Clinical PaperEarly cardiopulmonary resuscitation and use of Automated External Defibrillators by laypersons in out-of-hospital cardiac arrest using an SMS alert service☆
Introduction
Sudden out-of-hospital cardiac arrest is a leading cause of death in developed countries. In the Netherlands, approximately 16,000 cases of sudden cardiac arrest occur out-of-hospital each year.1 The overall survival rate is between 5% and 10%,2 and depends on early recognition and call for help, cardiopulmonary resuscitation (CPR), defibrillation with an Automated External Defibrillator (AED), and advanced care.3
Over 40% of cardiac arrests occur due to ventricular fibrillation.4, 5, 6, 7 Survival rates for patients with this abnormal heart rhythm can reach up to 50–75% if early CPR and defibrillation are performed within 3–5 min after cardiac arrest.8 However, patient's chance of survival decreases approximately 7–10% with every minute delay in defibrillation.9, 10
Several studies report that in most communities, time from collapse to arrival of emergency medical service (EMS) personnel is 7–8 min or longer.11, 12 It is virtually impossible to reduce the delay by improving logistics and availability of EMS teams. Therefore, it is expected that further improvements can only be achieved by involving laypersons to perform CPR and defibrillation during the first minutes after cardiac arrest. Ambulance Oost, the EMS of Twente, started an early intervention program in 2008 and implemented the AED-Alert system. The program is unique in that it enables the EMS to alert laypersons by sending them an SMS message on their mobile phone requesting them to go to patients requiring emergency care in order to perform early CPR and defibrillation.
In this aspect it is essentially different from other existing programs.11, 14 Guidelines have been developed including planned and practised response, training of anticipated rescuers in CPR and use of the AED, link with the local EMS system, and continuous audit and quality improvement.8, 14, 15 This study aims to systematically collect relevant information with which to make recommendations for EMS providers who wish to adopt such a program. It is not, however, the goal to evaluate the clinical value of an SMS alert service.
Therefore, the objective of this study is to evaluate the process of alerting laypersons to go to patients with an out-of-hospital cardiac arrest and perform early CPR and defibrillation. The evaluation provides insight in the extent to which laypersons take action upon SMS alerts and provide first aid. Moreover, it identifies problems and potential solutions which may be used to improve the process. An efficient process is important since immediate resuscitation of patients with an out-of-hospital cardiac arrest is assumed to increase survival.11
Section snippets
Setting
This study evaluated initial consecutive emergency calls to the EMS provider from February 1, 2010 to April 30, 2010, in which an out-of-hospital cardiac arrest was suspected and laypersons had been alerted by AED-Alert. The AED-Alert system is part of a program which was started by the EMS in order to build a system that could alert citizens through SMS messages urging them to go to patients requiring emergency care in order to perform early CPR and defibrillation.
On April 30, 2010 almost 6000
Results
Between February 1, 2010 and April 30, 2010 AED-Alert was activated for 52 patients with a suspected out-of-hospital cardiac arrest. For each patient on average 62 laypersons were alerted (range: 1–407). During these 3 months, AED-Alert sent 3227 alerts to 2287 laypersons (Table 1). Laypersons often received one alert or two alerts during this period (range: 1–6). Most suspected cardiac arrests occurred in urban areas (42.3%) or areas with less than 10,000 inhabitants (32.7%). Alerts were often
Discussion
This study evaluated the AED-Alert process during a 3 month time window, by sending questionnaires to laypersons involved in an alert. In 52 patients, nurses at the dispatch centre suspected an out-of-hospital cardiac arrest in the emergency call, and activated the AED-Alert system. Laypersons provided aid in 75 (3.6%) of 2098 alerts. In 84% of 2098 evaluated alerts laypersons suggested several improvements. These included laypersons’ registration, mobile phone settings and carrying of mobile
Conclusion
Improvements of the SMS alert service by laypersons, the EMS, and through technical adjustments, could increase the number of laypersons who provide early aid. It is expected that by implementing similar programs in other emergency medical service regions, the overall survival of patients with a cardiac arrest outside the hospital increases. Other studies are needed to investigate patient quality of life and clinical outcomes, and to investigate to what extent this program is cost-effective in
Conflict of interest statement
No conflicts of interest to declare.
Acknowledgements
Special appreciation is extended to all laypersons who tested and completed questionnaires, the EMS Ambulance Oost for the fruitful collaboration, and R. Stieglis MSc of the Academic Medical Centre Amsterdam for the provision of additional data.
References (15)
- et al.
Incidence of EMS-treated out-of-hospital cardiac arrest in the United States
Resuscitation
(2004) - et al.
Out-of-hospital cardiac arrests in Amsterdam and its surrounding areas: results from the Amsterdam resuscitation study (ARREST) in Utstein style
Resuscitation
(1998) - et al.
European Resuscitation Council Guidelines for Resuscitation 2005 – Section 2. Adult basic life support and use of automated external defibrillators
Resuscitation
(2005) - et al.
Survival models for out-of-hospital cardiopulmonary resuscitation from the perspectives of the bystander, the first responder, and the paramedic
Resuscitation
(2001) - et al.
Out of hospital cardiac arrest – the relevance of heart failure. The Maastricht Circulatory Arrest Registry
Eur Heart J
(2003) Consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
Resuscitation
(2005)- et al.
Improving survival from sudden cardiac-arrest – the chain of survival concept – a statement for health-professionals from the Advanced Cardiac Life-Support Subcommittee and the Emergency Cardiac Care Committee, American-Heart-Association
Circulation
(1991)
Cited by (44)
Optimal pre-dispatch task assignment of volunteers in daily emergency response
2023, Socio-Economic Planning SciencesResponding to Cardiac Arrest in the Community in the Digital Age
2022, Canadian Journal of Cardiology
- ☆
A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.05.008.