Rationale, Methodology, and Implementation of a Dispatcher-assisted Cardiopulmonary Resuscitation Trial in the Asia-Pacific (Pan-Asian Resuscitation Outcomes Study Phase 2)

Abstract

Background. Survival outcomes from out-of-hospital cardiac arrest (OHCA) in Asia are poor (2-11%). Bystander cardiopulmonary resuscitation (CPR) rates are relatively low in Asia. Dispatcher-assisted CPR (DA-CPR) has recently emerged as a potentially cost-effective intervention to increase bystander CPR and survival from OHCA. The Pan-Asian Resuscitation Outcomes Study (PAROS), an Asia-Pacific cardiac arrest registry, was set up in 2009, with the aim of understanding OHCA as a disease in Asia and improving OHCA survival. The network has adopted DA-CPR as part of its strategy to improve OHCA survival. Objective. This article aims to describe the conceptualization, study design, potential benefits, and difficulties for implementation of DA-CPR trial in the Asia-Pacific. Methods. Two levels of intervention, basic and comprehensive, will be offered to PAROS participating sites. The basic level consists of implementation of a DA-CPR protocol and training program, while the comprehensive level consists of implementation of the basic level, with the addition of a dispatch quality measurement tool, quality improvement program, and community education program. Sites that are not able to implement the package will contribute control data. The primary outcome of the study is survival to hospital discharge or survival to 30 days post cardiac arrest. DA-CPR and bystander CPR are secondary outcomes. Conclusion. Implementation of DA-CPR requires concerted efforts by EMS leaders and supervisors, dispatchers, hospital stakeholders, policy makers, and the general public. The DA-CPR trial implemented by the PAROS sites, if successful, can serve as a model for other countries considering such an intervention in their EMS systems.

Performance of cardiopulmonary resuscitation during prolonged basic life support in military medical university students: A manikin study

“…Even though CPR performed by layperson bystanders improves the odds of survival from OHCA, only about 4.5%%-22.9% of victims received bystander CPR in Asia. [21,30] The rate was lower than that (28%-46%) of bystander CPR in America and Europe. [31][32][33] Barriers for implementation of bystander CPR include fear of possible harm to victims, concern for incorrect or poor CPR, legal liability, etc.…”

Emergency medical services key performance measurement in Asian cities

“…Some of the survey forms were handed to the participating members by hand during the annual PAROS meetings held in various cities within Asia. Some of the data was obtained from the previous publications within the PAROS group that is adopted from cardiac arrest registry to enhance survival (CARES) study based in the USA [ 18 , 19 ]. Twenty-four variables were assessed and compared, all of which were derived by consensus across the PAROS countries.…”

Emergency medical dispatch services across Pan-Asian countries: a web-based survey

“…The increase in number of DS's that have implemented DACPR compared to 2012 may also be attributed to Phase 2 of the PAROS study [19]. This study involved the introduction of a bundle of care to the participating PAROS dispatch services that included the implementation of a DACPR protocol and training program.…”