title: Association of Bystander and First-Responder Intervention With Survival After Out-of-Hospital Cardiac Arrest in North Carolina, 2010-2013.
abstract: OBJECTIVE
  Out-of-hospital cardiac arrest is associated with low survival, but early cardiopulmonary resuscitation (CPR) and defibrillation can improve outcomes if more widely adopted.
  
  
  OBJECTIVE
  To examine temporal changes in bystander and first-responder resuscitation efforts before arrival of the emergency medical services (EMS) following statewide initiatives to improve bystander and first-responder efforts in North Carolina from 2010-2013 and to examine the association between bystander and first-responder resuscitation efforts and survival and neurological outcome.
  
  
  METHODS
  We studied 4961 patients with out-of-hospital cardiac arrest for whom resuscitation was attempted and who were identified through the Cardiac Arrest Registry to Enhance Survival (2010-2013). First responders were dispatched police officers, firefighters, rescue squad, or life-saving crew trained to perform basic life support until arrival of the EMS.
  
  
  METHODS
  Statewide initiatives to improve bystander and first-responder interventions included training members of the general population in CPR and in use of automated external defibrillators (AEDs), training first responders in team-based CPR including AED use and high-performance CPR, and training dispatch centers in recognition of cardiac arrest.
  
  
  METHODS
  The proportion of bystander and first-responder resuscitation efforts, including the combination of efforts between bystanders and first responders, from 2010 through 2013 and the association between these resuscitation efforts and survival and neurological outcome.
  
  
  RESULTS
  The combination of bystander CPR and first-responder defibrillation increased from 14.1% (51 of 362; 95% CI, 10.9%-18.1%) in 2010 to 23.1% (104 of 451; 95% CI, 19.4%-27.2%) in 2013 (P < .01). Survival with favorable neurological outcome increased from 7.1% (82 of 1149; 95% CI, 5.8%-8.8%) in 2010 to 9.7% (129 of 1334; 95% CI, 8.2%-11.4%) in 2013 (P = .02) and was associated with bystander-initiated CPR. Adjusting for age and sex, bystander and first-responder interventions were associated with higher survival to hospital discharge. Survival following EMS-initiated CPR and defibrillation was 15.2% (30 of 198; 95% CI, 10.8%-20.9%) compared with 33.6% (38 of 113; 95% CI, 25.5%-42.9%) following bystander-initiated CPR and defibrillation (odds ratio [OR], 3.12; 95% CI, 1.78-5.46); 24.2% (83 of 343; 95% CI, 20.0%-29.0%) following bystander CPR and first-responder defibrillation (OR, 1.70; 95% CI, 1.06-2.71); and 25.2% (109 of 432; 95% CI, 21.4%-29.6%) following first-responder CPR and defibrillation (OR, 1.77; 95% CI, 1.13-2.77).
  
  
  CONCLUSIONS
  Following a statewide educational intervention on rescusitation training, the proportion of patients receiving bystander-initiated CPR and defibrillation by first responders increased and was associated with greater likelihood of survival. Bystander-initiated CPR was associated with greater likelihood of survival with favorable neurological outcome.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Carolina
authors.initials: C
authors.lastname: Malta Hansen
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Kristian
authors.initials: K
authors.lastname: Kragholm
authors.affiliation: Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: David A
authors.initials: DA
authors.lastname: Pearson
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina3Center for Educational Excellence, Durham, North Carolina.
authors.forename: Clark
authors.initials: C
authors.lastname: Tyson
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Lisa
authors.initials: L
authors.lastname: Monk
authors.affiliation: Wake County EMS, Raleigh, North Carolina.
authors.forename: Brent
authors.initials: B
authors.lastname: Myers
authors.affiliation: WFU Health Sciences, Winston-Salem, North Carolina.
authors.forename: Darrell
authors.initials: D
authors.lastname: Nelson
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina6Department of Community and Family Medicine, Duke University, Durham, North Carolina.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Dupre
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina7The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark.
authors.forename: Emil L
authors.initials: EL
authors.lastname: Fosbøl
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: James G
authors.initials: JG
authors.lastname: Jollis
authors.affiliation: Nicholas School of the Environment, Duke University, Durham, North Carolina.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Strauss
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Monique L
authors.initials: ML
authors.lastname: Anderson
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia10Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Bryan
authors.initials: B
authors.lastname: McNally
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000193:education / Q000639:trends*; D047548:Defibrillators; D004554:Electric Countershock / Q000639:trends*; D004632:Emergency Medical Services; D060731:Emergency Responders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D055815:Young Adult