title: The implementation of a dual dispatch system in out-of-hospital cardiac arrest is associated with improved short and long term survival.
abstract: OBJECTIVE
  To determine the impact of a dual dispatch system, using fire fighters as first responders, in out-of-hospital cardiac arrest (OHCA) on short (30 days) and long term (three years) survival, and, to investigate the potential differences regarding in-hospital factors and interventions between the patient groups, such as the use of therapeutic hypothermia and cardiac catheterization.
  
  
  RESULTS
  OHCAs from 2004 (historical controls) and 2006-2009 (intervention period) were included. During the intervention period, fire fighters equipped with automated external defibrillators (AEDs) were dispatched in suspected OHCA. Logistic regression analyses of outcome data included: the intervention with dual dispatch, sex, age, location, aetiology, witnessed status, bystander-cardiopulmonary resuscitation, first rhythm and therapeutic hypothermia. In total, 2581 OHCAs were included (historical controls n=620, intervention period n=1961). Fire fighters initiated cardiopulmonary resuscitation and connected an AED before emergency medical services' arrival in 41% of the cases. The median time from dispatch to arrival of first responder or emergency medical services shortened from 7.7 in the control period to 6.7 min in the intervention period (p<0.001). The 30-day survival improved from 3.9% to 7.6% (p=0.001), adjusted odds ratio 2.8 (confidence interval 1.6-4.9). Survival to three years increased from 2.4% to 6.5% (p<0.001), adjusted odds ratio 3.8 (confidence interval 1.9-7.6). In the logistic regression analysis including in-hospital factors we found no outcome benefit of therapeutic hypothermia.
  
  
  CONCLUSIONS
  The implementation of a dual dispatch system using fire fighters in OHCA was associated with increased 30-day and three-year survival. No major differences in the in-hospital treatment were seen between the studied patient groups.
authors.affiliation: Department of Clinical Science and Education Karolinska Institutet, Section of Cardiology, Södersjukhuset Stockholm, Sweden per.nordberg@sodersjukhuset.se.
authors.forename: Per
authors.initials: P
authors.lastname: Nordberg
authors.affiliation: Department of Clinical Science and Education Karolinska Institutet, Section of Cardiology, Södersjukhuset Stockholm, Sweden.
authors.forename: Jacob
authors.initials: J
authors.lastname: Hollenberg
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mårten
authors.initials: M
authors.lastname: Rosenqvist
authors.affiliation: Institute of Internal Medicine, Department of Metabolism and Cardiovascular Research, Sahlgrenska University Hospital, Gothenburg, Sweden The Prehospital Research Centre Western Sweden, Prehospen University College of Borås, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
authors.affiliation: Department of Clinical Science and Education Karolinska Institutet, Section of Cardiology, Södersjukhuset Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Jonsson
authors.affiliation: Department of Clinical Science and Education Karolinska Institutet, Södersjukhuset Stockholm, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Järnbert-Petterson
authors.affiliation: Department of Clinical Science and Education Karolinska Institutet, Section of Cardiology, Södersjukhuset Stockholm, Sweden.
authors.forename: Sune
authors.initials: S
authors.lastname: Forsberg
authors.affiliation: Department of Clinical Science and Education Karolinska Institutet, Section of Cardiology, Södersjukhuset Stockholm, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Dahlqvist
authors.affiliation: Department of Clinical Science and Education Karolinska Institutet, Section of Cardiology, Södersjukhuset Stockholm, Sweden.
authors.forename: Mattias
authors.initials: M
authors.lastname: Ringh
authors.affiliation: Department of Clinical Science and Education Karolinska Institutet, Section of Cardiology, Södersjukhuset Stockholm, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Svensson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000401:mortality; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D016022:Case-Control Studies; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007036:Hypothermia, Induced / Q000401:mortality; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D016019:Survival Analysis; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Heart arrest; cardiopulmonary resuscitation; defibrillation