Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest

Mads Wissenberg; Freddy K Lippert; Fredrik Folke; Peter Weeke; Carolina Malta Hansen; Erika Frischknecht Christensen; Henning Jans; Poul Anders Hansen; Torsten Lang-Jensen; Jonas Bjerring Olesen; Jesper Lindhardsen; Emil L Fosbol; Søren L Nielsen; Gunnar H Gislason; Lars Kober; Christian Torp-Pedersen

doi:10.1001/jama.2013.278483

Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest

Mads Wissenberg, Freddy K Lippert, Fredrik Folke, Peter Weeke, Carolina Malta Hansen, Erika Frischknecht Christensen, Henning Jans, Poul Anders Hansen, Torsten Lang-Jensen, Jonas Bjerring Olesen, Jesper Lindhardsen, Emil L Fosbol, Søren L Nielsen, Gunnar H Gislason, Lars Kober, Christian Torp-Pedersen

Institut for Klinisk Medicin

640 Citationer (Scopus)

Abstract

IMPORTANCE: Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many associated with improved survival. OBJECTIVE: To examine temporal changes in bystander resuscitation attempts and survival during a 10-year period in which several national initiatives were taken to increase rates of bystander resuscitation and improve advanced care. DESIGN, SETTING, AND PARTICIPANTS: Patients with out-of-hospital cardiac arrest for which resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29 111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n = 7390) and those with cardiac arrests witnessed by emergency medical services personnel (n = 2253), leaving a study population of 19 468 patients. MAIN OUTCOMES AND MEASURES: Temporal trends in bystander CPR, bystander defibrillation, 30-day survival, and 1-year survival. RESULTS: The median age of patients was 72 years; 67.4% were men. Bystander CPR increased significantly during the study period, from 21.1% (95% CI, 18.8%-23.4%) in 2001 to 44.9% (95% CI, 42.6%-47.1%) in 2010 (P < .001), whereas use of defibrillation by bystanders remained low (1.1% [95% CI, 0.6%-1.9%] in 2001 to 2.2% [95% CI, 1.5%-2.9%] in 2010; P = .003). More patients achieved survival on hospital arrival (7.9% [95% CI, 6.4%-9.5%] in 2001 to 21.8% [95% CI, 19.8%-23.8%] in 2010; P < .001). Also, 30-day survival improved (3.5% [95% CI, 2.5%-4.5%] in 2001 to 10.8% [95% CI, 9.4%-12.2%] in 2010; P < .001), as did 1-year survival (2.9% [95% CI, 2.0%-3.9%] in 2001 to 10.2% [95% CI, 8.9%-11.6%] in 2010; P < .001). Despite a decrease in the incidence of out-of-hospital cardiac arrests during the study period (40.4 to 34.4 per 100 000 persons in 2001 and 2010, respectively; P = .002), the number of survivors per 100 000 persons increased significantly (P < .001). For the entire study period, bystander CPR was positively associated with 30-day survival, regardless of witnessed status (30-day survival for nonwitnessed cardiac arrest, 4.3% [95% CI, 3.4%-5.2%] with bystander CPR and 1.0% [95% CI, 0.8%-1.3%] without; odds ratio, 4.38 [95% CI, 3.17-6.06]). For witnessed arrest the corresponding values were 19.4% (95% CI, 18.1%-20.7%) vs 6.1% (95% CI, 5.4%-6.7%); odds ratio, 3.74 (95% CI, 3.26-4.28). CONCLUSIONS AND RELEVANCE: In Denmark between 2001 and 2010, an increase in survival following out-of-hospital cardiac arrest was significantly associated with a concomitant increase in bystander CPR. Because of the co-occurrence of other related initiatives, a causal relationship remains uncertain.

Originalsprog	Engelsk
Tidsskrift	JAMA : the journal of the American Medical Association
Vol/bind	310
Udgave nummer	13
Sider (fra-til)	1377-1384
Antal sider	8
ISSN	0098-7484
DOI	https://doi.org/10.1001/jama.2013.278483
Status	Udgivet - 2 okt. 2013

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10.1001/jama.2013.278483

https://jamanetwork.com/journals/jama/articlepdf/1745678/joi130066.pdf

Citationsformater

Wissenberg, M., Lippert, F. K., Folke, F., Weeke, P., Hansen, C. M., Christensen, E. F., Jans, H., Hansen, P. A., Lang-Jensen, T., Olesen, J. B., Lindhardsen, J., Fosbol, E. L., Nielsen, S. L., Gislason, G. H., Kober, L., & Torp-Pedersen, C. (2013). Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest. JAMA : the journal of the American Medical Association, 310(13), 1377-1384. https://doi.org/10.1001/jama.2013.278483

Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest. / Wissenberg, Mads; Lippert, Freddy K ; Folke, Fredrik et al.

I: JAMA : the journal of the American Medical Association, Bind 310, Nr. 13, 02.10.2013, s. 1377-1384.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Wissenberg, M, Lippert, FK , Folke, F, Weeke, P, Hansen, CM, Christensen, EF, Jans, H, Hansen, PA, Lang-Jensen, T, Olesen, JB, Lindhardsen, J, Fosbol, EL, Nielsen, SL, Gislason, GH , Kober, L & Torp-Pedersen, C 2013, 'Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest', JAMA : the journal of the American Medical Association, bind 310, nr. 13, s. 1377-1384. https://doi.org/10.1001/jama.2013.278483

@article{20faae45da1a4fe5a253782c5cc84d68,

title = "Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest",

abstract = "IMPORTANCE: Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many associated with improved survival. OBJECTIVE: To examine temporal changes in bystander resuscitation attempts and survival during a 10-year period in which several national initiatives were taken to increase rates of bystander resuscitation and improve advanced care. DESIGN, SETTING, AND PARTICIPANTS: Patients with out-of-hospital cardiac arrest for which resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29 111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n = 7390) and those with cardiac arrests witnessed by emergency medical services personnel (n = 2253), leaving a study population of 19 468 patients. MAIN OUTCOMES AND MEASURES: Temporal trends in bystander CPR, bystander defibrillation, 30-day survival, and 1-year survival. RESULTS: The median age of patients was 72 years; 67.4% were men. Bystander CPR increased significantly during the study period, from 21.1% (95% CI, 18.8%-23.4%) in 2001 to 44.9% (95% CI, 42.6%-47.1%) in 2010 (P < .001), whereas use of defibrillation by bystanders remained low (1.1% [95% CI, 0.6%-1.9%] in 2001 to 2.2% [95% CI, 1.5%-2.9%] in 2010; P = .003). More patients achieved survival on hospital arrival (7.9% [95% CI, 6.4%-9.5%] in 2001 to 21.8% [95% CI, 19.8%-23.8%] in 2010; P < .001). Also, 30-day survival improved (3.5% [95% CI, 2.5%-4.5%] in 2001 to 10.8% [95% CI, 9.4%-12.2%] in 2010; P < .001), as did 1-year survival (2.9% [95% CI, 2.0%-3.9%] in 2001 to 10.2% [95% CI, 8.9%-11.6%] in 2010; P < .001). Despite a decrease in the incidence of out-of-hospital cardiac arrests during the study period (40.4 to 34.4 per 100 000 persons in 2001 and 2010, respectively; P = .002), the number of survivors per 100 000 persons increased significantly (P < .001). For the entire study period, bystander CPR was positively associated with 30-day survival, regardless of witnessed status (30-day survival for nonwitnessed cardiac arrest, 4.3% [95% CI, 3.4%-5.2%] with bystander CPR and 1.0% [95% CI, 0.8%-1.3%] without; odds ratio, 4.38 [95% CI, 3.17-6.06]). For witnessed arrest the corresponding values were 19.4% (95% CI, 18.1%-20.7%) vs 6.1% (95% CI, 5.4%-6.7%); odds ratio, 3.74 (95% CI, 3.26-4.28). CONCLUSIONS AND RELEVANCE: In Denmark between 2001 and 2010, an increase in survival following out-of-hospital cardiac arrest was significantly associated with a concomitant increase in bystander CPR. Because of the co-occurrence of other related initiatives, a causal relationship remains uncertain.",

author = "Mads Wissenberg and Lippert, {Freddy K} and Fredrik Folke and Peter Weeke and Hansen, {Carolina Malta} and Christensen, {Erika Frischknecht} and Henning Jans and Hansen, {Poul Anders} and Torsten Lang-Jensen and Olesen, {Jonas Bjerring} and Jesper Lindhardsen and Fosbol, {Emil L} and Nielsen, {S{\o}ren L} and Gislason, {Gunnar H} and Lars Kober and Christian Torp-Pedersen",

year = "2013",

month = oct,

day = "2",

doi = "10.1001/jama.2013.278483",

language = "English",

volume = "310",

pages = "1377--1384",

journal = "J A M A: The Journal of the American Medical Association",

issn = "0098-7484",

publisher = "American Medical Association",

number = "13",

}

TY - JOUR

T1 - Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest

AU - Wissenberg, Mads

AU - Lippert, Freddy K

AU - Folke, Fredrik

AU - Weeke, Peter

AU - Hansen, Carolina Malta

AU - Christensen, Erika Frischknecht

AU - Jans, Henning

AU - Hansen, Poul Anders

AU - Lang-Jensen, Torsten

AU - Olesen, Jonas Bjerring

AU - Lindhardsen, Jesper

AU - Fosbol, Emil L

AU - Nielsen, Søren L

AU - Gislason, Gunnar H

AU - Kober, Lars

AU - Torp-Pedersen, Christian

PY - 2013/10/2

Y1 - 2013/10/2

N2 - IMPORTANCE: Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many associated with improved survival. OBJECTIVE: To examine temporal changes in bystander resuscitation attempts and survival during a 10-year period in which several national initiatives were taken to increase rates of bystander resuscitation and improve advanced care. DESIGN, SETTING, AND PARTICIPANTS: Patients with out-of-hospital cardiac arrest for which resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29 111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n = 7390) and those with cardiac arrests witnessed by emergency medical services personnel (n = 2253), leaving a study population of 19 468 patients. MAIN OUTCOMES AND MEASURES: Temporal trends in bystander CPR, bystander defibrillation, 30-day survival, and 1-year survival. RESULTS: The median age of patients was 72 years; 67.4% were men. Bystander CPR increased significantly during the study period, from 21.1% (95% CI, 18.8%-23.4%) in 2001 to 44.9% (95% CI, 42.6%-47.1%) in 2010 (P < .001), whereas use of defibrillation by bystanders remained low (1.1% [95% CI, 0.6%-1.9%] in 2001 to 2.2% [95% CI, 1.5%-2.9%] in 2010; P = .003). More patients achieved survival on hospital arrival (7.9% [95% CI, 6.4%-9.5%] in 2001 to 21.8% [95% CI, 19.8%-23.8%] in 2010; P < .001). Also, 30-day survival improved (3.5% [95% CI, 2.5%-4.5%] in 2001 to 10.8% [95% CI, 9.4%-12.2%] in 2010; P < .001), as did 1-year survival (2.9% [95% CI, 2.0%-3.9%] in 2001 to 10.2% [95% CI, 8.9%-11.6%] in 2010; P < .001). Despite a decrease in the incidence of out-of-hospital cardiac arrests during the study period (40.4 to 34.4 per 100 000 persons in 2001 and 2010, respectively; P = .002), the number of survivors per 100 000 persons increased significantly (P < .001). For the entire study period, bystander CPR was positively associated with 30-day survival, regardless of witnessed status (30-day survival for nonwitnessed cardiac arrest, 4.3% [95% CI, 3.4%-5.2%] with bystander CPR and 1.0% [95% CI, 0.8%-1.3%] without; odds ratio, 4.38 [95% CI, 3.17-6.06]). For witnessed arrest the corresponding values were 19.4% (95% CI, 18.1%-20.7%) vs 6.1% (95% CI, 5.4%-6.7%); odds ratio, 3.74 (95% CI, 3.26-4.28). CONCLUSIONS AND RELEVANCE: In Denmark between 2001 and 2010, an increase in survival following out-of-hospital cardiac arrest was significantly associated with a concomitant increase in bystander CPR. Because of the co-occurrence of other related initiatives, a causal relationship remains uncertain.

AB - IMPORTANCE: Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many associated with improved survival. OBJECTIVE: To examine temporal changes in bystander resuscitation attempts and survival during a 10-year period in which several national initiatives were taken to increase rates of bystander resuscitation and improve advanced care. DESIGN, SETTING, AND PARTICIPANTS: Patients with out-of-hospital cardiac arrest for which resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29 111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n = 7390) and those with cardiac arrests witnessed by emergency medical services personnel (n = 2253), leaving a study population of 19 468 patients. MAIN OUTCOMES AND MEASURES: Temporal trends in bystander CPR, bystander defibrillation, 30-day survival, and 1-year survival. RESULTS: The median age of patients was 72 years; 67.4% were men. Bystander CPR increased significantly during the study period, from 21.1% (95% CI, 18.8%-23.4%) in 2001 to 44.9% (95% CI, 42.6%-47.1%) in 2010 (P < .001), whereas use of defibrillation by bystanders remained low (1.1% [95% CI, 0.6%-1.9%] in 2001 to 2.2% [95% CI, 1.5%-2.9%] in 2010; P = .003). More patients achieved survival on hospital arrival (7.9% [95% CI, 6.4%-9.5%] in 2001 to 21.8% [95% CI, 19.8%-23.8%] in 2010; P < .001). Also, 30-day survival improved (3.5% [95% CI, 2.5%-4.5%] in 2001 to 10.8% [95% CI, 9.4%-12.2%] in 2010; P < .001), as did 1-year survival (2.9% [95% CI, 2.0%-3.9%] in 2001 to 10.2% [95% CI, 8.9%-11.6%] in 2010; P < .001). Despite a decrease in the incidence of out-of-hospital cardiac arrests during the study period (40.4 to 34.4 per 100 000 persons in 2001 and 2010, respectively; P = .002), the number of survivors per 100 000 persons increased significantly (P < .001). For the entire study period, bystander CPR was positively associated with 30-day survival, regardless of witnessed status (30-day survival for nonwitnessed cardiac arrest, 4.3% [95% CI, 3.4%-5.2%] with bystander CPR and 1.0% [95% CI, 0.8%-1.3%] without; odds ratio, 4.38 [95% CI, 3.17-6.06]). For witnessed arrest the corresponding values were 19.4% (95% CI, 18.1%-20.7%) vs 6.1% (95% CI, 5.4%-6.7%); odds ratio, 3.74 (95% CI, 3.26-4.28). CONCLUSIONS AND RELEVANCE: In Denmark between 2001 and 2010, an increase in survival following out-of-hospital cardiac arrest was significantly associated with a concomitant increase in bystander CPR. Because of the co-occurrence of other related initiatives, a causal relationship remains uncertain.

U2 - 10.1001/jama.2013.278483

DO - 10.1001/jama.2013.278483

M3 - Journal article

C2 - 24084923

SN - 0098-7484

VL - 310

SP - 1377

EP - 1384

JO - J A M A: The Journal of the American Medical Association

JF - J A M A: The Journal of the American Medical Association

IS - 13

ER -

Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest

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