title: Bystander Defibrillation for Out-of-Hospital Cardiac Arrest in Public vs Residential Locations.
abstract: Bystander-delivered defibrillation (hereinafter referred to as bystander defibrillation) of patients with out-of-hospital cardiac arrests (OHCAs) remains limited despite the widespread dissemination of automated external defibrillators (AEDs).
  
  
  
  To examine calendar changes in bystander defibrillation and subsequent survival according to a public or a residential location of the cardiac arrest after nationwide initiatives in Denmark to facilitate bystander-mediated resuscitative efforts, including bystander defibrillation.
  
  
  
  This nationwide study identified 18 688 patients in Denmark with first-time OHCA from June 1, 2001, to December 31, 2012, using the Danish Cardiac Arrest Registry. Patients had a presumed cardiac cause of arrest that was not witnessed by emergency medical services personnel. Data were analyzed from April 1, 2015, to December 10, 2016.
  
  
  
  Nationwide initiatives to facilitate bystander resuscitative efforts, including bystander defibrillation, consisted of resuscitation training of Danish citizens, dissemination of on-site AEDs, foundation of an AED registry linked to emergency medical dispatch centers, and dispatcher-assisted guidance of bystander resuscitation efforts.
  
  
  
  The proportion of patients who received bystander defibrillation according to the location of the cardiac arrest and their subsequent 30-day survival.
  
  
  
  Of the 18 688 patients with OHCAs (67.8% men and 32.2% women; median [interquartile range] age, 72 [62-80] years), 4783 (25.6%) had a cardiac arrest in a public location and 13 905 (74.4%) in a residential location. The number of registered AEDs increased from 141 in 2007 to 7800 in 2012. The distribution of AED location was consistently skewed in favor of public locations. Bystander defibrillation increased in public locations from 3 of 245 (1.2%; 95% CI, 0.4%-3.5%) in 2001 to 78 of 510 (15.3%; 95% CI, 12.4%-18.7%) in 2012 (P < .001) but remained unchanged in residential locations from 7 of 542 (1.3%; 95% CI, 0.6%-2.6%) in 2001 to 21 of 1669 (1.3%; 95% CI, 0.8%-1.9%) in 2012 (P = .17). Thirty-day survival after bystander defibrillation increased in public locations from 8.3% (95% CI, 1.5%-35.4%) in 2001/2002 to 57.5% (95% CI, 48.6%-66.0%) in 2011/2012 (P < .001) in residential locations, from 0.0% (95% CI, 0.0%-19.4%) in 2001/2002 to 25.6% (95% CI, 14.6%-41.1%) in 2011/2012 (P < .001).
  
  
  
  Initiatives to facilitate bystander defibrillation were associated with a marked increase in bystander defibrillation in public locations, whereas bystander defibrillation remained limited in residential locations. Concomitantly, survival increased after bystander defibrillation in residential and public locations.
authors.affiliation: Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Steen Møller
authors.initials: SM
authors.lastname: Hansen
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
authors.forename: Carolina Malta
authors.initials: CM
authors.lastname: Hansen
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark3Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Folke
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
authors.forename: Shahzleen
authors.initials: S
authors.lastname: Rajan
authors.affiliation: Department of Anesthesiology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Kragholm
authors.affiliation: Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Linda
authors.initials: L
authors.lastname: Ejlskov
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark6The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark7The Danish Heart Foundation, Copenhagen, Denmark.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Gislason
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gerds
authors.affiliation: Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Hjortshøj
authors.affiliation: Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Freddy
authors.initials: F
authors.lastname: Lippert
authors.affiliation: Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark3Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Mads
authors.initials: M
authors.lastname: Wissenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D015331:Cohort Studies; D047548:Defibrillators / Q000600:supply & distribution; D003718:Denmark; D004554:Electric Countershock / Q000706:statistics & numerical data*; D004632:Emergency Medical Services; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D012042:Registries