Inverse Association Between Bystander Use of Audiovisual Feedback From an Automated External Defibrillator and Return of Spontaneous Circulation

Abstract

Background Treatment with an automated external defibrillator (AED) improves outcome in out‐of‐hospital cardiac arrest (OHCA). Audiovisual feedback from an AED may assist bystanders achieve higher quality cardiopulmonary resuscitation. However, the association between audiovisual feedback and clinical outcomes is not well assessed in real‐life OHCA. The aim of this study was to assess the association between audiovisual feedback from an AED used in bystander resuscitation with rates of return of spontaneous circulation (ROSC) and 30‐day survival in a real‐life cohort of patients with OHCA. Methods and Results We included 325 patients treated with bystander AED use before arrival of emergency medical services during 2016 to 2019 from the Capital Region of Denmark. Patients were divided into a “feedback” and a “nonfeedback” group, depending on presence of audiovisual feedback from the AED. Audiovisual feedback was defined as voice prompts with continuous feedback to ongoing resuscitation. Rates of ROSC upon hospital admission and 30‐day survival were assessed, and univariate and multivariable models were applied to decide the association to audiovisual feedback. Multivariable models were adjusted for sex, age, primary heart rhythm, and location of OHCA. A total of 155 (48%) patients had a bystander AED applied with audiovisual feedback and 170 (52%) without audiovisual feedback. A lower rate of ROSC was found in the feedback group compared with the nonfeedback group (33% [n=51] versus 45% [n=76]; P =0.03). No association was observed between AV feedback and 30‐day survival (feedback=27% [n=42] and nonfeedback=31% [n=53]; P =0.49). In the unadjusted logistic regression model, audiovisual feedback was associated with a decreased chance of ROSC (odds ratio, 0.61; 95% CI, 0.38–0.95; P =0.03), which remained significant after adjusted analysis (odds ratio, 0.53; 95% CI, 0.29–0.97; P =0.04), whereas we found no significant association between audiovisual feedback and 30‐day survival in the unadjusted and adjusted analyses. Conclusions Audiovisual feedback from an AED used by bystanders was associated with a lower chance of ROSC at hospital admission, but we found no significant difference in 30‐day survival. Focus on early and correct bystander cardiopulmonary resuscitation and AED use remain key for OHCA survival.