Abstract
BackgroundThe International Liaison Committee on Resuscitation recommends that dispatchers provide instructions to perform compression-only cardiopulmonary resuscitation (CPR) to callers responding to adults with out-of-hospital cardiac arrest (OHCA). This study aimed to determine the optimal dispatcher-assisted CPR (DA-CPR) instructions for OHCA.MethodsWe analysed the records of 24,947 adult patients (aged ≥ 18 years) who received bystander DA-CPR after bystander-witnessed OHCA. Data were obtained from a prospectively recorded Japanese nationwide Utstein-style database for a 2-year period (2016–2017). Patients were divided into compression-only DA-CPR (n = 22,778) and conventional DA-CPR (with a compression-to-ventilation ratio of 30:2, n = 2169) groups. The primary outcome measure was 1-month neurological intact survival, defined as a cerebral performance category score of 1–2 (CPC 1–2).ResultsThe 1-month CPC 1–2 rate was significantly higher in the conventional DA-CPR group than in the compression-only DA-CPR group (before propensity score (PS) matching, 7.5% [162/2169] versus 5.8% [1309/22778], p < 0.01; after PS matching, 7.5% (162/2169) versus 5.7% (123/2169), p < 0.05). Compared with compression-only DA-CPR, conventional DA-CPR was associated with increased odds of 1-month CPC 1–2 (before PS matching, adjusted odds ratio 1.39, 95% confidence interval [CI] 1.14–1.70, p < 0.01; after PS matching, adjusted odds ratio 1.34, 95% CI 1.00–1.79, p < 0.05).ConclusionWithin the limitations of this retrospective observational study, conventional DA-CPR with a compression-to-ventilation ratio of 30:2 was preferable to compression-only DA-CPR as an optimal DA-CPR instruction for coaching callers to perform bystander CPR for adult patients with bystander-witnessed OHCAs.
Highlights
The International Liaison Committee on Resuscitation recommends that dispatchers provide instructions to perform compression-only cardiopulmonary resuscitation (CPR) to callers responding to adults with out-ofhospital cardiac arrest (OHCA)
As an estimate of effect size and variability, we reported odds ratios (ORs) with 95% confidence intervals (CI)
Details of attempted resuscitations performed for 250,572 OHCA patients between 2016 and 2017 are documented in the database
Summary
The International Liaison Committee on Resuscitation recommends that dispatchers provide instructions to perform compression-only cardiopulmonary resuscitation (CPR) to callers responding to adults with out-ofhospital cardiac arrest (OHCA). A recent systematic review showed that DA-CPR is associated with improved outcomes compared with no bystander CPR in terms of survival with favourable neurological outcomes, survival to hospital discharge, and return of spontaneous circulation [5] Based on this evidence, the International Liaison Committee on Resuscitation (ILCOR) strongly recommends that dispatchers provide instructions to perform compression-only CPR without rescue breaths to callers for adults with suspected OHCA as a minimum if bystanders are untrained or unskilled in CPR [6]. There have been three randomised controlled trials (RCT) comparing compression-only CPR with conventional CPR (compression with rescue breaths) after instructions from EMS dispatchers to untrained bystanders [8,9,10] All these trials concluded that the overall survival rate was similar between compression-only CPR and conventional CPR groups. The optimal DA-CPR instructions for callers to perform bystander CPR for patients with OHCA before EMS arrival in the current era of 30:2 compression-toventilation ratio have not been fully investigated
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