Impact of bystander intervention on clinical outcome in out-of-hospital cardiac arrest. A study of 8,253 Polish cases from the European Registry of Cardiac Arrest (2014-2022)
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Background
Out-of-Hospital Cardiac Arrest (OCHA) remains a significant challenge for healthcare systems, with actions by witnesses playing a critical role. This study examines Polish data from the European Registry of Cardiac Arrest (EuReCa), identifying progress in updated paramedic protocols and public availability of automated external defibrillators (AED) while noting issues such as delays in emergency call localization, lack of synchronization in defibrillator maps, inadequate reporting, and absence of information on long-term neurological outcomes.
Aims
The aim of this study was to assess the role of bystanders and dispatchers in the chain of survival for OHCA.
Methods
A retrospective analysis was conducted on 8,253 patients included in the EuReCa between 2014 and 2022. Data were collected from emergency medical team reports, and survival outcomes at 30 days were obtained from the national death registry.
Results
Full cardiopulmonary resuscitation (CPR) performed by witnesses, including both chest compressions and rescue breaths, combined with the use of AED, significantly increased the likelihood of return of spontaneous circulation (ROSC) compared to chest compressions alone or no intervention. Dispatcher-guided resuscitation increased ROSC from 22.1% to 30.6% (p=0.01), though the increase in 30-day survival from 42.8% to 48.2% was not statistically significant (p=0.27). CPR by witnesses increased the number of patients transported to hospital with ROSC(74.0% vs. 26.0%; p=0.01).
Conclusions
Bystanders and dispatchers are pivotal in the chain of survival. Improving the quality of reporting on actions taken by witnesses, including dispatcher-assisted resuscitation and the use of automated defibrillators, is critical for identifying effective strategies and allocating resources to improve survival and outcomes for cardiac arrest outside hospitals in Poland.
