Bystander defibrillation for out-of-hospital cardiac arrest in Ireland

Abstract

Aims: To describe and explore predictors of bystander defibrillation in Ireland during the period 2012 to 2020. To examine the relationship between bystander defibrillation and health system developments.

Methods: National level Out of Hospital Cardiac Arrest (OHCA) registry data were interrogated, focusing on patients who had defibrillation performed. Bystander defibrillation (as compared to EMS initiated defibrillation) was the key outcome of concern. Logistic regression models were built and refined by fitting predictors, performing stepwise variable selection and by adding pairwise interactions that improved fit.

Results: The data included 5,751 cases of OHCA where defibrillation was performed. Increasing year over time (OR 1.17, 95% CI 1.13, 1.21) was associated with increased adjusted odds of bystander defibrillation. Non-cardiac aetiology was associated with reduced adjusted odds of bystander defibrillation (OR 0.30, 95% CI 0.21, 0.42), as were increasing age in years (OR 0.99, 95% CI 0.987, 0.996) and night-time occurrence of OHCA (OR 0.67, 95% CI 0.53, 0.83). Six further variables in the final model (sex, call response interval, incident location (home or other), who witnessed collapse (bystander or not witnessed), urban or rural location, and the COVID period) were involved in significant interactions. Bystander defibrillation was in general less likely in urban settings and at home locations. Whilst women were less likely to receive bystander defibrillation overall, in witnessed OHCAs, occurring outside the home, in urban areas and outside of the COVID-19 period women were more likely, to receive bystander defibrillation.

Conclusions: Defibrillation by bystanders has increased incrementally over time in Ireland. Interventions to address sex and age-based disparities, alongside interventions to increase bystander defibrillation at night, in urban settings and at home locations are required.

Keywords: Automatic External Defibrillators; Bystander Defibrillation; Cardiopulmonary Resuscitation; Out-of-Hospital Cardiac Arrest; Public Health; Registry Data; Resuscitation; Statistical Models.

Fig. 1

Bystander Defibrillation in Ireland 2012–2020: Case selection.

Fig. 2

Bystander Defibrillation in Ireland 2012–2020, absolute number and proportion of all patients who had defibrillation performed over time.

Fig. 3a

Bystander Defibrillation in Ireland in Ireland 2012–2020: Multivariable analysis, Final model − Predictors without Interactions (odds ratios & 95% confidence intervals – interval scale).

Fig. 3b

Bystander Defibrillation in Ireland in Ireland 2012–2020: Multivariable analysis, Final model predictors with interactions (odds ratio & 95% confidence intervals – log scale). Base case refers to the relevant variable with other model variables at baseline comparator status i.e. presumed cardiac aetiology, male sex, other than home location, daytime, witnessed, urban location, weekday and not the COVID period.