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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).
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 …
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.