Survival after dispatcher-assisted cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Abstract

Aim: Strategies to increase provision of bystander CPR include mass education of laypersons. Additionally, programs directed at emergency dispatchers to provide CPR instructions during emergency calls to untrained bystanders have emerged. The aim of this study was to evaluate the association between dispatcher-assisted CPR (DA-CPR) and 30-day survival compared with no CPR or spontaneously initiated CPR by lay bystanders prior to emergency medical services in out of hospital cardiac arrest (OHCA).Methods: Nationwide observational cohort study including all consecutive lay bystander witnessed OHCAs reported to the Swedish Register for Cardiopulmonary Resuscitation in 2010À2017. Exposure was categorized as: no CPR (NO-CPR), DA-CPR and spontaneously initiated CPR (SP-CPR) prior to EMS arrival. Propensity-score matched cohorts were used for comparison between groups. Main Outcome was 30-day survival.Results: A total of 15 471 patients were included and distributed as follows: NO-CPR 6440 (41.6%), DA-CPR 4793 (31.0%) and SP-CPR 4238 (27.4%).Survival rates to 30 days were 7.1%, 13.0% and 18.3%, respectively. In propensity-score matched analysis (DA-CPR as reference), NO-CPR was associated with lower survival (conditional OR 0.61, 95% CI 0.52À0.72) and SP-CPR was associated with higher survival (conditional OR 1.21 (95% CI 1.05À1.39).Conclusions: DA-CPR was associated with a higher survival compared with NO-CPR. However, DA-CPR was associated with a lower survival compared with SP-CPR. These results reinforce the vital role of DA-CPR, although continuous efforts to disseminate CPR training must be considered a top priority if survival after out of hospital cardiac arrest is to continue to increase.

Association of Dispatcher-assisted, Chest Compression-only Resuscitation With Annual Increases in Survival From Unwitnessed Out-of-hospital Cardiac Arrests

“…However, the guidelines endorsing the shift to compression-only BCPR also emphasized the role of dispatchers to detect OHCA and to instruct to callers and bystanders to perform CPR, and hence the continuous quality program for DA-CPR was activated and dispersed throughout Japan 19 and other countries. [20][21][22][23] Indeed, a prominent increase was observed in DA-CPR sensitivity for OHCA but a small increase in bystander's compliance with DA-CPR was also noted. Therefore, it is likely that the increase in BCPR rate during the study period is mainly attributed to the improved ability of dispatcher to detect OHCA, although the small increase in bystander's compliance with DA-CPR may re ect the preference of some bystanders for compression-only CPR.…”

The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan

“…To evaluate the net effect of mechanical CPR on patient outcomes, a forward stepwise logistic regression analysis was conducted, with adjustments for variables with p value < 0.1 as derived from the univariate analysis and the documented or possible predictors. The adjusted factors included age [19,20], sex [19], EMS response and scene time [21,22], number of dispatched EMTs, DACPR or bystander CPR [23][24][25][26], witnessed arrest, shockable rhythm [26], location of arrest [27], pre-hospital epinephrine injection [28,29], different batches of EMS stations with LUCAS-2 implementation, and level of transferred hospital [30]. Subgroup analyses with adjustment of the above-mentioned factors were also conducted to evaluate the net effect of mechanical CPR on different types of OHCA patients, including witness status, initial cardiac rhythm (shockable or non-shockable), different EMS response times (≤ and >4 min), and different age groups (< and ≥65 years).…”

Singapore Paediatric Resuscitation Guidelines 2021

“…Dispatch assistance has been successfully demonstrated to assist in identification of cardiac arrest states and administration of CPR, with resultant improved clinical outcomes. (10,(14)(15)(16) The Singapore Civil Defence Force dispatch service also activates nearby volunteer community first responders to obtain the nearest automated external defibrillator (AED) and mobilises them to the casualty's location. Thus, there is no need for lone rescuers to leave the paediatric cardiac arrest victim's side to obtain AEDs.…”