Improving bystander defibrillation in out-of-hospital cardiac arrests at home.
AIMS
Most out-of-hospital cardiac arrests occur at home with dismal bystander defibrillation rates. We investigated automated external defibrillator coverage of home arrests, and the proportion potentially reachable with an automated external defibrillator before emergency medical service arrival according to different bystander activation strategies.


METHODS AND RESULTS
Cardiac arrests in homes (private/nursing/senior homes) in Copenhagen, Denmark (2008-2016) and registered automated external defibrillators (2007-2016), were identified. Automated external defibrillator coverage (distance from arrest to automated external defibrillator) and accessibility at the time of arrest were examined according to route distance to nearest automated external defibrillator and emergency medical service response time. The proportion of arrests reachable with an automated external defibrillator by bystander was calculated using two-way (from patient to automated external defibrillator and back) and one-way (from automated external defibrillator to patient) potential activation strategies. Of 1879 home arrests, automated external defibrillator coverage ≤100 m was low (6.3%) and a two-way bystander could potentially only retrieve an accessible automated external defibrillator before emergency medical service in 31.1% (n=37) of cases. If a bystander only needed to travel one-way to bring an automated external defibrillator (≤100 m, ≤250 m and ≤500 m), 45.4% (n=54/119), 37.1% (n=196/529) and 29.8% (n=350/1174) could potentially be reached before the emergency medical service based on current automated external defibrillator accessibility.


CONCLUSIONS
Few home arrests were reachable with an automated external defibrillator before emergency medical service if bystanders needed to travel from patient to automated external defibrillator and back. However, nearly one-third of arrests ≤500 m of an automated external defibrillator could be reached before emergency medical service arrival if the bystander only needed to travel one-way from the automated external defibrillator to the patient.
['Karlsson|Lena|L|', 'Hansen|Carolina M|CM|', 'Vourakis|Christina|C|', 'Sun|Christopher Lf|CL|', 'Rajan|Shahzleen|S|', 'Søndergaard|Kathrine B|KB|', 'Andelius|Linn|L|', 'Lippert|Freddy|F|', 'Gislason|Gunnar H|GH|', 'Chan|Timothy Cy|TC|', 'Torp-Pedersen|Christian|C|', 'Folke|Fredrik|F|']
D000368:Aged D000369:Aged, 80 and over D016887:Cardiopulmonary Resuscitation D047548:Defibrillators D004632:Emergency Medical Services D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D058687:Out-of-Hospital Cardiac Arrest D012042:Registries D012189:Retrospective Studies
Cardiac arrest automated external defibrillator resuscitation survival