Dispatcher-assisted bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest

Hagihara, Akihito; Onozuka, Daisuke; Shibuta, Hidetoshi; Hasegawa, Manabu; Nagata, Takashi

doi:10.1016/j.ijcard.2018.04.067

Cited by 17 publications

(15 citation statements)

References 28 publications

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“…A previous study also demonstrated that the mortality rates were different within the urban-rural gap, and the main reason was EMT' arrival time [19]. When the EMT' arrival time increased, patient survival rates decreased even after DACPR intervention [20]. In our study, no significant difference was observed in the rates of ROSC and survival discharge between the urban and rural areas.…”

Section: Discussioncontrasting

confidence: 43%

Dispatcher-Assisted Cardiopulmonary Resuscitation: Disparity between Urban and Rural Areas

Chen

et al. 2020

Emergency Medicine International

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Object. To compare the provision and effectiveness of dispatcher-assisted cardiopulmonary resuscitation (DACPR) in rural and urban areas. Methods. Patients with out-of-hospital cardiac arrest (OHCA) were prospectively registered in Taichung. The 29 districts of Taichung city were divided into urban and rural areas based on whether the population density is more than 1,000 people per square kilometer. Prehospital data were collected according to the Utstein-style template, and telephone auditory records were collected by a dispatch center. Results. 2,716 patients were enrolled during the study period. 88.4% OHCA occurred in urban areas and 11.6% in rural areas. 74.9% after dispatcher assistance, laypersons performed CPR in urban areas and 67.7% in rural areas (p=0.023). The proportion of laypersons continued CPR until an emergency medical technician’s (EMT) arrival was higher in the urban areas (59.57% vs 52.27%, p=0.039). Laypersons continued CPR until an EMT’ arrival would increase the chance of return of spontaneous circulation in urban and rural areas, with adjusted odds ratio (aOR) of 1.02, 95% confidence interval (CI) of 0.82–1.27, and aOR of 1.49, 95% CI of 0.80–2.80, respectively. Continued laypersons CPR until the EMT’ arrival also improved survival with favorable neurological function, with aOR of 1.16, 95% CI of 0.61–2.20 in urban areas and aOR of 2.90 95% CI of 0.18–46.81 in rural areas. Conclusion. Bystanders in urban areas exhibited higher ratio of acceptance of DACPR. However, after DACPR intervention, prognosis improvement was considerably higher in rural areas than in urban areas.

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Section: Discussioncontrasting

confidence: 43%

Dispatcher-Assisted Cardiopulmonary Resuscitation: Disparity between Urban and Rural Areas

Chen

et al. 2020

Emergency Medicine International

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“…However, other studies have reported that DA-CPR provision is not correlated with a significant improvement in the survival to discharge rate in a real-world setting and that the current dispatch performance is below the proposed national standards [28]. These findings were consistent with those of another observational study showing negative associations between DA-CPR and outcomes, including ROSC, survival to discharge, and neurological recovery [29]. Furthermore, a review reported conflicting results concerning the survival to discharge between DA-CPR and BCPR [30].…”

Section: Discussionsupporting

confidence: 82%

Effectiveness of bystander cardiopulmonary resuscitation in improving the survival and neurological recovery of patients with out-of-hospital cardiac arrest: A nationwide patient cohort study

Lee

et al. 2020

PLoS ONE

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Introduction Few studies have focused on enhancing causality and yielding unbiased estimates on the effectiveness of bystander cardiopulmonary resuscitation (BCPR) on the outcomes of out-of-hospital cardiac arrest (OHCA) in a real-world setting. Therefore, this study evaluated the effect of BCPR on the outcomes of OHCA and its differences according to the characteristics of OHCA. Methods This study enrolled all patients with OHCA of cardiac etiology treated by emergency medical services (EMS) in Korea from 2012 to 2015. The endpoints were survival and neurological recovery at discharge, and the main exposure was BCPR conducted by a layperson. The effect of BCPR was analyzed after adjusting for confounders, determined using a directed acyclic graph, by inverse probability of treatment weighting (IPTW) and model-based standardization (STR). Moreover, differences in subgroups and time trends were evaluated. Results Among 10,505 eligible patients after excluding those with missing data on BCPR, 7,721 patients received BCPR, accounting for 74.3% of EMS-treated OHCA patients. BCPR increased the odds of survival and good neurological recovery at discharge by 1.67- (95% confidence interval (CI): 1.44–1.93) and 1.93- (95% CI: 1.56–2.39) fold, respectively, in the IPTW analysis. These findings were comparable to those obtained with STR. The odds ratios were 2.39 (95% CI: 1.91–2.94) and 2.70 (95% CI: 1.94–3.41), respectively, in the sensitivity analysis of the missing BCPR information considering confounders and the outcome variable. However, the effect of qualified BCPR was not evenly distributed, and it did not increase with time. BCPR was likely to be more effective in male patients aged <65 years, those who experienced an OHCA in a private place or non-capital region, and those with shockable rhythm at the scene. Conclusion Based on data from a nationwide registry, the estimated effect of BCPR on survival and neurological recovery was moderate and did not improve from 2012 to 2015.

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“…This study underscored that bystander CPR with or without DA had similar effects on increasing neurologically favorable outcome after OHCA. Previous studies showed bystander CPR without DA has a better outcome compared with bystander CPR with DA, [17][18][19] whereas, in other studies, bystander CPR with DA has the same or better effects than bystander CPR without DA. 10,20,21) Thus, the effect of bystander CPR with DA and without DA remains controversial.…”

Section: Discussionmentioning

confidence: 84%

Impact of Bystander Cardiopulmonary Resuscitation and Dispatcher Assistance on Survival After Out-of-Hospital Cardiac Arrest Among Adult Patients by Location of Arrest

et al. 2020

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We investigated the impact of bystander-initiated cardiopulmonary resuscitation (CPR), dispatcher assistance (DA), and location of arrest on survival and outcomes after out-of-hospital cardiac arrest (OHCA). From a nationwide population-based registry of OHCA patients in Japan, we enrolled adult patients with bystander-witnessed OHCA of medical origin between 2013 and 2015. The primary outcome measure was a neurologically favorable outcome, defined by cerebral performance category 1 or 2. Multivariable logistic regression analysis was used to assess the effects of bystander CPR and DA by location of arrest. A total of 104,621 cases were included (15,984 bystander CPR without DA [15.3%], 40,087 bystander CPR with DA [38.3%], and 48,550 no bystander CPR [46.4%]). In public locations, both the bystander-CPR-with-DA group (22.9% [1,068/4,665]; adjusted odds ratio (AOR), 1.62; 95% confidence interval (CI), 1.43-1.85) and the bystander-CPR-without-DA group (25.8% [918/3,557]; AOR, 1.43; 95% CI, 1.24-1.65) had neurologically favorable outcomes compared with the no-bystander-CPR group (9.9% [610/6,133]). In residential locations, the AORs were 1.44 (95% CI, 1.22-1.70) in the bystander-CPR-without-DA group and 1.60 (95% CI, 1.45-1.77) in the bystander-CPR-with-DA group. However, in nursing homes, bystander CPR was not associated with improved outcomes of OHCA, regardless of the implementation of DA. Bystander CPR with or without DA had better outcomes after OHCA in residential and public locations but not in nursing homes.

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Dispatcher-assisted bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest

Cited by 17 publications

References 28 publications

Dispatcher-Assisted Cardiopulmonary Resuscitation: Disparity between Urban and Rural Areas

Dispatcher-Assisted Cardiopulmonary Resuscitation: Disparity between Urban and Rural Areas

Effectiveness of bystander cardiopulmonary resuscitation in improving the survival and neurological recovery of patients with out-of-hospital cardiac arrest: A nationwide patient cohort study

Impact of Bystander Cardiopulmonary Resuscitation and Dispatcher Assistance on Survival After Out-of-Hospital Cardiac Arrest Among Adult Patients by Location of Arrest

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