Does GP based, cardiac arrest, community first response save lives?

Problem

CPR and defibrillation are the most important interventions following cardiac arrest but are critically time sensitive. The mobilization of ‘community first responders’ has been shown to shorten the interval from out-of-hospital cardiac arrest (OHCA) occurring to CPR and defibrillation being performed and is an important strategy to improve survival.Irish General Practitioners have historically been involved in the resuscitation efforts of 10-15% of all patients who survive cardiac arrest in Ireland, but have not been formally linked with emergency medical services dispatch systems. Since 2015 the worlds first GP based, ambulance service linked, cardiac arrest first response initiative has been operational in Ireland.

Approach

GPs volunteer to receive text message alerts to instances of cardiac arrest in their local communities from emergency services dispatch. Data on alerts, responses, OHCA incidents and outcomes are gathered prospectively, using ambulance control and GP data and with corroborative data from the national OHCA registry.

Findings

During 2016 to 2018, 190 GPs participated, 146 received one or more alert(s) and 80 responded. In total 228 patients were attended. GPs arrived before the emergency services on 83 (36% of) occasions. 196 patients (86%) had suffered OHCA of whom 138 (70%) had resuscitation attempted. The remainder were already deceased. GPs initiated CPR on three occasions and delivered the first defibrillation on eight occasions. 55 patients were transferred to hospital of whom 14 (10% of all whom had resuscitation attempted) are known to have survived.

Consequences

GPs are willing to volunteer to provide OHCA first response in their own communities. GPs reached patients in advance of the emergency medical services in a third of all incidents. A considerable volume of alerting activity is required to generate true resuscitation opportunities. A considerable component of the GP OHCA first responder role involves the management of death in the community. Opportunities to provide early CPR and defibrillation are more limited however likely to contribute to additional survival when they occur.