Poster Presentations / Resuscitation 84S (2013) S8–S98 S33

AP064

Efficiency of out-of-hospital cardiac arrestdefibrillation: Observational study

Daniel Jost 1,∗, Frédéric Lemoine 1, VincentLanoë 1, Pascal Dang Minh 1, Jean-PhilippeDidon 2, Nicolas Genotelle 1, Benoit Frattini 1,Tourtier Jean-Pierre 1

1 Paris Fire Brigade Emergency Medical Dept, Paris,France2 Schiller Médical SAS, 67160 Wissembourg, France

Purpose: Victims of Out-of-Hospital Cardiac Arrest (OHCA)present, in about 20% of cases, with ventricular fibrillation (VF)treated with an Automated External Defibrillator (AED) used bythe attending emergency service personnel. The aim of this studywas to measure the efficiency of AEDs used by professional rescuersin an urban area, by observing the post-shock electrocardiographictracing and their time course after the first External Electric Shock(EES).

Materials and methods: Prospective observational study. Inclu-sion criteria: OHCA victims > 18 years of age with VF treatedby EES/AED. Data collected: AED rhythm: 5, 15, 30, and 60 spost-shock. The primary endpoint was the resolution of VF at5 s post-shock. Secondary endpoint was occurrence of OrganizedRhythm (OR) on patients that had been shocked. OR was defined bythe presence of at least 2 electrocardiographic organized complexesin an interval of 10 s.

Results: From 01/06/11 to 01/09/11, 111 consecutive OHCAtreated by EES/AED were analyzed. Mean age was 66 + 20 years,77% were men, and 32% occurred in public place. The average timebetween cardiac arrest and 1st shock was 10 + 3 min. The resultsare shown in Fig. 1 (90% efficiency at 5 s). Out of the 100 patientsfulfilling the primary endpoint, 41 experienced VF recurrence inpost-shock at minute 1. VF recurrence was related to asystole morethan to organized rhythm (48% (n = 34) vs. 10% (n = 3), respectively;p = 0.001).

Fig. 1.

Conclusions: The efficacy rate of AED is high, as it has alreadybeen described in the literature.1,2 However, the high rate of VFrecurrence needs more research in order to identify the explanatory

factors. These results raise the question of eventually treating thosepatients before the 2 minutes of CPR elapsed.

References

1. Hess EP, White RD. Ventricular fibrillation is not provoked by chest compressionduring post-shock organized rhythms in out-of-hospital cardiac arrest. Resusci-tation 2005;66:7–11.

2. Jost D, Hertgen P, Fontaine D, et al. Impact of reducing CPR hands off time duringOut-of-Hospital Cardiac arrest on post shock rhythm progression. In: Abstract,ESC Congress. 2008.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.095

AP066

Community cardiac first responders in Ireland

Siobhan Masterson 3,∗, Eve Robinson 1, PeterWright 1, John Dowling 2, Andrew Murphy 3

1 Health Service Executive, Ballyshannon, Ireland2 North West Immediate Care Programme,Manorcunningham, Ireland3 National University of Ireland, Galway, Ireland

Purpose of the study: To describe the role cardiac first respon-ders (CFRs) have played in out-of-hospital cardiac arrests (OHCA)in Ireland and to determine if their presence impacts on survival.

Methods: A retrospective analysis of the national Out-of-Hospital Cardiac Arrest Register (OHCAR) was performed. A CFRis considered to be anyone with BLS and AED training other thanon-duty Emergency Medical Services (EMS) personnel and medicaldoctors.

Results: OHCAR to date has recorded 3217 non-EMS witnessedevents, 277 were attended by a CFR. There are 21 survivorsfrom CFR-attended scenes. The majority of CFR-attended OHCAsoccurred in private residences (63.9%). When compared to non-CFRcases, CFR attended OHCAs were more likely to have occurred in apublic location [OR 2.10 (95% CI 1.62–2.73)]; were more likely tohave been witnessed [OR 2.07(95% CI 1.57–2.72)]; and were morelikely to occur in a rural setting [OR 1.98 (95% CI 1.54–2.54)].

In CFR-attended events, the initial recorded rhythm was shock-able in 33% of cases compared to 21% for non CFR-attended events.The initial shock was delivered prior to the arrival of the EMS in44% of CFR-attended events compared to 8% for non CFR-attendedevents. CFR-attended OHCAs were more likely to have ROSC at anystage [OR 1.46 (95% CI 1.09–1.95)].

The likelihood of survival was increased for CFR-attendedOHCAs [OR 1.75 (95% CI 1.09–2.83)]. When stratified for publiclocation, this effect becomes non-significant.

Conclusion: Almost nine percent of OHCAs in Ireland wereattended by a CFR and survival following CFR intervention isdocumented. The high percentages of shockable rhythms and defi-brillation attempts in the CFR-attended group suggest timely CFRarrival at scene and timely resuscitation being attempted. Whileunivariate analysis suggests that CFRs confer a survival benefit, theeffect is lost when known confounders are accounted for. Increaseddata volume and collection of data on additional CFR-related vari-ables (particularly call-response interval data) will be of value forthe future advancement of the CFR role.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.096