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Heartbeat: improving outcomes after out-of-hospital cardiac arrest
  1. Catherine M Otto
  1. Division of Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, Washington, USA; cmotto{at}

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Immediate cardiopulmonary resuscitation (CPR) and early defibrillation are essential in ensuring survival after an out-of-hospital cardiac arrest (OHCA), which is estimated to account for 15–20% of global mortality. Yet widespread training in CPR and availability of public defibrillators remains suboptimal in many places. In this issue of Heart, Haskins and colleagues report a retrospective study of adults with an OHCA between 2010 and 2019 in Victoria, Australia.1 In the 6050 patients with a shockable rhythm (mean age 60 years, 17% women) 53.1% had a pulse on hospital arrival and 31.1% survived to hospital discharge. Survival was highest with defibrillation by a bystander with an automated external defibrillator (52.8%) compared with defibrillation by first responders (36.7%) or paramedics (27.9%). In the 1520 patients who were interviewed 1 year after the event, most were initially shocked by paramedics (71.6%) or first responders (17.8%). However, the 161 survivors at 1 year initially treated with bystander defibrillation (10.6%) had higher scores on measures of functional and health-related quality of life and were more likely to return to work and live at home without care, compared with those with the initial shock delivered by paramedics. As expected, favourable outcomes were more likely with a shorter time to defibrillation (figure 1).

Figure 1

Functional and health-related quality-of-life outcomes of out-of-hospital cardiac arrest (OHCA) survivor at 12 months after arrest as a percentage of all OHCAs in a shockable rhythm from 2010 to 2019, stratified in 5 min time intervals from emergency call to initial shock. Glasgow Outcome Scale-Extended (GOS-E)≥7 includes ‘upper good recovery’ and ‘lower good …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.