observational studies. Circulation. 2017;136(10):954–965. PubMed

Ringh M, Rosenqvist M, Hollenberg J. Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest. The New Eng J Med. 2015;372(24):2316–2325. PubMed

Yannopoulos D, Aufderheide TP, Abella BS. Quality of CPR: an important effect modifier in cardiac arrest clinical outcomes and intervention effectiveness trials. Resuscitation. 2015;94:106–113. PubMed

Reynolds JC, Grunau BE, Rittenberger JC, Sawyer KN, Kurz MC, Callaway CW. Association between duration of resuscitation and favorable outcome after out-of-hospital cardiac arrest: implications for prolonging or terminating resuscitation. Circulation. 2016;134(25):2084–2094. PubMed PMC

Ro YS, Shin SD, Song KJ. Public awareness and self-efficacy of cardiopulmonary resuscitation in communities and outcomes of out-of-hospital cardiac arrest: a multi-level analysis. Resuscitation. 2016;102:17–24. PubMed

Wissenberg M, Lippert FK, Folke F. 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(13):1377–1384. PubMed

Blewer AL, Ho AFW, Shahidah N. Impact of bystander-focused public health interventions on cardiopulmonary resuscitation and survival: a cohort study. Lancet Public Health. 2020;5(8):e428–ee36. PubMed

Dyson K, Brown SP, May S. Community lessons to understand resuscitation excellence (CULTURE): association between emergency medical services (EMS) culture and outcome after out-of-hospital cardiac arrest. Resuscitation. 2020 PubMed

Oving I, de Graaf C, Karlsson L. Occurrence of shockable rhythm in out-of-hospital cardiac arrest over time: a report from the COSTA group. Resuscitation. 2020;151:67–74. PubMed