Abstract
Aim: To assess the benefit of immediate call-first or CPR-first basic life support (BLS) in promoting a better outcome of out-of-hospital cardiac arrest (OHCA). Methods: From the nation-wide database of 2005 to 2012, we extracted bystander-witnessed OHCAs in which both emergency call and CPR were performed by bystanders on their own initiative (without instruction over telephone) within 6 min of witnessing patient collapse. These cases were categorized into the following four groups; immediate Call+CPR group (N=10,195 ,emergency call and/or CPR within 2 min of witness, call-CPR time interval = 0 or 1 min), immediate Call-First group (N=1,820 , emergency call within 2 min of witness, call-CPR interval = 2[[Unable to Display Character: &#8210;]]4 min), immediate CPR-First group (N=5,446 , bystander CPR within 2 min of witness, CPR-call interval =2[[Unable to Display Character: &#8210;]]4 min), the delayed Call/CPR group (N=4,671, the remaining cases). We compared the rates of neurologically favorable survival at 1-month among the four groups for all OHCAs and subgroups of OHCAs. Results: The overall survival rate was highest in Call-First group and lowest in delayed Call/CPR group (Figure). The rate of Call-First group was significantly higher than that of CPR-First group in OHCAs of presumed cardiac etiology (17.2% vs. 14.1%, unadjusted OR; 95% CI, 1.26; 1.05[[Unable to Display Character: &#8210;]]1.52). The rate of CPR-First group was significantly higher than that of Call-First group in OHCAs of presumed non-cardiac etiology (7.7% vs. 5.0%, 1.59; 1.11[[Unable to Display Character: &#8210;]]2.33) and young adults/children (age<35y, 32.8% vs. 17.8%, 2.25; 1.33[[Unable to Display Character: &#8210;]]3.95). Multiple logistic regression analysis confirmed the results of univariate analyses and disclosed that delayed Call/CPR is associated with poor outcomes. Conclusions: The immediate (within 2 min) CPR-first BLS action followed by emergency call without a large (>4 min) delay may be recommended when a single bystander having a fundamental skill to initiate CPR witnesses OHCAs of non-cardiac etiology and young adults/children.
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