PLoS ONE (Jan 2020)

The impact of a high-quality basic life support police-based first responder system on outcome after out-of-hospital cardiac arrest.

  • Mario Krammel,
  • Elisabeth Lobmeyr,
  • Patrick Sulzgruber,
  • Markus Winnisch,
  • David Weidenauer,
  • Michael Poppe,
  • Philip Datler,
  • Sebastian Zeiner,
  • Markus Keferboeck,
  • Jakob Eichelter,
  • Thomas Hamp,
  • Thomas Uray,
  • Sebastian Schnaubelt,
  • Alexander Nuernberger

DOI
https://doi.org/10.1371/journal.pone.0233966
Journal volume & issue
Vol. 15, no. 6
p. e0233966

Abstract

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BACKGROUND:Laypersons' efforts to initiate basic life support (BLS) in witnessed Out-of-Hospital Cardiac Arrest (OHCA) remain comparably low within western society. Therefore, in order to shorten no-flow times in cardiac arrest, several police-based first responder systems equipped with automated external defibrillators (Pol-AED) were established in urban areas, which subsequently allow early BLS and AED administration by police officers. However, data on the quality of BLS and AED use in such a system and its impact on patient outcome remain scarce and inconclusive. METHODS:A total of 85 Pol-AED cases were randomly assigned to a gender, age and first rhythm matched non-Pol-AED control group (n = 170) in a 1:2 ratio. Data on quality of BLS were extracted via trans-thoracic impedance tracings of used AED devices. RESULTS:Comparing Pol-AED cases and the control group, we observed a similar compression rate per minute (p = 0.677) and compression ratio (p = 0.651), mirroring an overall high quality of BLS administered by police officers. Time to the first shock was significantly shorter in Pol-AED cases (6 minutes [IQR: 2-10] vs. 12 minutes [IQR: 8-17]; p<0.001). While Pol-AED was not associated with increased sustained return of spontaneous circulation (p = 0.564), a strong and independent impact on survival until hospital discharge (adj. OR: 1.85 [95%CI: 1.06-3.23; p = 0.030]) and a borderline significance for the association with favorable neurological outcome (adj. OR: 1.58 [95%CI: 0.96-2.89; p = 0.052) were observed. CONCLUSION:We were able to demonstrate an early start and a high quality of BLS and AED use in Pol-AED assessed OHCA cases. Moreover, the presence of Pol-AED care was associated with better patient survival and borderline significance for favorable neurological outcome.