European Heart Journal Advance Access originally published online on May 27, 2009
European Heart Journal 2009 30(14):1781-1789; doi:10.1093/eurheartj/ehp177
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Dual dispatch early defibrillation in out-of-hospital cardiac arrest: the SALSA-pilot
1 Department of Cardiology, Karolinska Institute, South Hospital, SE-118 83 Stockholm, Sweden
2 Department of Cardiology, University of Göteborg, Sahlgrenska Hospital, Göteborg, Sweden
3 Department of Clinical Science and Education, Karolinska Institute, South Hospital, Stockholm, Sweden
4 Department of Clinical Science and Education, Karolinska Institute, Section of Prehospital Care, South Hospital, Stockholm, Sweden
Received 9 October 2008; revised 12 March 2009; accepted 21 April 2009; online publish-ahead-of-print 27 May 2009.
* Corresponding author. Tel: +46 8 6161000, Fax: +46 8 6163040, Email: jacob.hollenberg{at}sodersjukhuset.se
Aims: Out-of-hospital cardiac arrest (OHCA) is a major public health problem. The objective of this study is to explore the effects of a dual dispatch early defibrillation programme.
Methods and results: In this pilot study, automated external defibrillators (AEDs) were provided to all 43 fire stations in Stockholm during 2005. Fire-fighters were dispatched in parallel with traditional emergency medical responders (EMS) to all suspected cases of OHCA. Additionally, 65 larger public venues were equipped with AEDs. All 863 OHCA from December 2005 to December 2006 were included during the intervention, whereas all 657 OHCA from 2004 served as historical controls. Among dual dispatches, fire-fighters assisted with cardiopulmonary resuscitation (CPR) in 94% of the cases and arrived first on scene in 36%. The median time from call to arrival of first responder decreased from 7.5 min during the control period to 7.1 min during the intervention (P = 0.004). The proportion of patients in shockable rhythm remained unchanged. The proportion of patients alive 1 month after OHCA rose from 4.4 to 6.8% [adjusted odds ratio (OR): 1.6; 95% confidence interval (CI): 0.9–2.9]. One-month survival in witnessed cases rose from 5.7 to 9.7% (adjusted OR: 2.0; 95% CI: 1.1–3.7). Survival after OHCA in the rest of Sweden (Stockholm excluded) declined from 8.3 to 6.6% during the corresponding time period (unadjusted OR: 0.8; 95% CI: 0.6–1.0). Only three OHCA occurred at public venues equipped with AEDs.
Conclusion: An introduction of a dual dispatch early defibrillation programme in Stockholm has shortened response times and is likely to have improved survival in patients with OHCA, especially in the group of witnessed cardiac arrests. The increase in survival is believed to be associated with improved CPR and shortened time intervals.
Key Words: Out-of-hospital cardiac arrest • Sudden cardiac death • Ventricular fibrillation • Cardiopulmonary resuscitation • Automated external defibrillators • Fire brigade
These results were presented as an oral abstract at the ESC Congress 2008 in Munich.
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  F. Kee, A. Hamilton, and J. Adgey The importance of witnesses to maximize survival from out-of-hospital cardiac arrest Eur. Heart J., February 1, 2010; 31(3): 378 - 378. [Full Text] [PDF]
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J. Hollenberg The importance of witnesses to maximize survival from out-of-hospital cardiac arrest: reply Eur. Heart J., February 1, 2010; 31(3): 378 - 379. [Full Text] [PDF]
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