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Neighborhood characteristics, bystander automated external defibrillator use, and patient outcomes in public out-of-hospital cardiac arrest

  • Lars W. Andersen
    Correspondence
    Corresponding author at: Research Center for Emergency Medicine Department of Clinical Medicine Aarhus University Hospital, Nørrebrogade 44, Building 1B, 1st floor, 8000, Aarhus C, Denmark.
    Affiliations
    Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000, Aarhus, Denmark

    Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 02115, Boston, MA, USA
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  • Mathias J. Holmberg
    Affiliations
    Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000, Aarhus, Denmark

    Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 02115, Boston, MA, USA
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  • Asger Granfeldt
    Affiliations
    Department of Anesthesiology, Aarhus University Hospital, 8000, Aarhus, Denmark
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  • Bo Løfgren
    Affiliations
    Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000, Aarhus, Denmark

    Department of Internal Medicine, Regional Hospital of Randers, 8900, Randers, Denmark
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  • Kimberly Vellano
    Affiliations
    Department of Emergency Medicine, Emory University, 30322, Atlanta, Georgia, USA
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  • Bryan F. McNally
    Affiliations
    Department of Emergency Medicine, Emory University, 30322, Atlanta, Georgia, USA
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  • Bob Siegerink
    Affiliations
    Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, 10117, Berlin, Germany

    Institute of Public Health, Charité – Universitätsmedizin Berlin, 10117, Berlin, Germany
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  • Tobias Kurth
    Affiliations
    Institute of Public Health, Charité – Universitätsmedizin Berlin, 10117, Berlin, Germany
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  • Michael W. Donnino
    Affiliations
    Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 02115, Boston, MA, USA

    Department of Internal Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, 02115, Boston, MA, USA
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  • the CARES Surveillance Group

      Abstract

      Background

      Automated external defibrillators (AEDs) can be used by bystanders to provide rapid defibrillation for patients with out-of-hospital cardiac arrest (OHCA). Whether neighborhood characteristics are associated with AED use is unknown. Furthermore, the association between AED use and outcomes has not been well characterized for all (i.e. shockable and non-shockable) public OHCAs.

      Methods

      We included public, non-911-responder witnessed OHCAs registered in the Cardiac Arrest Registry to Enhance Survival (CARES) between 2013 and 2016. The primary patient outcome was survival to hospital discharge with a favorable functional outcome. We first assessed the association between neighborhood characteristics and bystander AED use using logistic regression and then assessed the association between bystander AED use and patient outcomes in a propensity score matched cohort.

      Results

      25,182 OHCAs were included. Several neighborhood characteristics, including the proportion of people living alone, the proportion of white people, and the proportion with a high-school degree or higher, were associated with bystander AED use. 5132 OHCAs were included in the propensity score-matched cohort. Bystander AED use was associated with an increased risk of a favorable functional outcome (35% vs. 25%, risk difference: 9.7% [95% confidence interval: 7.2%, 12.2%], risk ratio: 1.38 [95% confidence interval: 1.27, 1.50]). This was driven by increased favorable functional outcomes with AED use in patients with shockable rhythms (58% vs. 39%) but not in patients with non-shockable rhythms (10% vs. 10%).

      Conclusions

      Specific neighborhood characteristics were associated with bystander AED use in OHCA. Bystander AED use was associated with an increase in favorable functional outcome.

      Keywords

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