Exploring the real-life value of first responders for out-of-hospital cardiac arrest in a Belgian urban context: a retrospective analysis.

Abstract

Aim: First Responder [FR] systems are associated with improved outcomes. However, this evidence has very low certainty. We aimed to explore - using real-life data - the reality of out-of-hospital cardiac arrest [OHCA] in a Belgian municipal region where there currently is no such system.

Methods: We explored the hypothetical potential for an FR in all cases of OHCA attended by the physician-staffed emergency medical services [EMS] team of Ghent University Hospital [07/2020-06/2021].

Results: Of the 200 attended cases, 76% were residential; 54% were unwitnessed. Bystander CPR occurred in 36.5%, a public-access AED was used in only three cases. Eleven patients survived beyond hospital discharge, all but one with good neurological outcomes. In 60%, we considered an FR obsolete from start (due to irreversible death, existing advance directive, resourceful setting, early EMS arrival, OHCA not recognized, or EMS witnessed). Another 10% were traumatic OHCA, a category universally excluded. Although impossible to identify those cases from the remaining 30% (n = 60) that would truly benefit, the actual number is likely far lower due to a.o. the likelihood of prolonged no-flow in unwitnessed residential OHCA (one-third or complicating contexts, victim accessibility, or FR availability).

Conclusion: There might be added value for an FR system in selected populations, but the associated cost-effectiveness ratios and the potential for harm should not be ignored. Better identification of victims potentially benefitting at the system point of entry is crucial.