Abstract 313: Assessment of Arrest Procedures, Hospital Care and Functional Survival of Initial VT/VF Arrest Patients Shocked by a Bystander AED vs Patients Shocked by EMS
Introduction: Although one randomized trial and a prospective cohort study suggest that survival to hospital discharge doubles if a bystander uses an AED to defibrillate vs waiting for an EMS provider to defibrillate, there has been no comprehensive comparison of functional survival outcomes or resuscitation treatment differences for these two resuscitation strategies.
METHODS: Population based data from the ROC Registry (Epistry) provided a comparison of public, witnessed initial VT/VF arrests treated with bystander AED shock (n=77) vs EMS shock (n=328) during 2010. Modified Rankin score (MRS) was determined from the hospital record and MRS <3 at discharge was considered to be good functional survival.
Results: The two groups were similar in EMS response time, age, and sex. More of the bystander AED vs. EMS shocked patients had bystander CPR (98.7 vs. 62.5%, p<0.001) and fewer received epinephrine (42.9 vs. 72.6%, p<0.001) or amiodarone (9.1 vs. 29.3%, p<0.001). In-hospital care was not different in use of hypothermia (31-32%) but median hospitalization was shorter for bystander AED shocked patients who survived to discharge (10 days vs 13.5 days, ns) Survival to discharge for bystander AED vs. EMS shocked patients was 68% vs. 46% (p=0.001) and survival with MRS < 3 was 53% vs. 33% (p=0.001). The functional survival advantage for bystander AED shocked patients persisted after adjustment for age, sex, bystander CPR and study site: OR of 2.17 (95% CI 1.26, 3.75 p=0.006).
CONCLUSIONS: Thus AED shock by bystanders for initial VT/VF arrests is associated with greater survival with good to excellent functional recovery and results in less use of medications to achieve stable hemodynamics after arrest.
- © 2013 by American Heart Association, Inc.