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Bundgaard Ringgren K, Ung V, Gerds TA, Kragholm KH, Ascanius Jacobsen P, Lyng Lindgren F, Grabmayr AJ, Christensen HC, Mills EHA, Kollander Jakobsen L, Yonis H, Hansen CM, Folke F, Lippert F, Torp-Pedersen C. Prediction model for future OHCAs based on geospatial and demographic data: An observational study. Medicine (Baltimore) 2024; 103:e38070. [PMID: 38728490 PMCID: PMC11081540 DOI: 10.1097/md.0000000000038070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
This study used demographic data in a novel prediction model to identify areas with high risk of out-of-hospital cardiac arrest (OHCA) in order to target prehospital preparedness. We combined data from the nationwide Danish Cardiac Arrest Registry with geographical- and demographic data on a hectare level. Hectares were classified in a hierarchy according to characteristics and pooled to square kilometers (km2). Historical OHCA incidence of each hectare group was supplemented with a predicted annual risk of at least 1 OHCA to ensure future applicability. We recorded 19,090 valid OHCAs during 2016 to 2019. The mean annual OHCA rate was highest in residential areas with no point of public interest and 100 to 1000 residents per hectare (9.7/year/km2) followed by pedestrian streets with multiple shops (5.8/year/km2), areas with no point of public interest and 50 to 100 residents (5.5/year/km2), and malls with a mean annual incidence per km2 of 4.6. Other high incidence areas were public transport stations, schools and areas without a point of public interest and 10 to 50 residents. These areas combined constitute 1496 km2 annually corresponding to 3.4% of the total area of Denmark and account for 65% of the OHCA incidence. Our prediction model confirms these areas to be of high risk and outperforms simple previous incidence in identifying future risk-sites. Two thirds of out-of-hospital cardiac arrests were identified in only 3.4% of the area of Denmark. This area was easily identified as having multiple residents or having airports, malls, pedestrian shopping streets or schools. This result has important implications for targeted intervention such as automatic defibrillators available to the public. Further, demographic information should be considered when implementing such interventions.
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Affiliation(s)
| | - Vilde Ung
- Department of Public Health, University of Copenhagen, København, Denmark
| | | | | | | | | | - Anne Juul Grabmayr
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
- National Clinical Registries, Frederiksberg, Denmark
| | | | | | - Harman Yonis
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Torp-Pedersen
- Department of Public Health, University of Copenhagen, København, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
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Kragh AR, Gregers MT, Andelius L, Grabmayr AJ, Kollander L, Kjærulf VE, Kjølbye JS, Sheikh AP, Ersbøll AK, Folke F, Hansen CM. Volunteer Responder Interventions in Out-of-Hospital Cardiac Arrest in Urban, Suburban, and Rural Areas. J Am Heart Assoc 2024; 13:e032629. [PMID: 38348801 PMCID: PMC11010116 DOI: 10.1161/jaha.123.032629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Patients with out-of-hospital cardiac arrest (OHCA) in rural areas experience longer emergency response times and have lower survival rates compared with patients in urban areas. Volunteer responders might improve care and outcomes for patients with OHCA specifically in rural areas. Therefore, we investigated volunteer responder interventions based on the degree of urbanization. METHODS AND RESULTS We included 1310 OHCAs from 3 different regions in Denmark where volunteer responders had arrived at the OHCA location. The location was classified as urban, suburban, or rural according to the Eurostat Degree of Urbanization Tool. A logistic regression model was used to examine associations between the degree of urbanization and volunteer responder arrival before emergency medical services, cardiopulmonary resuscitation, or defibrillation. We found the odds for volunteer responder arrival before emergency medical services more than doubled in rural areas (odds ratio [OR], 2.60 [95% CI, 1.91-3.53]) and suburban areas (OR, 2.05 [95% CI, 1.56-2.69]) compared with urban areas. In OHCA cases where volunteer responders arrived first, odds for bystander cardiopulmonary resuscitation was tripled in rural areas (OR, 3.83 [95% CI, 1.64-8.93]) and doubled in suburban areas (OR, 2.27 [95% CI, 1.17-4.41]) compared with urban areas. Bystander defibrillation was more common in suburban areas (OR, 1.53 [95% CI, 1.02-2.31]), where almost 1 out of 4 patients received bystander defibrillation, compared with urban areas. CONCLUSIONS Volunteer responders are significantly more likely to arrive before emergency medical services in rural and suburban areas than in urban areas. Patients with OHCA received more cardiopulmonary resuscitation in rural and suburban areas and more defibrillation in suburban areas than in urban areas.
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Affiliation(s)
- Astrid Rolin Kragh
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Mads Tofte Gregers
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Linn Andelius
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
| | - Anne Juul Grabmayr
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Louise Kollander
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Victor Elnegaard Kjærulf
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Julie Samsøe Kjølbye
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Annam Pervez Sheikh
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
| | - Annette Kjær Ersbøll
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- National Institute of Public Health, University of Southern DenmarkCopenhagenDenmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
- Department of CardiologyHerlev Gentofte University HospitalCopenhagenDenmark
| | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services, University of CopenhagenBallerupDenmark
- Department of Clinical MedicineUniversity of CopenhagenBallerupDenmark
- Department of CardiologyHerlev Gentofte University HospitalCopenhagenDenmark
- Department of CardiologyRigshospitalet, University of CopenhagenBallerupDenmark
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Juul Grabmayr A, Folke F, Tofte Gregers MC, Kollander L, Bo N, Andelius L, Jensen TW, Ettl F, Krammel M, Sulzgruber P, Krychtiuk KA, Torp-Pedersen C, Kjær Ersbøll A, Malta Hansen C. Public Out-of-Hospital Cardiac Arrest in Residential Neighborhoods. J Am Coll Cardiol 2023; 82:1777-1788. [PMID: 37879782 DOI: 10.1016/j.jacc.2023.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/17/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Although one-half of all public out-of-hospital cardiac arrests (OHCAs) occur outside private homes in residential neighborhoods, their characteristics and outcomes remain unexplored. OBJECTIVES The authors assessed interventions before ambulance arrival and survival for public OHCA patients in residential neighborhoods. METHODS Public OHCAs from Vienna (2018-2021) and Copenhagen (2016-2020) were designated residential neighborhoods or nonresidential areas. Interventions (cardiopulmonary resuscitation [CPR], automated external defibrillator [AED] attached, and defibrillation) and 30-day survival were compared using a generalized estimation equation model adjusted for age and time of day and presented as ORs. RESULTS We included 1,052 and 654 public OHCAs from Vienna and Copenhagen, respectively, and 68% and 55% occurred in residential neighborhoods, respectively. The likelihood of CPR, defibrillation, and survival in residential neighborhoods vs nonresidential areas (reference) were as follows: CPR Vienna, 73% vs 78%, OR: 0.78 (95% CI: 0.57-1.06), CPR Copenhagen, 83% vs 90%, OR: 0.54 (95% CI: 0.34-0.88), and CPR combined, 76% vs 84%, OR: 0.70 (95% CI: 0.53-0.90); AED attached Vienna, 36% vs 44%, OR: 0.69 (95% CI: 0.53-0.90), AED attached Copenhagen, 21% vs 43%, OR: 0.33 (95% CI: 0.24-0.48), and AED attached combined, 31% vs 44%, OR: 0.53 (95% CI: 0.42-0.65); defibrillation Vienna, 14% vs 20%, OR: 0.61 (95% CI: 0.43-0.87), defibrillation Copenhagen, 16% vs 36%, OR: 0.35 (95% CI: 0.24-0.51), and defibrillation combined, 15% vs 27%, OR: 0.46 (95% CI: 0.36-0.61); and 30-day survival rate Vienna, 21% vs 26%, OR: 0.84 (95% CI: 0.58-1.20), 30-day survival rate Copenhagen, 33% vs 44%, OR: 0.65 (95% CI: 0.47-0.90), and 30-day survival rate combined, 25% vs 36%, OR: 0.73 (95% CI: 0.58-0.93). CONCLUSIONS Two-thirds of public OHCAs occurred in residential neighborhoods with fewer resuscitative efforts before ambulance arrival and lower survival than in nonresidential areas. Targeted efforts to improve early CPR and defibrillation for public OHCA patients in residential neighborhoods are needed.
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Affiliation(s)
- Anne Juul Grabmayr
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Fredrik Folke
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte, Denmark
| | - Mads Christian Tofte Gregers
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Louise Kollander
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Bo
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Linn Andelius
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Theo Walter Jensen
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Florian Ettl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Mario Krammel
- PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria; Emergency Medical Service Vienna, Vienna, Austria
| | - Patrick Sulzgruber
- PULS - Austrian Cardiac Arrest Awareness Association, Vienna, Austria; Department of Internal Medicine II - Division of Cardiology Medical University of Vienna, Vienna, Austria
| | - Konstantin A Krychtiuk
- Department of Internal Medicine II - Division of Cardiology Medical University of Vienna, Vienna, Austria; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Christian Torp-Pedersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, North Zealand Hospital, Hilleroed, Denmark
| | - Annette Kjær Ersbøll
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Carolina Malta Hansen
- Research Department, Copenhagen University Hospital, Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Juul Grabmayr A, Malta Hansen C, Bo N, Sheikh AP, Hassager C, Ersbøll A, Kjaergaard J, Lippert F, Tjørnhøj-Thomsen T, Gislason G, Torp-Pedersen C, Folke F. Community intervention to improve defibrillation before ambulance arrival in residential neighbourhoods with a high risk of out-of-hospital cardiac arrest: study protocol of a cluster-randomised trial (the CARAMBA trial). BMJ Open 2023; 13:e073541. [PMID: 37816557 PMCID: PMC10565309 DOI: 10.1136/bmjopen-2023-073541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/21/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION In Denmark, multiple national initiatives have been associated with improved bystander defibrillation and survival following out-of-hospital cardiac arrest (OHCA) in public places. However, OHCAs in residential neighbourhoods continue to have poor outcomes. The Cardiac Arrest in Residential Areas with MoBile volunteer responder Activation trial aims to improve bystander defibrillation and survival following OHCA in residential neighbourhoods with a high risk of OHCA. The intervention consists of: (1) strategically deployed automated external defibrillators accessible at all hours, (2) cardiopulmonary resuscitation (CPR) training of residents and (3) recruitment of residents for a volunteer responder programme. METHODS AND ANALYSIS This is a prospective, pair-matched, cluster-randomised, superiority trial with clusters of 26 residential neighbourhoods, testing the effectiveness of the intervention in a real-world setting. The areas are randomised for intervention or control. Intervention and control areas will receive the standard OHCA emergency response, including volunteer responder activation. However, targeted automated external defibrillator deployment, CPR training and volunteer responder recruitment will only be provided in the intervention areas. The primary outcome is bystander defibrillation, and the secondary outcome is 30-day survival. Data on patients who had an OHCA will be collected through the Danish Cardiac Arrest Registry. ETHICS AND DISSEMINATION Approval to store OHCA data has been granted from the Legal Office, Capital Region of Denmark (j.nr: 2012-58-0004, VD-2018-28, I-Suite no: 6222, and P-2021-670). In Denmark, formal approval from the ethics committee is only obtainable when the study regards testing medicine or medical equipment on humans or using genome or diagnostic imagine as data source. The Ethics Committee of the Capital Region of Denmark has evaluated the trial and waived formal approval unnecessary (H-19037170). Results will be published in peer-reviewed papers and shared with funders, stakeholders, and housing organisations through summaries and presentations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04446585).
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Affiliation(s)
- Anne Juul Grabmayr
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Carolina Malta Hansen
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Nanna Bo
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Annam Pervez Sheikh
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Annette Ersbøll
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
- Department of Population Health and Morbidity, National Institute of Public Health, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Freddy Lippert
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
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Gregers MCT, Møller SG, Kjoelbye JS, Jakobsen LK, Grabmayr AJ, Kragh AR, Hansen CM, Torp-Pedersen C, Andelius L, Ersbøll AK, Folke F. Association of Degree of Urbanization and Survival in Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2023; 12:e8322. [PMID: 37158087 DOI: 10.1161/jaha.122.028449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Background Survival from out-of-hospital cardiac arrest (OHCA) varies across regions. The aim of this study was to evaluate the association between urbanization (rural, suburban, and urban areas), bystander interventions (cardiopulmonary resuscitation and defibrillation), and 30-day survival from OHCAs in Denmark. Methods and Results We included OHCAs not witnessed by ambulance staff in Denmark from January 1, 2016, to December 31, 2020. Patients were divided according to the Eurostat Degree of Urbanization Tool in rural, suburban, and urban areas based on the 98 Danish municipalities. Poisson regression was used to estimate incidence rate ratios. Logistic regression (adjusted for ambulance response time) tested differences between the groups with respect to bystander interventions and survival, according to degree of urbanization. A total of 21 385 OHCAs were included, of which 8496 (40%) occurred in rural areas, 7025 (33%) occurred in suburban areas, and 5864 (27%) occurred in urban areas. Baseline characteristics, as age, sex, location of OHCA, and comorbidities, were comparable between groups. The annual incidence rate ratio of OHCA was higher in rural areas (1.54 [95% CI, 1.48-1.58]) compared with urban areas. Odds for bystander cardiopulmonary resuscitation were lower in suburban (0.86 [95% CI, 0.82-0.96]) and urban areas (0.87 [95% CI, 0.80-0.95]) compared with rural areas, whereas bystander defibrillation was higher in urban areas compared with rural areas (1.15 [95% CI, 1.01-1.31]). Finally, 30-day survival was higher in suburban (1.13 [95% CI, 1.02-1.25]) and urban areas (1.17 [95% CI, 1.05-1.30]) compared with rural areas. Conclusions Degree of urbanization was associated with lower rates of bystander defibrillation and 30-day survival in rural areas compared with urban areas.
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Affiliation(s)
- Mads Christian Tofte Gregers
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | | | - Julie Samsoe Kjoelbye
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Louise Kollander Jakobsen
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Anne Juul Grabmayr
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Astrid Rolin Kragh
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Carolina Malta Hansen
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Cardiology, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology Copenhagen University Hospital, North Zealand Hospital Copenhagen Denmark
- Department of Public Health University of Copenhagen Copenhagen Denmark
| | - Linn Andelius
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Anaesthesiology Copenhagen University Hospital, Herlev and Gentofte Hospital Copenhagen Denmark
| | - Annette Kjær Ersbøll
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- National Institute of Public Health University of Southern Denmark Copenhagen Denmark
| | - Fredrik Folke
- Emergency Medical Services, Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
- Department of Cardiology Copenhagen University Hospital, Herlev and Gentofte Hospital Copenhagen Denmark
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Kragh AR, Grabmayr AJ, Tjørnhøj-Thomsen T, Zinckernagel L, Gregers MCT, Andelius LC, Christensen AK, Kjærgaard J, Folke F, Malta Hansen C. Volunteer responder provision of support to relatives of out-of-hospital cardiac arrest patients: a qualitative study. BMJ Open 2023; 13:e071220. [PMID: 36944472 PMCID: PMC10032384 DOI: 10.1136/bmjopen-2022-071220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES Smartphone dispatch of volunteer responders for out-of-hospital cardiac arrest (OHCA) is implemented worldwide. While basic life support courses prepare participants to provide CPR, the courses rarely address the possibility of meeting a family member or relative in crisis. This study aimed to examine volunteer responders' provision of support to relatives of cardiac arrest patients and how relatives experienced the interaction with volunteer responders. DESIGN In this qualitative study, we conducted 16 semistructured interviews with volunteer responders and relatives of cardiac arrest patients. SETTING Interviews were conducted face to face and by video and recorded and transcribed verbatim. PARTICIPANTS Volunteer responders dispatched to cardiac arrests and relatives of cardiac arrest patients were included in the study. Participants were included from all five regions of Denmark. RESULTS A thematic analysis was performed with inspiration from Braun and Clarke. We identified three themes: (1) relatives' experiences of immediate relief at arrival of assistance, (2) volunteer responders' assessment of relatives' needs and (3) the advantage of being healthcare educated. CONCLUSIONS Relatives to out-of-hospital cardiac arrest patients benefited from volunteer responders' presence and support and experienced the mere presence of volunteer responders as supportive. Healthcare-educated volunteer responders felt confident and skilled to provide care for relatives, while some non-healthcare-educated volunteer responders felt they lacked the proper training and knowledge to provide emotional support for relatives. Future basic life support courses should include a lesson on how to provide emotional support to relatives of cardiac arrest patients.
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Affiliation(s)
- Astrid Rolin Kragh
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Emergency Medical Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Anne Juul Grabmayr
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Emergency Medical Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | | | - Mads Christian Tofte Gregers
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Emergency Medical Services, Capital Region of Denmark, Copenhagen, Denmark
| | | | | | - Jesper Kjærgaard
- Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Emergency Medical Services, Capital Region of Denmark, Copenhagen, Denmark
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Carolina Malta Hansen
- Department of Emergency Medical Services, Capital Region of Denmark, Copenhagen, Denmark
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
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Gregers MCT, Andelius L, Kjoelbye JS, Juul Grabmayr A, Jakobsen LK, Bo Christensen N, Kragh AR, Hansen CM, Lyngby RM, Væggemose U, Torp-Pedersen C, Ersbøll AK, Folke F. Association Between Number of Volunteer Responders and Interventions Before Ambulance Arrival for Cardiac Arrest. J Am Coll Cardiol 2023; 81:668-680. [PMID: 36792282 DOI: 10.1016/j.jacc.2022.11.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/03/2022] [Accepted: 11/08/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Volunteer responder (VR) programs for activation of laypersons in out-of-hospital cardiac arrest (OHCA) have been deployed worldwide, but the optimal number of VRs to dispatch is unknown. OBJECTIVES The purpose of this study was to investigate the association between the number of VRs arriving before Emergency Medical Services (EMS) and the proportion of bystander cardiopulmonary resuscitation (CPR) and defibrillation. METHODS We included OHCAs not witnessed by EMS with VR activation from the Capital Region (September 2, 2017, to May 14, 2019) and the Central Region of Denmark (November 5, 2018, to December 31, 2019). We created 4 groups according to the number of VRs arriving before EMS: 0, 1, 2, and 3 or more. Using a logistic regression model adjusted for EMS response time, we examined associations between the number of VRs arriving before EMS and bystander CPR and defibrillation. RESULTS We included 906 OHCAs. The adjusted ORs for bystander CPR were 2.40 (95% CI: 1.42-4.05), 3.18 (95% CI: 1.39-7.26), and 2.70 (95% CI: 1.32-5.52) when 1, 2, or 3 or more VRs arrived before EMS (reference), respectively. The adjusted OR for bystander defibrillation increased when 1 (1.97 [95% CI: 1.12-3.52]), 2 (2.88 [95% CI: 1.48-5.58]), or 3 or more (3.85 [95% CI: 2.11-7.01]) VRs arrived before EMS (reference). The adjusted OR of bystander defibrillation increased to 1.95 (95% CI: 1.18-3.22) when ≥3 VRs arrived first compared with 1 VR arriving first (reference). CONCLUSIONS We found an association of increased bystander CPR and defibrillation when 1 or more VRs arrived before the EMS with a trend toward increased bystander defibrillation with increasing number of VRs arriving first.
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Affiliation(s)
- Mads Christian Tofte Gregers
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. https://twitter.com/mads_tofte
| | - Linn Andelius
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Julie Samsoee Kjoelbye
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Juul Grabmayr
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Louise Kollander Jakobsen
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Bo Christensen
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Rolin Kragh
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carolina Malta Hansen
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Meyer Lyngby
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Ulla Væggemose
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital - North Zealand, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
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Juul Grabmayr A, Andelius L, Bo Christensen N, Folke F, Bundgaard Ringgren K, Torp-Pedersen C, Gislason G, Jensen TW, Rolin Kragh A, Tofte Gregers MC, Samsoee Kjoelbye J, Malta Hansen C. Contemporary levels of cardiopulmonary resuscitation training in Denmark. Resusc Plus 2022; 11:100268. [PMID: 35812720 PMCID: PMC9256815 DOI: 10.1016/j.resplu.2022.100268] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/10/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Aim Many efforts have been made to train the Danish population in cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use. We assessed CPR and AED training levels among the broad Danish population and volunteer responders. Methods In November 2018, an electronic cross-sectional survey was sent to (1) a representative sample of the general Danish population (by YouGov) and (2) all volunteer responders in the Capital Region of Denmark. Results A total of 2,085 people from the general population and 7,768 volunteer responders (response rate 36%) completed the survey. Comparing the general Danish population with volunteer responders, 81.0% (95% CI 79.2–82.7%) vs. 99.2% (95% CI 99.0–99.4%) p < 0.001 reported CPR training, and 54.0% (95% CI 51.8; 56.2) vs. 89.5% (95% CI 88.9–90.2) p < 0.001 reported AED training, at some point in life. In the general population, the unemployed and the self-employed had the lowest proportion of training with CPR training at 71.9% (95% CI 68.3–75.4%) and 65.4% (95% CI 53.8–75.8%) and AED training at 39.0% (95% CI 35.2–42.9%) and 34.6% (95% CI 24.2–46.2%), respectively. Applicable to both populations, the workplace was the most frequent training provider. Among 18–29-year-olds in the general population, most reported training when acquiring a driver's license. Conclusions A large majority of the Danish population and volunteer responders reported previous CPR/AED training. Mandatory training when acquiring a driver's license and training through the workplace seems to disseminate CPR/AED training effectively. However, new strategies reaching the unemployed and self-employed are warranted to ensure equal access.
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Affiliation(s)
- Anne Juul Grabmayr
- Emergency Medical Services Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Corresponding author at: Telegrafvej 5, 2750 Ballerup, Denmark.
| | - Linn Andelius
- Emergency Medical Services Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark
| | - Nanna Bo Christensen
- Emergency Medical Services Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Fredrik Folke
- Emergency Medical Services Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Cardiology, Herlev Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | | | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Cardiology, Herlev Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Theo Walther Jensen
- Emergency Medical Services Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Astrid Rolin Kragh
- Emergency Medical Services Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Mads Christian Tofte Gregers
- Emergency Medical Services Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Julie Samsoee Kjoelbye
- Emergency Medical Services Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Carolina Malta Hansen
- Emergency Medical Services Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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