Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation

Abstract

Introduction: Bystander cardiopulmonary resuscitation (B-CPR) is associated with improved out-ofhospital cardiac arrest survival. Community-level interventions including dispatcher-assisted CPR (DA-CPR) and myResponder were implemented to increase B-CPR. We sought to assess whether these interventions increased B-CPR. Methods: The Singapore out-of-hospital cardiac arrest registry captured cases that occurred between 2010 and 2017. Outcomes occurring in 3 time periods (Baseline, DA-CPR, and DA-CPR plus myResponder) were compared. Segmented regression of time-series data was conducted to investigate our intervention impact on the temporal changes in B-CPR. Results: A total of 13,829 out-of-hospital cardiac arrest cases were included from April 2010 to December 2017. Higher B-CPR rates (24.8% versus 50.8% vs 64.4%) were observed across the 3 time periods. B-CPR rates showed an increasing but plateauing trend. DA-CPR implementation was significantly associated with an increased B-CPR (level odds ratio [OR] 2.26, 95% confidence interval [CI] 1.79–2.88; trend OR 1.03, 95% CI 1.01–1.04), while no positive change was detected with myResponder (level OR 0.95, 95% CI 0.82–1.11; trend OR 0.99, 95% CI 0.98–1.00). Conclusion: B-CPR rates in Singapore have been increasing alongside the implementation of community-level interventions such as DA-CPR and myResponder. DA-CPR was associated with improved odds of receiving B-CPR over time while the impact of myResponder was less clear.

Dispatching citizens as first responders to out-of-hospital cardiac arrests: a systematic review and meta-analysis

“…Rates of ROSC, available for nine studies [12,15,17,21,28,29,31–33], were higher among OHCAs with citizen first responders dispatched compared with standard EMS response [Fig. 3; 2575/9169 (28%) vs. 3445/12 607 (27%); OR, 1.40; 95% CI, 1.07–1.81; P = 0.01; I 2 = 83%].…”

“…Eight studies investigated the effect of dispatching first responders to OHCAs on rates of bystander-initiated CPR [15,17,21,28,29,31–33] and use of AED before EMS arrival [12,15,17,28,29,31–33]. Rates of bystander-initiated CPR were significantly higher among patients with OHCA for which citizen first responders were activated compared with standard EMS response [Fig.…”

“…Details of studies excluded are displayed in the Supplementary Table 1, Supplemental digital content 1, http://links.lww.com/EJEM/A327. All included studies were published between 2015 and 2021, seven in Europe [12,15,17,21,[28][29][30], two in Asia [31,32], and one in the USA [33]. Four of the included studies adopted a text message-based alert system [21,28,30,31], whereas the remaining six studies implemented a smartphone app to alert citizen first responders [12,15,17,29,32,33].…”

“…The primary outcome of survival at hospital discharge or 30 days was reported in nine studies [12,15,17,21,[28][29][30][31][32]. We found that citizen first responders activation was associated with higher rates of survival at hospital discharge or 30 days [Fig.…”

Long term survival and disease burden from out-of-hospital cardiac arrest in Singapore: a population-based cohort study

“…However, the overall decrease in the mean DALY from 2010 to 2018 in our study suggests that the long-term burden per OHCA patient has improved in Singapore over time, whereas international data revealed an increasing burden of disease due to OHCA from 2013 to 2018 (possibly because of more precise national OHCA surveillance in the later years). 20 This result from a cohort of initial OHCA survivors in a small city-state may have been influenced by nation-wide improvements to OHCA interventions, 34 ranging from community interventions such as the MyResponder phone application to improve rates of bystander CPR and AED use 35 to post-resuscitation interventions including coronary angiography (CAG) with percutaneous coronary intervention (PCI) 36 and targeted temperature management (TTM). 37 , 38 , 39 Although bystander CPR was not significantly associated with long-term survival in this study, the sum effect of these interventions may have improved short-term neurological outcomes, which was significantly associated with long-term survival here and elsewhere.…”