Effects of Dispatcher-Assisted Public-Access Defibrillation Programs on the Outcomes of Out-of-Hospital Cardiac Arrest: A Before-and-After Study

Chien-Hsiung Huang; Cheng-Yu Chien; Chip-Jin Ng; Shao-Yu Fang; Ming-Fang Wang; Chi-Chun Lin; Chen-Bin Chen; Li-Heng Tsai; Kuang-Hung Hsu; Sherry Yueh-Hsia Chiu

doi:10.1161/JAHA.123.031662

Effects of Dispatcher-Assisted Public-Access Defibrillation Programs on the Outcomes of Out-of-Hospital Cardiac Arrest: A Before-and-After Study

J Am Heart Assoc. 2024 Feb 6;13(3):e031662. doi: 10.1161/JAHA.123.031662. Epub 2024 Jan 19.

Authors

Chien-Hsiung Huang^{1

2

3}, Cheng-Yu Chien^{1

4

2

5

6

7

8}, Chip-Jin Ng^{1

4

7}, Shao-Yu Fang¹, Ming-Fang Wang¹, Chi-Chun Lin^{1

5}, Chen-Bin Chen^{1

9}, Li-Heng Tsai¹, Kuang-Hung Hsu^{1

10

11

12}, Sherry Yueh-Hsia Chiu^{10

13}

Affiliations

¹ Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine Chang Gung University Taoyuan Taiwan.
² Graduate Institute of Management, College of Management Chang Gung University Taoyuan Taiwan.
³ Department of Emergency Medicine New Taipei City Hospital New Taipei City Taiwan.
⁴ Department of Emergency Medicine Chang Gung Memorial Hospital Taipei Branch Taipei Taiwan.
⁵ Department of Emergency Medicine Ton-Yen General Hospital Zhubei Taiwan.
⁶ Institute of Epidemiology and Preventive Medicine, College of Public Health National Taiwan University Taipei Taiwan.
⁷ Department of Nursing Chang Gung University of Science and Technology Taoyuan Taiwan.
⁸ Department of Senior Service Industry Management Minghsin University of Science and Technology Hsinchu Taiwan.
⁹ Department of Emergency Medicine New Taipei Municipal TuCheng Hospital and Chang Gung University New Taipei City Taiwan.
¹⁰ Department of Health Care Management, College of Management Chang Gung University Taoyuan Taiwan.
¹¹ Research Center for Food and Cosmetic Safety, College of Human Ecology Chang Gung University of Science and Technology Taoyuan Taiwan.
¹² Department of Safety, Health and Environmental Engineering Ming Chi University of Technology New Taipei City Taiwan.
¹³ Division of Hepato-Gastroenterology, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan.

Abstract

Background: Public access defibrillation (PAD) programs have been implemented globally over the past decade. Although PAD can substantially increase the survival of cardiac arrest, PAD use remains low. This study aimed to evaluate whether drawing upon the successful experiences of dispatcher-assisted cardiopulmonary resuscitation programs would increase the use of PAD in dispatcher-assisted PAD programs.

Methods and results: This study using a before-and-after design was conducted in Taoyuan City using a local out-of-hospital cardiac arrest registry system and data of dispatcher performance derived from audio recordings. The primary outcomes were the rate of bystander PAD use, sustained return of spontaneous circulation, survival to discharge, and favorable neurological outcomes. The secondary outcomes were the performance of dispatchers in terms of PAD instruction and dispatcher-assisted cardiopulmonary resuscitation administration, the time interval indicators of dispatcher-assisted cardiopulmonary resuscitation. A total of 1159 patients were included and divided into 2 groups: the before-run-in group (502 patients) and the after-run-in group (657 patients). No significant difference was observed between the 2 groups in terms of baseline characteristics. The rate of PAD use in the after-run-in group significantly increased from 5.0% to 8.7% (P=0.015). The rate of favorable neurological outcomes increased from 4.4% to 5.9%, which was not a statistically significant difference. Compared with the before-run-in group, the rate of successful automated external defibrillator acquisition was 13.5% in the after-run-in group (P<0.001).

Conclusions: Implementing a dispatcher-assisted PAD protocol in a municipality setting significantly increased bystander PAD use without affecting dispatcher performance in out-of-hospital cardiac arrest recognition, cardiopulmonary resuscitation instruction, or dispatcher-assisted cardiopulmonary resuscitation time indicators.

Keywords: access to automated external defibrillators; cardiopulmonary resuscitation; dispatcher‐assisted CPR; out‐of‐hospital cardiac arrest.

MeSH terms

Cardiopulmonary Resuscitation* / methods
Emergency Medical Services* / methods
Humans
Out-of-Hospital Cardiac Arrest* / diagnosis
Out-of-Hospital Cardiac Arrest* / therapy
Registries