Comparison of the effects of audio-instructed and video-instructed dispatcher-assisted cardiopulmonary resuscitation on resuscitation outcomes after out-of-hospital cardiac arrest

Abstract

BackgroundThis study compared the real-world effects of audio-instructed dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) and video-instructed DA-CPR on resuscitation outcomes after out-of-hospital cardiac arrest (OHCA). MethodsA retrospective cohort study was conducted among adult OHCA patients in whom resuscitation was attempted in 2017 in Seoul, Korea. The dispatch center of Seoul introduced video-instructed DA-CPR in 2017, whereas audio-instructed DA-CPR was first implemented in 2010. When more than two bystanders were at the scene and could handle a video-call, the dispatcher call back a video-call and provided CPR instructions. In other situations, standard audio-instructed DA-CPR was provided. The primary outcome was survival to discharge. The secondary outcome was good neurological outcome at hospital discharge. The tertiary outcome was early instruction time interval (ITI, time from call to the initiation of CPR instruction ≤90 s). The study outcomes of audio-instructed DA-CPR (audio group) and video-instructed DA-CPR (video group) were compared. The propensity score matching (PSM) method was used to increase the comparability of the two groups and the logistic regression was performed for the PSM cohort. ResultsA total of 1720 eligible OHCA patients (1489 and 231 in the audio and video groups, respectively) were evaluated. The median ITI was 136 s in the audio group and 122 s in the video group (p = 0.12). The survival to discharge rates were 8.9% in the audio group and 14.3% in the video groups (p < 0.01). Good neurological outcome occurred in 5.8% and 10.4% in the audio and video groups, respectively (p < 0.01). Compared to the audio group, the AORs (95% CIs) for survival to discharge, good neurological outcome and early ITI of the video group were 1.20 (0.74–1.94), 1.28 (0.73–2.26) and 1.00 (0.70–1.43), respectively. The PSM population showed similar results as those of the original cohort. ConclusionCompared to audio-instructed DA-CPR, video-instructed DA-CPR was not associated with survival improvement in this observational study conducted in one metropolitan city. Randomized controlled trials are needed to compare the effects of video- and audio-instructed DA-CPR.