Abstract
BackgroundPerforming high-quality bystander cardiopulmonary resuscitation (CPR) improves the clinical outcomes of victims with sudden cardiac arrest. Thus far, no systematic review has been performed to identify interventions associated with improved bystander CPR quality.MethodsWe searched Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, Ovid PsycInfo, Thomson Reuters SCI-EXPANDED, and the Cochrane Central Register of Controlled Trials to retrieve studies published from 1 January 1966 to 5 October 2018 associated with interventions that could improve the quality of bystander CPR. Data regarding participant characteristics, interventions, and design and outcomes of included studies were extracted.ResultsOf the initially identified 2,703 studies, 42 were included. Of these, 32 were randomized controlled trials. Participants included adults, high school students, and university students with non-medical professional majors. Interventions improving bystander CPR quality included telephone dispatcher-assisted CPR (DA-CPR) with simplified or more concrete instructions, compression-only CPR, and other on-scene interventions, such as four-hand CPR for elderly rescuers, kneel on opposite sides for two-person CPR, and CPR with heels for a tired rescuer. Devices providing real-time feedback and mobile devices containing CPR applications or software were also found to be beneficial in improving the quality of bystander CPR. However, using mobile devices for improving CPR quality or for assisting DA-CPR might cause rescuers to delay starting CPR.ConclusionsTo further improve the clinical outcomes of victims with cardiac arrest, these effective interventions may be included in the guidelines for bystander CPR.
Highlights
Sudden cardiac arrest (SCA) poses a significant threat to our community in the industrialized world and is responsible for 420,000 and 275,000 deaths per year in the US and Europe, respectively [1,2]
To further improve the clinical outcomes of victims with cardiac arrest, these effective interventions may be included in the guidelines for bystander cardiopulmonary resuscitation (CPR)
The reasons for exclusion included papers that were not in English (9), review articles (19), those included participants who were not laypersons (37), publication types that do not meet the inclusion criteria (26), and those articles with outcomes which were not CPR quality parameters considered in this study (19)
Summary
Sudden cardiac arrest (SCA) poses a significant threat to our community in the industrialized world and is responsible for 420,000 and 275,000 deaths per year in the US and Europe, respectively [1,2]. It has been proved that bystander cardiopulmonary resuscitation (CPR) improves the survival rate of victims with SCA [3]. Dispatcherassisted CPR programs had been shown to increase bystander CPR rates and the clinical outcomes of victims with SCA [4,5], and were recommended to be integrated into the system of care for prehospital cardiac arrest [6,7,8]. The aim of our study was to perform a systematic review to identify interventions that could improve the quality of bystander CPR. Performing high-quality bystander cardiopulmonary resuscitation (CPR) improves the clinical outcomes of victims with sudden cardiac arrest. No systematic review has been performed to identify interventions associated with improved bystander CPR quality.
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