Purpose:  We examined the effect of empowering a community-wide bystander defibrillation program on good neurological outcome in patients after out-of-hospital cardiac arrest during a four-year prospective follow-up period.
Materials and methods:  A prospective 4-year community-wide observational database collected from an OHCA e-Registry in a metropolitan was studied, after a citywide bystander defibrillation rescue program had been launched that strategically providing public accessed AEDs (automated external defibrillators) and dispatcher-assisted CPR rescue in public locations that were also citywide e-registered. Outcomes included 2-hour sustained ROSC (return of spontaneous circulation) at hospital, survival to hospital discharge, and good CPC (Cerebral Performance Category Scale 1 or 2). All patient pre-hospital characteristics and outcome relations were evaluated and adjusted by regression analysis. 
Results:  The density of public AEDs distribution increased from 0.85 to 6.24 per square kilometres in the studied 4 years. Among a total of 12,368 OHCA, 1,210 occurred in public locations, and 52 patients (male for 83%, witnessed arrest for 77%) received bystander aid by public accessed AEDs (automated external defibrillators) and CPR rescue. For these 52 patients, 44.2% (23/52) achieved pre-hospital ROSC at scene or during transport, 67.3% (35/52) achieved sustained ROSC after resuscitation at hospital, 44.2% (23/52) achieved survival-to-discharge and noticeably all those 23 (100%, 23/23) survival-to-discharge patients achieved excellent neurological outcome of CPC 1 (Cerebral Performance Category Scale 1). Their outcomes were significantly better (67.3 vs 26.5%, OR: 5.7 [95%CI: 3.2-10.4] for sustained ROSC; 44.2 vs 10.1%, OR: 7.0 [95%CI: 3.9-12.6] for survival of discharge; 44.2 vs 6.6%, OR: 11.6 [95%CI: 6.4-21.2] for good CPC 1or2, and 100 vs 62.9% for good CPC among survival -to-discharge) compared with those not by public accessed AED plus dispatcher-assisted CPR rescue. In all 52 patients only one man without pre-hospital ROSC still achieved survival-to-discharge and good CPC.
Conclusions:  In our study, we found that empowering a bystander defibrillation rescue program were significantly associated with excellent neurological outcome of CPC 1 and higher survival to hospital discharge. It would be noticeably in our community that by rescue program all patients achieving survival-to-discharge could achieve excellent CPC1.

Empowering a Community-wide Bystander Defibrillation Effects and Good Neurological Outcome in Out-of-Hospital Cardiac Arrest