Abstract
Methods Patients with out-of-hospital cardiac arrest (OHCA) were prospectively registered in Taichung. The 29 districts of Taichung city were divided into urban and rural areas based on whether the population density is more than 1,000 people per square kilometer. Prehospital data were collected according to the Utstein-style template, and telephone auditory records were collected by a dispatch center. Results 2,716 patients were enrolled during the study period. 88.4% OHCA occurred in urban areas and 11.6% in rural areas. 74.9% after dispatcher assistance, laypersons performed CPR in urban areas and 67.7% in rural areas (p=0.023). The proportion of laypersons continued CPR until an emergency medical technician's (EMT) arrival was higher in the urban areas (59.57% vs 52.27%, p=0.039). Laypersons continued CPR until an EMT' arrival would increase the chance of return of spontaneous circulation in urban and rural areas, with adjusted odds ratio (aOR) of 1.02, 95% confidence interval (CI) of 0.82–1.27, and aOR of 1.49, 95% CI of 0.80–2.80, respectively. Continued laypersons CPR until the EMT' arrival also improved survival with favorable neurological function, with aOR of 1.16, 95% CI of 0.61–2.20 in urban areas and aOR of 2.90 95% CI of 0.18–46.81 in rural areas. Conclusion Bystanders in urban areas exhibited higher ratio of acceptance of DACPR. However, after DACPR intervention, prognosis improvement was considerably higher in rural areas than in urban areas.
Highlights
400,000 cases of out-of-hospital cardiac arrest (OHCA) occur in the United States each year, which accounts for 13.5% of the total mortality rate. e incidence of OHCA has been increasing each year [1]
In Chicago, after establishing integrated resuscitation systems of care, the bystander cardiopulmonary resuscitation (CPR) rate increased from 11.6% to 19.4%, the return of spontaneous circulation (ROSC) rate increased from 28.6% to 36.9%, and the overall survival rate improved from 7.3% to 9.9% [9]
We explored the urban–rural gap of dispatcher-assisted cardiopulmonary resuscitation (DACPR) from a single dispatch center. e DACPR execution rate was higher in urban areas than in rural areas. e study showed that patients with OHCA may have superior prognosis if they receive continued DACPR until the emergency medical technician (EMT)’ arrival in rural areas
Summary
400,000 cases of out-of-hospital cardiac arrest (OHCA) occur in the United States each year, which accounts for 13.5% of the total mortality rate. e incidence of OHCA has been increasing each year [1]. Recognition of OHCA, early bystander cardiopulmonary resuscitation (CPR), and automated external defibrillation (AED) have substantial effects on survival rates and neurological outcomes in patients with OHCA [1,2,3]. E survival rates of patients with OHCA have gradually increased recently through the promotion of the resuscitation training program, simplified CPR process, improved CPR quality by laypersons, and willingness [4]. Dispatcher-assisted CPR (DACPR) encourages laypersons to perform CPR [1, 7, 8]. DACPR has been deemed as an effective method for encouraging laypersons to perform CPR early and improve patient survival [10, 11]
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