Abstract 20: Bystander Cardiopulmonary Resuscitation with Chest Compressions Only According to Dispatcher Telephone Instruction Status

Abstract

BACKGROUND The 2010 AHA guidelines for cardiopulmonary (CPR) recommended that untrained lay rescuers should continue chest compression-only CPR under dispatcher-telephone CPR instruction and trained lay rescuers should continue conventional CPR if he or she is able to perform rescue breaths. We assessed the effect of bystander CPR according to dispatcher-telephone CPR instruction status. METHODS From the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest, we extracted the adult patients with bystander-witnessed out-of hospital cardiac arrest due to cardiac etiology, and divided into groups according to the dispatcher-telephone CPR instruction status, inclusive of CPR techniques. The primary endpoint was 30-day favorable neurological outcome after cardiac arrest. RESULTS Of the 113,624 patients who met the inclusion criteria, 45,565 received dispatcher-telephone CPR instruction and 68,059 did not. Higher proportions in the instruction group than in the no instruction group were the performance of bystander CPR (chest-compression only CPR or conventional CPR) (68% [30,929/45,565] vs. 31% [20,900/68,059], p<0.0001), especially that of chest-compression only CPR (46.2% [21,032/45,565] vs. 17.0% [11,541/68,059], p<0.0001). Although frequencies of 30-day favorable neurological outcome in the instruction group were significantly lower than in the no instruction group for the whole cohorts (4.8% vs. 5.5%, p<0.0001) and the subgroups of patients receiving bystander CPR (5.7% vs. 7.8%, p<0.0001), chest-compression only CPR was equivalent or superior to conventional CPR in each group in terms of neurological benefit (5.7% vs. 5.9% in the instruction group, p=0.57, and 8.2% vs. 7.3% in the no instruction group, p=0.03). Among patents receiving bystander CPR, adjusted odds ratios of favorable neurological outcome were 1.2 (95% CI; 1.1 to 1.3) after no instruction group, and 1.1 (1.0 to 1.2) after chest-compression only CPR. CONCLUSIONS Bystander chest-compression only CPR was not inferior to conventional CPR in terms of neurological benefits, and dispatcher-telephone CPR instruction increased the performance rate of chest-compression only CPR.