Abstract 235: More Than Doubled Survival in Out-of-Hospital Cardiac Arrest After the Implementation of a Dual Dispatch System is Attributable to Pre-Hospital Rather Than In-Hospital Factors
Introduction: In 2005, a dual dispatch system using fire fighters as first responders in addition to emergency medical service in out-of-hospital cardiac arrest (OHCA) was implemented in Stockholm, Sweden. A pilot study from 2006 showed doubled survival in witnessed OHCA compared to historical controls. The aim of this study was to determine the short and long term impact of the intervention and to investigate the additional effect on survival of in-hospital interventions such as therapeutic hypothermia and acute catheterization.
Methods and Results: OHCA from 2004 (historical controls, n=620) and 2006-2009 (intervention period, n=2863). Fire fighters performed CPR in 90 % of the patients. They were first on scene and connected an automated external defibrillator in 41% of the cases. The median time from dispatch to arrival of first responder shortened from 7.7 minutes in the control period to 6.7 minutes (p<0.001). Survival to 1 month improved from 3.9 % to 7.4 % (p=0.002). Logistic regression (adjustments for: sex, age, place, etiology, witnessed status, bystander-CPR, first rhythm) gave adjusted OR 2.7 (CI 1.5-4.6). Survival to 3 years increased from 2.4% to 6.2% (p<0.001), adjusted OR 3.5 (CI 1.8-7.0). In the logistic regression analysis including in-hospital factors we found no additional outcome benefit of therapeutic hypothermia, adjusted OR 1.5 (CI 0.7-3.2) and acute catheterization/thrombolysis, adjusted OR 1.7 (CI 0.9-3.1).
Conclusions: The implementation of a dual dispatch system using fire-fighters has significantly increased survival after 1 month and 3 year in OHCA. Only pre-hospital factors had an impact on outcome.
- © 2013 by American Heart Association, Inc.