title: 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.
abstract: OBJECTIVE
  Defibrillation by bystanders and first responders has been associated with increased survival, but limited data are available from non-metropolitan areas. We examined time from 911-call to defibrillation (according to who defibrillated patients) and survival in North Carolina.
  
  
  METHODS
  Through the Cardiac Arrest Registry to Enhance Survival, we identified 1732 defibrillated out-of-hospital cardiac arrests from counties with complete case capture (population 2.7 million) from 2010 to 2013.
  
  
  RESULTS
  Most patients (60.9%) were defibrillated in > 10 min. A minority (8.0%) was defibrillated < 5 min; most of these patients were defibrillated by first responders (51.8%) and bystanders (33.1%), independent of location of arrest (residential or public). Bystanders initiated cardiopulmonary resuscitation (CPR) in 49.0% of cases and defibrillated 13.4% of those. Survival decreased with increasing time to defibrillation (< 2 min: 59.1%; 2 to < 5 min: 38.5%; 5-10 min: 33.1%; > 10 min: 13.2%). Odds of survival with favorable neurologic outcome adjusted for age, sex, and bystander CPR improved with faster defibrillation (<2 min: OR 7.73 [95% CI 3.19-18.73]; 2 to < 5 min: 3.78 [2.45-5.84]; 5-10 min: 3.16 [2.42-4.12]; > 10 min: reference).
  
  
  CONCLUSIONS
  Bystanders and first responders were mainly responsible for defibrillation within 5 min, independent of location of arrest. Bystanders initiated CPR in half of the cardiac arrest cases but only defibrillated a minority of those. Timely defibrillation and defibrillation by bystanders and/or first responders were strongly associated with increased survival. Strategic efforts to increase bystander and first-responder defibrillation are warranted to increase survival after out-of-hospital cardiac arrest.
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States. Electronic address: Carolina.hansen@duke.edu.
authors.forename: Carolina Malta
authors.initials: CM
authors.lastname: Hansen
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States.
authors.forename: Kristian
authors.initials: K
authors.lastname: Kragholm
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.affiliation: Carolinas Medical Center, Charlotte, NC, United States.
authors.forename: David A
authors.initials: DA
authors.lastname: Pearson
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States; Center for Educational Excellence, Duke Clinical Research Institute, Durham, NC, United States.
authors.forename: Clark
authors.initials: C
authors.lastname: Tyson
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States.
authors.forename: Lisa
authors.initials: L
authors.lastname: Monk
authors.affiliation: New Hanover Regional Medical Center, Wilmington, NC, United States.
authors.forename: Claire
authors.initials: C
authors.lastname: Corbett
authors.affiliation: WFU Health Sciences, Winston-Salem, NC, United States.
authors.forename: R Darrell
authors.initials: RD
authors.lastname: Nelson
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States; Department of Community and Family Medicine, Duke University, Durham, NC, United States.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Dupre
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States; The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark.
authors.forename: Emil L
authors.initials: EL
authors.lastname: Fosbøl
authors.affiliation: Nicholas School of the Environment, Duke University, Durham, NC, United States.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Strauss
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Fordyce
authors.affiliation: Emory University School of Medicine, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States.
authors.forename: Bryan
authors.initials: B
authors.lastname: McNally
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States.
authors.forename: James G
authors.initials: JG
authors.lastname: Jollis
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004554:Electric Countershock / Q000592:standards*; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D012042:Registries; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D000078329:Workforce
keywords: Cardiopulmonary resuscitation; Defibrillation; Heart arrest