Author + information
- Received January 28, 2020
- Revision received April 13, 2020
- Accepted April 27, 2020
- Published online June 29, 2020.
- Linn Andelius, MDa,∗ (, )@landelius,
- Carolina Malta Hansen, MD, PhDa,b,
- Freddy K. Lippert, MDa,
- Lena Karlsson, MD, PhDa,b,
- Christian Torp-Pedersen, MD, DScc,d,
- Annette Kjær Ersbøll, MSc, PhDe,
- Lars Køber, MD, DScif,
- Helle Collatz Christensen, MD, PhDa,
- Stig Nikolaj Blomberg, MSca,
- Gunnar H. Gislason, MD, PhDb and
- Fredrik Folke, MD, PhDa,b
- aCopenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
- bDepartment of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
- cDepartment of Cardiology and Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark
- dDepartment of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- eNational Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- fDepartment of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- ↵∗Address for correspondence:
Dr. Linn Andelius, Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, opgang 2, 3. sal, 2750 Ballerup, Denmark.
Background Dispatching citizen responders through a smartphone application (app) holds the potential to increase bystander cardiopulmonary resuscitation (CPR) and defibrillation in out-of-hospital cardiac arrest (OHCA).
Objectives This study investigated arrival at the OHCA location of app-dispatched citizen responders before the Emergency Medical Services (EMS) and the association with bystander CPR and bystander defibrillation.
Methods Suspected OHCAs with alerted citizen responders from September 1, 2017, to August 31, 2018, were included. Citizen responders located 1.8 km (1.1 miles) from the OHCA were dispatched to start CPR or retrieve an automated external defibrillator. OHCAs where at least 1 citizen responder arrived before EMS were compared with OHCAs where EMS arrived first. In both groups, random bystanders could be present before the arrival of citizen responders and the EMS. Primary outcomes were bystander CPR and bystander defibrillation, which included CPR and defibrillation by citizen responders and random bystanders.
Results Citizen responders were alerted in 819 suspected OHCAs, of which 438 (53.5%) were confirmed cardiac arrests eligible for inclusion. At least 1 citizen responder arrived before EMS in 42.0% (n = 184) of all included OHCAs. When citizen responders arrived before EMS, the odds for bystander CPR increased (odds ratio: 1.76; 95% confidence interval: 1.07 to 2.91; p = 0.027) and the odds for bystander defibrillation more than tripled (odds ratio: 3.73; 95% confidence interval: 2.04 to 6.84; p < 0.001) compared with OHCAs in which citizen responders arrived after EMS.
Conclusions Arrival of app-dispatched citizen responders before EMS was associated with increased odds for bystander CPR and a more than 3-fold increase in odds for bystander defibrillation. (The HeartRunner Trial; NCT03835403)
The citizen responder program in Denmark is financially supported by the Danish foundation TrygFonden. This study was funded by research grants from TrygFonden. TrygFonden had no influence on study design, methodology, analysis, or presentation of study results. Dr. Andelius has received research grants from TrygFonden. Dr. Malta Hansen has received research grants from TrygFonden and Helsefonden; and has received unrestricted research grants from the Laerdal Foundation. Dr. Lippert has received unrestricted research grants from the Laerdal Foundation. Dr. Karlsson has received research grants from TrygFonden. Dr. Torp-Pedersen has received research grants from Bayer and Novo Nordisk. Dr. Køber has received honoraria from AstraZeneca, Boehringer Ingelheim, and Novartis. Dr. Christensen has received research grants from TrygFonden. Mr. Blomberg has received research grants from TrygFonden. Dr. Folke has received research grants from TrygFonden; and has received unrestricted research grants from the Laerdal Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received January 28, 2020.
- Revision received April 13, 2020.
- Accepted April 27, 2020.
- 2020 The Authors