Abstract 178: Long-Term Benefit of Using Dual Dispatch in Out-of-Hospital Cardiac Arrest: The Salsa (Saving Lives in Stockholm Area) Trial
Introduction: Out-of-hospital cardiac arrest (OHCA) afflicts around 275,000 victims per year across Europe and is accountable for more than 60% of deaths from coronary heart disease. In 2005, a dual dispatch system in OHCA was implemented in Stockholm, Sweden, using CPR-trained fire fighters with automatic external defibrillators as first responders in addition to the emergency medical services (EMS). The pilot study from 2006 showed promising results on improving time intervals and survival rates.
Hypothesis: We assessed the hypothesis that reduced pre-hospital response times to shorten the time to CPR and defibrillation and to optimize the quality of CPR would improve survival rates in OHCA.
Methods Included in the trial were witnessed out-of-hospital cardiac arrest patients, where resuscitation attempts was initiated, irrespective of first rhythm, from the years 2004 (historical controls) and 2007-2009 (intervention period). In 2007-2009 fire-fighters were dispatched in suspected OHCA in parallel with the EMS.
Results and Conclusions In total, 2060 patients were included, 427 controls and 1633 in the intervention group. During the intervention period 2007-2009, fire fighters were first on scene in 39% of cases with dual dispatch. The median time from call to arrival of first responder shortened from 7.5 minutes during the control period to 6.8 minutes among dual dispatch cases in the intervention group. The proportion of patients admitted alive to hospital increased from 27.4% among controls to 33.5% in the intervention group (OR 1.3, p=0.02). The proportion of patients alive after 1 month increased from 5.9% to 12.3 % (OR 2.3, p<0.001). In conclusion, the implementation of a dual dispatch system using fire-fighters as first responders have shortened response times and significantly increased the survival to 1 month, irrespective of the first rhythm in witnessed OHCA. The increase in survival is mainly believed to be associated with improved CPR and shortened time intervals.
- Cardiac arrest
- Sudden cardiac death
- Ventricular fibrillation
- Cardiopulmonary resuscitation
- Emergency care
- © 2011 by American Heart Association, Inc.