Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest

Kristian Kragholm; Mads Wissenberg; Rikke N Mortensen; Steen M Hansen; Carolina Malta Hansen; Kristinn Thorsteinsson; Shahzleen Rajan; Freddy Lippert; Fredrik Folke; Gunnar Gislason; Lars Køber; Kirsten Fonager; Svend Eggert Jensen; Thomas A Gerds; Christian Torp-Pedersen; Bodil Steen Rasmussen

doi:10.1056/nejmoa1601891

Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest

Kristian Kragholm, Mads Wissenberg, Rikke N Mortensen, Steen M Hansen, Carolina Malta Hansen, Kristinn Thorsteinsson, Shahzleen Rajan, Freddy Lippert, Fredrik Folke, Gunnar Gislason, Lars Køber, Kirsten Fonager, Svend Eggert Jensen, Thomas A Gerds, Christian Torp-Pedersen, Bodil Steen Rasmussen

142 Citations (Scopus)

Abstract

BACKGROUND The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied. METHODS We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes. RESULTS Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (P<0.001), the rate of bystander defibrillation increased from 2.1% to 16.8% (P<0.001), the rate of brain damage or nursing home admission decreased from 10.0% to 7.6% (P<0.001), and all-cause mortality decreased from 18.0% to 7.9% (P = 0.002). In adjusted analyses, bystander CPR was associated with a risk of brain damage or nursing home admission that was significantly lower than that associated with no bystander resuscitation (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.82), as well as a lower risk of death from any cause (hazard ratio, 0.70; 95% CI, 0.50 to 0.99) and a lower risk of the composite end point of brain damage, nursing home admission, or death (hazard ratio, 0.67; 95% CI, 0.53 to 0.84). The risks of these outcomes were even lower among patients who received bystander defibrillation as compared with no bystander resuscitation. CONCLUSIONS In our study, we found that bystander CPR and defibrillation were associated with risks of brain damage or nursing home admission and of death from any cause that were significantly lower than those associated with no bystander resuscitation.

Original language	English
Journal	New England Journal of Medicine
Volume	376
Issue number	18
Pages (from-to)	1737-1747
Number of pages	11
ISSN	0028-4793
DOIs	https://doi.org/10.1056/nejmoa1601891
Publication status	Published - 4 May 2017

Keywords

Adult
Aged
Cardiopulmonary Resuscitation
Denmark
Electric Countershock
Female
Humans
Hypoxia, Brain
Institutionalization
Intention to Treat Analysis
Male
Middle Aged
Nursing Homes
Out-of-Hospital Cardiac Arrest
Risk
Survival Analysis
Volunteers
Comparative Study
Journal Article

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https://www.nejm.org/doi/pdf/10.1056/NEJMoa1601891?articleTools=true

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Kragholm, K., Wissenberg, M., Mortensen, R. N., Hansen, S. M., Hansen, C. M., Thorsteinsson, K., Rajan, S., Lippert, F., Folke, F., Gislason, G., Køber, L., Fonager, K., Jensen, S. E., Gerds, T. A., Torp-Pedersen, C., & Rasmussen, B. S. (2017). Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest. New England Journal of Medicine, 376(18), 1737-1747. https://doi.org/10.1056/nejmoa1601891

Kragholm, K, Wissenberg, M, Mortensen, RN, Hansen, SM, Hansen, CM, Thorsteinsson, K, Rajan, S, Lippert, F , Folke, F , Gislason, G , Køber, L, Fonager, K, Jensen, SE, Gerds, TA, Torp-Pedersen, C & Rasmussen, BS 2017, 'Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest', New England Journal of Medicine, vol. 376, no. 18, pp. 1737-1747. https://doi.org/10.1056/nejmoa1601891

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title = "Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest",

abstract = "BACKGROUND The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied. METHODS We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes. RESULTS Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (P<0.001), the rate of bystander defibrillation increased from 2.1% to 16.8% (P<0.001), the rate of brain damage or nursing home admission decreased from 10.0% to 7.6% (P<0.001), and all-cause mortality decreased from 18.0% to 7.9% (P = 0.002). In adjusted analyses, bystander CPR was associated with a risk of brain damage or nursing home admission that was significantly lower than that associated with no bystander resuscitation (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.82), as well as a lower risk of death from any cause (hazard ratio, 0.70; 95% CI, 0.50 to 0.99) and a lower risk of the composite end point of brain damage, nursing home admission, or death (hazard ratio, 0.67; 95% CI, 0.53 to 0.84). The risks of these outcomes were even lower among patients who received bystander defibrillation as compared with no bystander resuscitation. CONCLUSIONS In our study, we found that bystander CPR and defibrillation were associated with risks of brain damage or nursing home admission and of death from any cause that were significantly lower than those associated with no bystander resuscitation.",

keywords = "Adult, Aged, Cardiopulmonary Resuscitation, Denmark, Electric Countershock, Female, Humans, Hypoxia, Brain, Institutionalization, Intention to Treat Analysis, Male, Middle Aged, Nursing Homes, Out-of-Hospital Cardiac Arrest, Risk, Survival Analysis, Volunteers, Comparative Study, Journal Article",

author = "Kristian Kragholm and Mads Wissenberg and Mortensen, {Rikke N} and Hansen, {Steen M} and Hansen, {Carolina Malta} and Kristinn Thorsteinsson and Shahzleen Rajan and Freddy Lippert and Fredrik Folke and Gunnar Gislason and Lars K{\o}ber and Kirsten Fonager and Jensen, {Svend Eggert} and Gerds, {Thomas A} and Christian Torp-Pedersen and Rasmussen, {Bodil Steen}",

year = "2017",

month = may,

day = "4",

doi = "10.1056/nejmoa1601891",

language = "English",

volume = "376",

pages = "1737--1747",

journal = "New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachusetts Medical Society",

number = "18",

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TY - JOUR

T1 - Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest

AU - Kragholm, Kristian

AU - Wissenberg, Mads

AU - Mortensen, Rikke N

AU - Hansen, Steen M

AU - Hansen, Carolina Malta

AU - Thorsteinsson, Kristinn

AU - Rajan, Shahzleen

AU - Lippert, Freddy

AU - Folke, Fredrik

AU - Gislason, Gunnar

AU - Køber, Lars

AU - Fonager, Kirsten

AU - Jensen, Svend Eggert

AU - Gerds, Thomas A

AU - Torp-Pedersen, Christian

AU - Rasmussen, Bodil Steen

PY - 2017/5/4

Y1 - 2017/5/4

N2 - BACKGROUND The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied. METHODS We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes. RESULTS Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (P<0.001), the rate of bystander defibrillation increased from 2.1% to 16.8% (P<0.001), the rate of brain damage or nursing home admission decreased from 10.0% to 7.6% (P<0.001), and all-cause mortality decreased from 18.0% to 7.9% (P = 0.002). In adjusted analyses, bystander CPR was associated with a risk of brain damage or nursing home admission that was significantly lower than that associated with no bystander resuscitation (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.82), as well as a lower risk of death from any cause (hazard ratio, 0.70; 95% CI, 0.50 to 0.99) and a lower risk of the composite end point of brain damage, nursing home admission, or death (hazard ratio, 0.67; 95% CI, 0.53 to 0.84). The risks of these outcomes were even lower among patients who received bystander defibrillation as compared with no bystander resuscitation. CONCLUSIONS In our study, we found that bystander CPR and defibrillation were associated with risks of brain damage or nursing home admission and of death from any cause that were significantly lower than those associated with no bystander resuscitation.

AB - BACKGROUND The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied. METHODS We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes. RESULTS Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (P<0.001), the rate of bystander defibrillation increased from 2.1% to 16.8% (P<0.001), the rate of brain damage or nursing home admission decreased from 10.0% to 7.6% (P<0.001), and all-cause mortality decreased from 18.0% to 7.9% (P = 0.002). In adjusted analyses, bystander CPR was associated with a risk of brain damage or nursing home admission that was significantly lower than that associated with no bystander resuscitation (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.82), as well as a lower risk of death from any cause (hazard ratio, 0.70; 95% CI, 0.50 to 0.99) and a lower risk of the composite end point of brain damage, nursing home admission, or death (hazard ratio, 0.67; 95% CI, 0.53 to 0.84). The risks of these outcomes were even lower among patients who received bystander defibrillation as compared with no bystander resuscitation. CONCLUSIONS In our study, we found that bystander CPR and defibrillation were associated with risks of brain damage or nursing home admission and of death from any cause that were significantly lower than those associated with no bystander resuscitation.

KW - Adult

KW - Aged

KW - Cardiopulmonary Resuscitation

KW - Denmark

KW - Electric Countershock

KW - Female

KW - Humans

KW - Hypoxia, Brain

KW - Institutionalization

KW - Intention to Treat Analysis

KW - Male

KW - Middle Aged

KW - Nursing Homes

KW - Out-of-Hospital Cardiac Arrest

KW - Risk

KW - Survival Analysis

KW - Volunteers

KW - Comparative Study

KW - Journal Article

U2 - 10.1056/nejmoa1601891

DO - 10.1056/nejmoa1601891

M3 - Journal article

C2 - 28467879

SN - 0028-4793

VL - 376

SP - 1737

EP - 1747

JO - New England Journal of Medicine

JF - New England Journal of Medicine

IS - 18

ER -

Bystander Efforts and 1-Year Outcomes in Out-of-Hospital Cardiac Arrest

Abstract

Keywords

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