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Arrhythmias and sudden death
Original research
One-year quality-of-life outcomes of cardiac arrest survivors by initial defibrillation provider
  1. Brian Haskins1,2,
  2. Ziad Nehme1,3,4,
  3. Emily Andrew1,4,
  4. Stephen Bernard1,
  5. Peter Cameron1,5,
  6. Karen Smith1,4
  1. 1School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
  2. 2Department of Paramedicine, Victoria University, Melbourne, Victoria, Australia
  3. 3Department of Paramedicine, Monash University, Clayton, Victoria, Australia
  4. 4Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
  5. 5Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr Brian Haskins, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC 3199, Australia; Brian.Haskins{at}vu.edu.au

Abstract

Objective To assess the long-term functional and health-related quality-of-life (HRQoL) outcomes for out-of-hospital cardiac arrest (OHCA) survivors stratified by initial defibrillation provider.

Methods This retrospective study included adult non-traumatic OHCA with initial shockable rhythms between 2010 and 2019. Survivors at 12 months after arrest were invited to participate in structured telephone interviews. Outcomes were identified using the Glasgow Outcome Scale-Extended (GOS-E), EuroQol-5 Dimension (EQ-5D), 12-Item Short Form Health Survey and living and work status-related questions.

Results 6050 patients had initial shockable rhythms, 3211 (53.1%) had a pulse on hospital arrival, while 1879 (31.1%) were discharged alive. Bystander defibrillation using the closest automated external defibrillator had the highest survival rate (52.8%), followed by dispatched first responders (36.7%) and paramedics (27.9%). 1802 (29.8%) patients survived to 12-month postarrest; of these 1520 (84.4%) were interviewed. 1088 (71.6%) were initially shocked by paramedics, 271 (17.8%) by first responders and 161 (10.6%) by bystanders. Bystander-shocked survivors reported higher rates of living at home without care (87.5%, 75.2%, 77.0%, p<0.001), upper good recovery (GOS-E=8) (41.7%, 30.4%, 30.6%, p=0.002) and EQ-5D visual analogue scale (VAS) ≥80 (64.9%, 55.9%, 52.9%, p=0.003) compared with first responder and paramedics, respectively. After adjustment, initial bystander defibrillation was associated with higher odds of EQ-5D VAS ≥80 (adjusted OR (AOR) 1.56, 95% CI 1.15–2.10; p=0.004), good functional recovery (GOS-E ≥7) (AOR 1.53, 95% CI 1.12–2.11; p=0.009), living at home without care (AOR 1.77, 95% CI 1.16–2.71; p=0.009) and returning to work (AOR 1.72, 95% CI 1.05–2.81; p=0.031) compared with paramedic defibrillation.

Conclusion Survivors receiving initial bystander defibrillation reported better functional and HRQoL outcomes at 12 months after arrest compared with those initially defibrillated by paramedics.

  • tachycardia, ventricular
  • ventricular fibrillation
  • myocardial infarction
  • defibrillators, implantable

Data availability statement

Data may be obtained from a third party and are not publicly available.

http://dx.doi.org/10.1136/heartjnl-2021-320559

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    Data availability statement

    Data may be obtained from a third party and are not publicly available.

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    Footnotes

    • Twitter @brianhaskins5, @vacar_av

    • Contributors BH conceived the study. BH, ZN and EA contributed to data collection. BH, ZN, EA, SB, PC and KS were responsible for data analysis and interpretation of results. BH drafted the manuscript and all authors made edits to the manuscript for important intellectual property. All authors approved the final manuscript. BH is responsible for the overall content as guarantor.

    • Funding BH was funded by a PhD scholarship from the National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Pre-hospital Emergency Care Australia and New Zealand (PEC-ANZ). ZN is funded by an NHMRC Early Career Fellowship (APP1146809). PC is funded by a Medical Research Future Fund (MRFF) Practitioner Fellowship (MRF1139686). EA is funded by an NHMRC Postgraduate Scholarship (APP2003449).

    • Competing interests BH is an unpaid member of the Medical Board of Advisers for DefibsPlus.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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