Bystander Defibrillation for Out-of-Hospital Cardiac Arrest in Public vs Residential Locations | Cardiology | JAMA Cardiology | JAMA Network
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Original Investigation
May 2017

Bystander Defibrillation for Out-of-Hospital Cardiac Arrest in Public vs Residential Locations

Author Affiliations
  • 1Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
  • 2Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
  • 3Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
  • 4Department of Anesthesiology, Aalborg University Hospital, Aalborg, Denmark
  • 5Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark
  • 6The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
  • 7The Danish Heart Foundation, Copenhagen, Denmark
  • 8Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  • 9Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
  • 10Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
JAMA Cardiol. 2017;2(5):507-514. doi:10.1001/jamacardio.2017.0008
Key Points

Question  Were nationwide initiatives to facilitate public-access defibrillation associated with an increase in bystander defibrillation in residential and public locations of out-of-hospital cardiac arrests?

Findings  This nationwide cohort study of 18 688 patients showed a large increase in bystander defibrillation in public locations from 1.2% in 2001 to 15.3% in 2012, whereas bystander defibrillation in residential locations remained unchanged from 1.3% in 2001 to 1.3% in 2012. During this period, several initiatives were undertaken to facilitate bystander defibrillation.

Meaning  Nationwide initiatives to facilitate bystander defibrillation were associated with a marked increase in bystander defibrillation in public but not residential locations.


Importance  Bystander-delivered defibrillation (hereinafter referred to as bystander defibrillation) of patients with out-of-hospital cardiac arrests (OHCAs) remains limited despite the widespread dissemination of automated external defibrillators (AEDs).

Objective  To examine calendar changes in bystander defibrillation and subsequent survival according to a public or a residential location of the cardiac arrest after nationwide initiatives in Denmark to facilitate bystander-mediated resuscitative efforts, including bystander defibrillation.

Design, Setting, and Participants  This nationwide study identified 18 688 patients in Denmark with first-time OHCA from June 1, 2001, to December 31, 2012, using the Danish Cardiac Arrest Registry. Patients had a presumed cardiac cause of arrest that was not witnessed by emergency medical services personnel. Data were analyzed from April 1, 2015, to December 10, 2016.

Exposures  Nationwide initiatives to facilitate bystander resuscitative efforts, including bystander defibrillation, consisted of resuscitation training of Danish citizens, dissemination of on-site AEDs, foundation of an AED registry linked to emergency medical dispatch centers, and dispatcher-assisted guidance of bystander resuscitation efforts.

Main Outcomes and Measures  The proportion of patients who received bystander defibrillation according to the location of the cardiac arrest and their subsequent 30-day survival.

Results  Of the 18 688 patients with OHCAs (67.8% men and 32.2% women; median [interquartile range] age, 72 [62-80] years), 4783 (25.6%) had a cardiac arrest in a public location and 13 905 (74.4%) in a residential location. The number of registered AEDs increased from 141 in 2007 to 7800 in 2012. The distribution of AED location was consistently skewed in favor of public locations. Bystander defibrillation increased in public locations from 3 of 245 (1.2%; 95% CI, 0.4%-3.5%) in 2001 to 78 of 510 (15.3%; 95% CI, 12.4%-18.7%) in 2012 (P < .001) but remained unchanged in residential locations from 7 of 542 (1.3%; 95% CI, 0.6%-2.6%) in 2001 to 21 of 1669 (1.3%; 95% CI, 0.8%-1.9%) in 2012 (P = .17). Thirty-day survival after bystander defibrillation increased in public locations from 8.3% (95% CI, 1.5%-35.4%) in 2001/2002 to 57.5% (95% CI, 48.6%-66.0%) in 2011/2012 (P < .001) in residential locations, from 0.0% (95% CI, 0.0%-19.4%) in 2001/2002 to 25.6% (95% CI, 14.6%-41.1%) in 2011/2012 (P < .001).

Conclusions and Relevance  Initiatives to facilitate bystander defibrillation were associated with a marked increase in bystander defibrillation in public locations, whereas bystander defibrillation remained limited in residential locations. Concomitantly, survival increased after bystander defibrillation in residential and public locations.