European first responder systems and differences in return of spontaneous circulation and survival after out-of-hospital cardiac arrest: A study of registry cohorts

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Background: In Europe, survival-rates after out-of-hospital cardiac arrest (OHCA) vary widely between regions. Whether a system dispatching First Responders (FRs; main FR-types: firefighters, police officers, citizen-responders) is present or not may be associated with survival-rates. This study aimed to assess the association between having a dispatched FR-system and rates of return of spontaneous circulation (ROSC) and survival across Europe. Methods: Results of an inventory of dispatched FR-systems for OHCA in Europe were combined with aggregate ROSC and survival data from the EuReCa-TWO study and additionally collected data. Regression analysis (weighted on number of patients included per region) was performed to study the association between having a dispatched FR-system and ROSC and survival-rates to hospital discharge in the total population and in patients with shockable initial rhythm, witnessed OHCA and bystander cardiopulmonary resuscitation (CPR; Utstein comparator group). For regions without a dispatched FR-system, the theoretical survival-rate if a dispatched FR-system would have existed was estimated. Findings: We included 27 European regions. There were 15,859 OHCAs in the total group and 2,326 OHCAs in the Utstein comparator group. Aggregate ROSC and survival-rates were significantly higher in regions with an FR-system compared to regions without (ROSC: 36% [95%CI 35%-37%] vs. 24% [95%CI 23%–25%]; P<0.001; survival in total population [N=15.859]: 13% [95%CI 12%–15%] vs. 5% [95%CI 4%–6%]; P<0.001; survival in Utstein comparator group [N=2326]: 33% [95%CI 30%–36%] vs. 18% [95%CI 16%–20%]; P<0.001), and in regions with more than one FR-type compared to regions with only one FR-type. All main FR-types were associated with higher survival-rates (all P<0.050). Interpretation: European regions with dispatched FRs showed higher ROSC and survival-rates than regions without. Funding: This project/work has received funding from the European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381 (IO, HLT and MTB) and the European Union's COST programme under acronym PARQ, registered under grant agreement No CA19137 (IO, DC, HLT, MTB). HLT and MTB were supported by a grant from the Netherlands CardioVascular Research Initiative, Dutch Heart Foundation, Dutch Federation of University Medical Centres, Netherlands Organization for Health Research and Development, Royal Netherlands Academy of Sciences - CVON2017-15 RESCUED (HLT), and CVON2018-30 Predict2 (HLT and MTB).

Original languageEnglish
Article number100004
JournalThe Lancet Regional Health - Europe
Volume1
Number of pages9
ISSN2666-7762
DOIs
Publication statusPublished - Feb 2021

Bibliographical note

Funding Information:
We thank the European Union's Horizon 2020 research and innovation programme for funding the ESCAPE-NET project. Furthermore, we are greatly indebted to Nikolaos Nikolaou (MD, PhD, from Greece), Simone Savastano (MD, from Italy), Michael Baubin (MD, PhD) and Maximilian Mörtl (MD, ) from Austria, Cristina Granja (MD, PhD, from Portugal), Ari Salo (MD, from Finland), Linn Andelius (MD, from Denmark), Mark Biancardi (MD, from Malta), Veronika Reinhard (MD, from Estonia), Marios Ioannidis (MD, PhD, from Cyprus), Violetta Raffay (MD, PhD, from Serbia), Emma Scott and Nicola Dunbar (from the United Kingdom), Martin Quinn (MA) from Ireland, Fernando Rosell Ortiz (MD, PhD from Spain), Nagy Enikő (from Hungary), Pascal Stammet (MD, PhD from Luxembourg), Andrej Markota (MD, PhD) and Janez Strnad (MD, PhD) (from Slovenia), Craig Hunter (from Scotland), Monika Praunova and Jaroslava Krencikova (MD, from the Czech Republic), and Xavier Jouven (MD, PhD, from France) for their cooperation and data collection. Also, we would like to thank all other OHCA experts who so generously shared their expert opinion and knowledge to make this study possible.

Funding Information:
We thank the European Union's Horizon 2020 research and innovation programme for funding the ESCAPE-NET project. Furthermore, we are greatly indebted to Nikolaos Nikolaou (MD, PhD, from Greece), Simone Savastano (MD, from Italy), Michael Baubin (MD, PhD) and Maximilian M?rtl (MD, ) from Austria, Cristina Granja (MD, PhD, from Portugal), Ari Salo (MD, from Finland), Linn Andelius (MD, from Denmark), Mark Biancardi (MD, from Malta), Veronika Reinhard (MD, from Estonia), Marios Ioannidis (MD, PhD, from Cyprus), Violetta Raffay (MD, PhD, from Serbia), Emma Scott and Nicola Dunbar (from the United Kingdom), Martin Quinn (MA) from Ireland, Fernando Rosell Ortiz (MD, PhD from Spain), Nagy Enik? (from Hungary), Pascal Stammet (MD, PhD from Luxembourg), Andrej Markota (MD, PhD) and Janez Strnad (MD, PhD) (from Slovenia), Craig Hunter (from Scotland), Monika Praunova and Jaroslava Krencikova (MD, from the Czech Republic), and Xavier Jouven (MD, PhD, from France) for their cooperation and data collection. Also, we would like to thank all other OHCA experts who so generously shared their expert opinion and knowledge to make this study possible. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all of the data and the final responsibility to submit for publication. Iris Oving*: study design, data collection, data analysis, data interpretation, writing manuscript, figures and tables. Corina de Graaf*: data analysis, data interpretation, writing manuscript, figures and tables, Siobhan Masterson: data collection, data interpretation, review manuscript, Rudolph Koster: data interpretation, review manuscript, Aeilko Zwinderman: statistical analysis, review manuscript, Remy Stieglis: data interpretation, review manuscript, Hajriz AliHodzic: data collection, review manucript, Enrico Baldi: data collection, review manucript, Susanne Betz: data collection, review manucript, Diana Cimpoesu: data collection, review manucript, Fredrik Folke: data collection, review manucript, Dennis Rupp: data collection, review manucript, Federico Semeraro: data collection, review manucript, Anatolij Truhlar: data collection, review manucript, Hanno Tan: study supervisor, study design, data interpretation, writing and review of manuscript, Marieke Blom*: study supervisor, study design, data analysis, data interpretation, writing and review of manuscript, *Author verified the underlying data, Data sharing agreement

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