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Ahmed A, Mewes JC, Lepage-Nefkens I, Tan HL, Vrijhoef HJM. Early modelling of the effects and healthcare costs of the Dutch citizen-rescuer system for out-of-hospital cardiac arrests. PLoS One 2023; 18:e0293965. [PMID: 37948427 PMCID: PMC10637662 DOI: 10.1371/journal.pone.0293965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/24/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES 1) to analyse the total average healthcare costs of a patient with an out-of-hospital cardiac arrest (OHCA), as well as estimating the operational costs of the citizen-rescuer system (CRS); 2) to conduct an early modelling of the effects and healthcare costs of the Dutch CRS in comparison to no CRS. METHODS A health economic modelling study was conducted. Adult patients with OHCA from cardiac causes in the province of Limburg (the Netherlands) were included. The time horizon was from OHCA occurrence up to one year after hospital discharge. First, the total average healthcare costs of OHCA patients were analysed as well as the yearly operating costs of the CRS. Second, an early modelling was conducted to compare from the healthcare perspective the healthcare costs of OHCA patients with the CRS being activated but no responders attended (CRS-NV) versus the CRS being activated with attendance of ≥1 responder(s) (CRS-V). RESULTS The total average healthcare costs per patient are €42,533. The yearly operating costs for the CRS are approximately €1.5 million per year in the Netherlands. The early modelling of costs and effects showed that the incremental healthcare costs per patient thus were €4,131 in the CRS-V versus the CRS-NV group (€25,184 in the CRS-V group and €21,053 in the CRS-NV group). Incremental quality-adjusted life years (QALYs) was 5 per 100 patients (16 per 100 patients in the CRS-V group versus 11 per 100 patients in the CRS-NV group). The incremental cost-effectiveness ratio (ICER) was €79,662 per QALY for the CRS-V group. CONCLUSION This study shows that patients in the CSR-V group had additional health care costs of €4,131 per patient compared to patients in the CRS-NV group. This increase is caused by patients surviving more often, who then continue to utilise health services, which results in a (logic) increase in healthcare costs. For future research, accurate and up-to-date data on effectiveness and costs of the CRS needs to be collected.
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Affiliation(s)
- Anam Ahmed
- Panaxea B.V., Den Bosch, The Netherlands
| | | | | | - Hanno L. Tan
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
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Folke F, Shahriari P, Hansen CM, Gregers MCT. Public access defibrillation: challenges and new solutions. Curr Opin Crit Care 2023; 29:168-174. [PMID: 37093002 PMCID: PMC10155700 DOI: 10.1097/mcc.0000000000001051] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review the current status of public access defibrillation and the various utility modalities of early defibrillation. RECENT FINDINGS Defibrillation with on-site automated external defibrillators (AEDs) has been the conventional approach for public access defibrillation. This strategy is highly effective in cardiac arrests occurring in close proximity to on-site AEDs; however, only a few cardiac arrests will be covered by this strategy. During the last decades, additional strategies for public access defibrillation have developed, including volunteer responder programmes and drone assisted AED-delivery. These programs have increased chances of early defibrillation within a greater radius, which remains an important factor for survival after out-of-hospital cardiac arrest. SUMMARY Recent advances in the use of public access defibrillation show great potential for optimizing early defibrillation. With new technological solutions, AEDs can be transported to the cardiac arrest location reaching OHCAs in both public and private locations. Furthermore, new technological innovations could potentially identify and automatically alert the emergency medical services in nonwitnessed OHCA previously left untreated.
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Affiliation(s)
- Fredrik Folke
- Copenhagen University Hospital - Emergency Medical Services Capital Region
- Department of Clinical Medicine, University of Copenhagen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte
| | - Persia Shahriari
- Copenhagen University Hospital - Emergency Medical Services Capital Region
- Department of Clinical Medicine, University of Copenhagen
| | - Carolina Malta Hansen
- Copenhagen University Hospital - Emergency Medical Services Capital Region
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mads Christian Tofte Gregers
- Copenhagen University Hospital - Emergency Medical Services Capital Region
- Department of Clinical Medicine, University of Copenhagen
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Ball J, Mahony E, Ray M, Nehme Z, Stub D, Smith K. No fear: Willingness of smartphone activated first responders to assist with cardiac arrest during the COVID-19 pandemic. Resusc Plus 2023; 13:100341. [PMID: 36530349 PMCID: PMC9747697 DOI: 10.1016/j.resplu.2022.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
Aim To understand the fear and willingness to respond of smartphone activated first responders during the COVID-19 pandemic. Methods We invited smartphone activated first responders registered with the GoodSAM application in Victoria, Australia to take part in an online survey in November 2020. We assessed willingness to respond to an alert and provide CPR during the pandemic and administered the Fear of COVID-19 Scale questionnaire. Regression analysis was conducted to investigate associations between occupation, clinical training, and years of clinical experience with willingness to respond and fear of COVID-19. Results The survey response rate was 5.1%. Responders (n = 348) had a median age (interquartile range) of 46 years (33-55). Most (67%) were aged 30-59 years and 43% were female. Responders spanned several occupations including paramedics (12.6%), registered nurses (14.7%), and non-clinical individuals (21.8%). Most (92%) reported they would feel comfortable responding to a GoodSAM alert during the pandemic. Almost all (>95%) reported they would provide CPR. About 20% reported being afraid of COVID-19 but only 3.2% reported they had a high-level of fear of COVID-19. The odds of paramedics being willing to respond to an alert was reduced by 73% during the pandemic (OR 0.27, 95% CI 0.11 to 0.69). No other associations were found with willingness or fear of COVID-19. Conclusion Although willingness was high and fear of COVID-19 was low, some smartphone activated first responders were less willing to respond to an alert during the pandemic. These findings may inform future pandemic planning and decision-making around pausing first-responder programs.
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Affiliation(s)
- Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia,Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia 3004,Corresponding author at: Centre of Cardiovascular Research and Education in Therapeutics (CCRET) School of Public Health and Preventive Medicine Monash University 553 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Emily Mahony
- Ambulance Victoria, 31 Joseph Street, Blackburn North, Victoria 3004, Australia
| | - Michael Ray
- Ambulance Victoria, 31 Joseph Street, Blackburn North, Victoria 3004, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia,Ambulance Victoria, 31 Joseph Street, Blackburn North, Victoria 3004, Australia,Department of Paramedicine, Monash University, Moorooduc Highway, Frankston, Victoria 3199, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia,Ambulance Victoria, 31 Joseph Street, Blackburn North, Victoria 3004, Australia,Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia,Department of Paramedicine, Monash University, Moorooduc Highway, Frankston, Victoria 3199, Australia
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Yoshimoto H, Fukui K, Nishimoto Y, Kuboyama K, Oishi Y, Sekine K, Hiraide A. Annual improvement trends in resuscitation outcome of patients defibrillated by laypersons after out-of-hospital cardiac arrests and compression-only resuscitation of laypersons. Resuscitation 2023; 183:109672. [PMID: 36549434 DOI: 10.1016/j.resuscitation.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
AIM We aimed to investigate the effect of compression-only cardiopulmonary resuscitation (CPR) with conventional CPR in patients who were defibrillated by laypersons. METHODS This is a population-based, nationwide observational study. Adult and children who sustained a witnessed out-of-hospital cardiac arrest and defibrillated by laypersons between 2005 to 2019 were identified on the national database. The study used trend analyses, multivariate logistic regression, and inverse probability weighting using propensity score to explore changes in one-month survival and survival with a good neurological outcome over time and the influence of compression-only CPR compared with conventional CPR. RESULTS In total, 11,402 patients defibrillated by laypersons were enrolled in this study. The percentages of compression-only resuscitation increased dramatically and more than 50% from 2012 (P < 0.001). The percentages of cases with favorable resuscitation outcomes also increased annually (P < 0.001). By regression analysis, favorable outcomes were associated with recent years, male sex, younger age, and shorter resuscitation start time. In addition, the adjusted odds ratio of compression-only CPR to conventional CPR was 1.23 with a 95% confident interval 1.13-1.34. By inverse probability weighting, compression-only CPR was superior to conventional CPR for the favorable outcomes (P < 0.001). The adjusted outcomes in each year were better in compression-only resuscitation in most of the years. The overall relative risk reduction and the number needed to treat for compression-only resuscitation compared with conventional resuscitation were 7.6% and 22.1, respectively. CONCLUSIONS In Japan, the outcomes of out-of-hospital cardiac arrest patients who were defibrillated by laypersons were considerably better in compression-only resuscitation of laypersons every year.
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Affiliation(s)
- Hiroshi Yoshimoto
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan; Kyotanabe Fire Department, Tanabe 78, Kyotabane, Kyoto 610-0331, Japan
| | - Kenko Fukui
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan
| | - Yasuhisa Nishimoto
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan
| | - Kazutoshi Kuboyama
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan
| | - Yasuo Oishi
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan
| | - Kazuhiro Sekine
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan
| | - Atsushi Hiraide
- Department of Emergency Medical Science, Kyoto Tachibana University, Japan.
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Nielsen CG, Folke F, Andelius L, Hansen CM, Væggemose U, Christensen EF, Torp-Pedersen C, Ersbøll AK, Gregers MCT. Increased bystander intervention when volunteer responders attend out-of-hospital cardiac arrest. Front Cardiovasc Med 2022; 9:1030843. [DOI: 10.3389/fcvm.2022.1030843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
AimThe primary aim was to investigate the association between alarm acceptance compared to no-acceptance by volunteer responders, bystander intervention, and survival in out-of-hospital cardiac arrest.Materials and methodsThis retrospective observational study included all suspected out-of-hospital cardiac arrests (OHCAs) with activation of volunteer responders in the Capital Region of Denmark (1 November 2018 to 14 May 2019), the Central Denmark Region (1 November 2018 to 31 December 2020), and the Northern Denmark Region (14 February 2020 to 31 December 2020). All OHCAs unwitnessed by Emergency Medical Services (EMS) were analyzed on the basis on alarm acceptance and arrival before EMS. The primary outcomes were bystander cardio-pulmonary resuscitation (CPR), bystander defibrillation and secondary outcome was 30-day survival. A questionnaire sent to all volunteer responders was used with respect to their arrival status.ResultsWe identified 1,877 OHCAs with volunteer responder activation eligible for inclusion and 1,725 (91.9%) of these had at least one volunteer responder accepting the alarm (accepted). Of these, 1,355 (79%) reported arrival status whereof 883 (65%) arrived before EMS. When volunteer responders accepted the alarm and arrived before EMS, we found increased proportions and adjusted odds ratio for bystander CPR {94 vs. 83%, 4.31 [95% CI (2.43–7.67)] and bystander defibrillation [13 vs. 9%, 3.16 (1.60–6.25)]} compared to cases where no volunteer responders accepted the alarm.ConclusionWe observed a fourfold increased odds ratio for bystander CPR and a threefold increased odds ratio for bystander defibrillation when volunteer responders accepted the alarm and arrived before EMS.
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