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Shortening time to defibrillation in shockable cardiac arrest matters: how do we do it?
  1. Neal A Chatterjee1,
  2. Thomas D Rea2
  1. 1 Deparment of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
  2. 2 General Internal Medicine, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Neal A Chatterjee, University of Washington, Seattle, WA 98195, USA; nchatter{at}

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Out-of-hospital cardiac arrest (OHCA) is a vital public health problem accounting for 15%–20% of global mortality. OHCA is often fatal, with only 10% survival to hospital discharge serving as sobering context for global efforts to improve clinical outcomes. For patients with OHCA secondary to ventricular tachyarrhythmia (ie, shockable OHCA), the interval from collapse to defibrillation (‘time to shock’) is an exceptionally strong predictor of outcome.1 Chances of survival to hospital discharge and survival with favourable functional status decline steadily as the time to shock increases.2 Bystander cardiopulmonary resuscitation (CPR) can slow this time-dependent decline, but only defibrillator shock offers definitive therapy, with the optimal approach involving both early bystander CPR and early defibrillator shock through a combination of programmatic strategies (figure 1).

Figure 1

Programmes designed to reduce the interval from cardiac arrest to cardiopulmonary resuscitation (CPR) and defibrillation. CPR and reducing time to defibrillator shock are key components of improving survival in shockable out-of-hospital cardiac arrest. Shown are complementary programmes and strategies that could be deployed in the community to achieve these goals. The cornerstone of reducing time to defibrillator shock is rapid emergency medical service response and this can be supplemented by the presence of first responder defibrillation, public access defibrillators, use of smart technology and crowdsourcing to empower willing bystander volunteers. Use of drone technology to deliver defibrillator therapy is an experimental approach.

Leveraging this scientific understanding, resuscitation systems have invested in a range of programmes designed to shorten ‘time to shock’ starting with rapid response by emergency medical services (EMS) as a cornerstone. Rapid EMS response can be supplemented by innovative approaches to achieve earlier shock through deployment of fixed-location public access defibrillators (PADs),3 crowdsourcing through smartphone applications directing willing volunteers to retrieve and apply …

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  • Contributors Both authors were responsible for the drafting and review of the manuscript content.

  • 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.

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