Dispatcher-assisted Cardiopulmonary Resuscitation Research Articles

Online training to improve BLS performance with dispatcher assistance? Results of a cluster-randomised controlled simulation trial

BackgroundThe prognosis for patients improves significantly with effective cardiopulmonary resuscitation (CPR) performed by bystanders. Current research indicates that individuals who receive CPR from trained bystanders have a greater likelihood of survival compared to those who receive dispatcher-assisted CPR from untrained laypersons. This cluster-randomised controlled trial assessed the impact of a 30-min online training session prior to a simulated cardiac arrest situation with dispatcher-assisted CPR (DA-CPR) on enhancing Basic Life Support (BLS) performance.MethodsThis study was performed in 2018 in Hamburg, Germany. The primary outcome was the practical BLS skills of high school students in simulated out-of-hospital cardiac arrest scenarios with dispatcher assistance. The intervention group participants underwent a 30-min online BLS training session, while the control group did not receive an intervention. It was hypothesized that the average practical BLS scores of the intervention group would be 1.5 points higher than those of the control group.ResultsBLS assessments of 286 students of 16 different classes were analysed. The estimated mean BLS score in the intervention group was 7.60 points (95% CI: 6.76 to 8.44) compared to 6.81 (95% CI: 5.97 to 7.65) in the control group adjusted for BLS training and class. Therefore, the estimated mean difference between the groups was 0.79 (95% CI: -0.40 to 1.97) and not significantly different (p-value: 0.176). Based on a logistic regression analysis the intervention had only a significant effect on the chance to pass the item “vertically above the chest” (OR = 4.99; 95% CI: 1.46 to 17.12) adjusted for BLS training and class.ConclusionPrior online training exhibits beneficial impacts on the BLS performance of bystanders during DA-CPR. To maximise the effect size, online training should be incorporated into a set of interventions that are mutually complementary and specifically designed for the target participants.Trial registrationDRKS00033531. "Kann online Training Laien darauf vorbereiten Reanimationsmaßnahmen unter Anleitung der Leitstelle adäquat durchzuführen? " Registered on January 29, 2024.

Assessment of dispatch-assisted cardiopulmonary resuscitation performance during out-of- hospital cardiac arrest in a Tuscan emergency operation center: a retrospective study

Background: Time is the most crucial prognostic factor in out-of-hospital cardiac arrest (OHCA) owing to its clinical features. Dispatcher-assisted CPR (DA-CPR) by dispatch centers to a bystander calling for an ambulance, enabling even an inexperienced bystander to start CPR in 50% of cases and reducing the free therapy interval from chest compression to less than three minutes. Objectives: to assess the dispatch-assisted cardiopulmonary resuscitation performance during out-of-hospital cardiac arrest. Methods: a retrospective study was conducted at the Firenze-Prato Emergency Operation Centre to analyse data collected from all dispatch audio recordings of OHCA events that occurred between 1 January 2019 and 31 December 2020. Emergency calls lasting less than 60 s were excluded from the analysis, as this duration does not provide dispatchers with adequate time to accurately identify OHCA and provide pre-arrival instructions to the bystander.Results: A total of 1,267 OHCAs cases were included in this study, with 832 (65.7%) occurring in 2019 and 435 (34.3%) in 2020. Emergency nurses offered pre-arrival instructions in 272 cases (21.5%), with 160 cases in 2019 (19.2%) and 112 cases (25.7%) in 2020 (c2=7.19, p=0.007). These instructions were accepted by the caller in 9% (n=75) and 14% (n=61) of the cases, respectively (c2=7.48, p=0.006). OHCA events that could not be identified by telephone (therefore, DA-CPR was not possible) were 365 cases (43.9%) in 2019 and 175 cases (40.2%) in 2020 (c2=1.55, p=0.213). Conclusions: The adoption of a standardised protocol for delivering pre-arrival instructions, along with training programs focusing on OHCA and interview techniques, is strongly recommended based on the findings of our study. This was reinforced by the analysis of nighttime calls during which DA-CPR was not provided, including cases without clear justification.

Barriers to dispatcher-assisted cardiopulmonary resuscitation in Thailand

Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) has proven effective in boosting bystander CPR rates in out-of-hospital cardiac arrests (OHCA). Recently, Thailand has implemented a DA-CPR program. Our objective was to delineate the obstacles to initiating chest compressions by callers. Methods: We reviewed dispatch recordings of OHCA cases received by the ambulance call center from July 2012 to March 2015. Excluding audio recordings of subpar quality, trained evaluators documented the successive stages of the dispatcher's CPR recognition, delivery of CPR instructions, and the caller's execution of CPR. The time required to achieve these milestones was recorded, while barriers hindering chest compressions were identified. Results: Throughout the study period, researchers identified 280 cases of OHCA. Among these cases, it was observed that 134 bystanders declined to administer CPR. Reasons for refusal varied: 25.4% cited difficulty in controlling their emotions, 21.65% encountered challenges accessing the scene, 20.9% refused to perform CPR, 14.9% dropped out of the call, 9.7% did not approach the emergency patient, 5.9% were unable to perform CPR due to physical limitations, and 2.9% faced difficulty moving the emergency patient to the ground floor. Conclusions: Barriers were present in 47.85% correlating with a reduced proportion of CPR initiation and longer delays in CPR initiation.

Impact of pandemic-related movement restriction on public access defibrillation in Japan: a retrospective cohort study

ObjectivesTo analyse monthly changes in public access defibrillation (PAD) incidence and outcomes of out-of-hospital cardiac arrest (OHCA) during the 2020–2021 COVID-19 pandemic compared with those during the 2016–2019 prepandemic period...

A systematic review and meta-analysis of the impact of the pandemic on dispatcher-assisted cardiopulmonary resuscitation

A systematic review and meta-analysis of the impact of the pandemic on dispatcher-assisted cardiopulmonary resuscitation

Dispatchers trained in persuasive communication techniques improved the effectiveness of dispatcher-assisted cardiopulmonary resuscitation

BackgroundEarly recognition of cardiac arrest and early initiation of bystander cardiopulmonary resuscitation can increase the survival of patients with out-of-hospital cardiac arrest (OHCA). We compared dispatcher-assisted cardiopulmonary resuscitation (DACPR) effectiveness before and after using different communication models in the dispatching center. MethodWe analyzed dispatch recordings of non-trauma origin OHCA cases received by the Taichung dispatch center between May 1 to September 30, 2021, and November 1, 2021, to March 31, 2022. The dispatchers underwent an 8-hour training intervention consisting of targeted education using a new communication model for DACPR. Several outcome measures were evaluated, including the sustained return of spontaneous circulation and the time to first chest compression. ResultsWe included 640 cases in the preintervention group and 580 cases in the postintervention group. The return of spontaneous circulation (ROSC) rate, the time to first chest compression, and good neurological outcome were significantly improved in the postintervention group (20.9% vs. 31.0%, p < 0.001;168 seconds vs. 151 seconds, p = 0.004; 2.8% vs. 5.3%, p = 0.024, respectively). In subgroup analyses, the intervention was related to a statistical improvement in ROSC rate among patients whose caller was a family member (18.7% vs. 31.4%, p < 0.001). Among patients whose caller was female, both ROSC and good neurological outcome significantly improved after the intervention (19.8% vs. 36.6%, p < 0.001; 2.7% vs. 7.5%, p = 0.006, respectively). There was a statistical difference between the pre-intervention and post-intervention group with respect to ROSC rate among patients whose caller was family (the adjusted odds ratio:1.78, 95% CI: 0.59–1.25], p < 0.001.) or female (the adjusted odds ratio:3.18,95% CI: 1.77–5.70], p = 0.008.) in the multivariable regression model. ConclusionThe new communication model has enhanced the effectiveness of DACPR in terms of the ROSC rate, particularly when the caller was a family member or female, leading to improved rates of ROSC and favorable neurological outcomes.

Effects of Dispatcher-Assisted Public-Access Defibrillation Programs on the Outcomes of Out-of-Hospital Cardiac Arrest: A Before-and-After Study.

Public access defibrillation (PAD) programs have been implemented globally over the past decade. Although PAD can substantially increase the survival of cardiac arrest, PAD use remains low. This study aimed to evaluate whether drawing upon the successful experiences of dispatcher-assisted cardiopulmonary resuscitation programs would increase the use of PAD in dispatcher-assisted PAD programs. This study using a before-and-after design was conducted in Taoyuan City using a local out-of-hospital cardiac arrest registry system and data of dispatcher performance derived from audio recordings. The primary outcomes were the rate of bystander PAD use, sustained return of spontaneous circulation, survival to discharge, and favorable neurological outcomes. The secondary outcomes were the performance of dispatchers in terms of PAD instruction and dispatcher-assisted cardiopulmonary resuscitation administration, the time interval indicators of dispatcher-assisted cardiopulmonary resuscitation. A total of 1159 patients were included and divided into 2 groups: the before-run-in group (502 patients) and the after-run-in group (657 patients). No significant difference was observed between the 2 groups in terms of baseline characteristics. The rate of PAD use in the after-run-in group significantly increased from 5.0% to8.7% (P=0.015). The rate of favorable neurological outcomes increased from 4.4% to 5.9%, which was not a statistically significant difference. Compared with the before-run-in group, the rate of successful automated external defibrillator acquisition was 13.5% in the after-run-in group (P<0.001). Implementing a dispatcher-assisted PAD protocol in a municipality setting significantly increased bystander PAD use without affecting dispatcher performance in out-of-hospital cardiac arrest recognition, cardiopulmonary resuscitation instruction, or dispatcher-assisted cardiopulmonary resuscitation time indicators.

Effectiveness of a dispatcher-assisted CPR using an animated image: Simulation study

IntroductionConsidering the few studies evaluating bystander cardiopulmonary resuscitation (CPR) performance, we sought to analyze differences in bystander CPR performance with and without the use of our self-developed animated GIFs based on dispatcher-assisted CPR simulation. MethodsA total of 80 adults who had not received CPR training over the past two years participated in the study. Among them, 40 people were classified into the auditory group (receiving CPR instructions only over the phone), and the other 40 people were classified into the audiovisual group (receiving CPR instructions over the phone after receiving images on a smartphone). All participants were asked to perform adult and infant CPR for 2 min. CPR performance was recorded using two video cameras (front and side) and analyzed by two emergency physicians, whereas CPR quality was measured using Resusci Anne & Baby QCPR Mk II (Laerdal). ResultsIn the adult CPR study, the audiovisual group had higher performance scores for adequacy of “knee position,” “hand posture,” “elbow extension,” and “vertical compression,” as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). No significant difference in CPR quality was observed between the two groups. In the infant CPR study, audiovisual group had higher performance scores in adequacy of “compression site,” “finger posture,” and “vertical compression,” as well as higher Standard Posture Completeness and Instruction Performance scores (p < 0.001). Regarding CPR quality, the audiovisual group had higher scores for “adequate compression rate ratio” (p = 0.047). ConclusionAudiovisual guidance using animated GIFs more effectively improved CPR Standard Posture Completeness and Instruction Performance than did traditional auditory guidance.

Outline and validation of a new dispatcher-assisted cardiopulmonary resuscitation educational bundle using the Delphi method

AimDispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is time-dependent. To date, evidence-based training programmes for dispatchers are lacking. This study aimed to reach expert consensus on an educational bundle content for dispatchers to provide DA-CPR using the Delphi method. MethodAn educational bundle was created by the Swedish Resuscitation Council consisting of three parts: e-learning on DA-CPR, basic life support training and audit of emergency out-of-hospital cardiac arrest calls. Thereafter, a two-round modified Delphi study was conducted between November 2022 and March 2023; 37 experts with broad clinical and/or scientific knowledge of DA-CPR were invited. In the first round, the experts participated in the e-learning module and answered a questionnaire with 13 closed and open questions, whereafter the e-learning part of the bundle was revised. In the second round, the revised e-learning part was evaluated using Likert scores (20 items). The predefined consensus level was set at 80%. ResultsDelphi rounds one and two were assessed by 20 and 18 of the invited experts, respectively. In round one, 18 experts (18 of 20, 90%) stated that they did not miss any content in the programme. In round two, the scale-level content validity index based on the average method (S-CVI/AVE, 0.99) and scale-level content validity index based on universal agreement (S-CVI/UA, 0.85) exceeded the threshold level of 80%. ConclusionExpert consensus on the educational bundle content was reached using the Delphi method. Further work is required to evaluate its effect in real-world out-of-hospital cardiac arrest calls.

Identifying the Barriers to Performing Dispatcher-assisted Bystander Cardiopulmonary Resuscitation in Out-of-hospital Cardiac Arrest

Background: Bystander cardiopulmonary resuscitation (BCPR) is critical for the survival of patients with out-of-hospital cardiac arrest (OHCA). This study aims to identify barriers to performing dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) in patients with OHCA. Materials and Methods: This cross-sectional study was conducted on bystanders of 151 patients with OHCA who received emergency medical services (EMS) from June 2022 to June 2023 in Neyshabur City, Iran. The study data were collected using a questionnaire and telephone interviews. Data were analyzed using the chi-square test and Fisher exact test. P&lt;0.05 was considered statistically significant for all tests. Analyses were done using R software, version 4.0.1. Results: Of 151 patients, 18.92% were less than 50 years old and 68.92% were male. In 69% of cases, the arrival time of EMS was less than 10 min, and 84.46% of patients received BCPR at the scene. The most common barrier to performing DA-BCPR was “not recognizing a cardiac arrest and how to perform cardiopulmonary resuscitation (CPR)” (41.48%). It was reported that 38.35% of the bystanders were familiar with CPR. There was a significant relationship between the bystanders’ familiarity with CPR and performing DA-BCPR (P&lt;0.01). Conclusion: The most common barrier to performing DA-BCPR on patients with OHCA is the lack of knowledge and skills in bystanders. Improving bystanders’ knowledge and educating them about cardiac arrest, CPR, and DA-BCPR is critical to help them improve outcomes for OHCA patients.

Is dispatcher-assisted cardiopulmonary resuscitation affected by a bystander’s emotional stress state in out-of-hospital cardiac arrest?

AimThe study aimed to investigate whether a bystander’s emotional stress state affects dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) in out-of-hospital cardiac arrest (OHCA). The primary outcome was initiation of chest compressions (Yes/No). Secondarily we analysed time until chest compressions were initiated and assessed how dispatchers instructed CPR.MethodThe study was a retrospective, observational study of OHCA emergency calls from the Capital Region of Denmark. Recorded calls were evaluated by five observers using a pre-defined code catalogue regarding the variables wished investigated.ResultsIncluded were 655 OHCA emergency calls, of which 211 callers were defined as emotionally stressed. When cardiac arrest was recognized, chest compressions were initiated in, respectively, 76.8% of cases with an emotionally stressed caller and 73.9% in cases with a not emotionally stressed caller (2.18 (0.80–7.64)). Cases with an emotionally stressed caller had a longer time until chest compressions were initiated compared to cases with a not emotionally stressed caller, however non-significant (164 s. vs. 146 s.; P = 0.145). The dispatchers were significantly more likely to be encouraging and motivating, and to instruct on speed and depth of chest compressions in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller (1.64 (1.07–2.56); 1.78 (1.13–2.88)). Barriers to CPR were significantly more often reported in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller (1.83 (1.32–2.56)).ConclusionThere was no significant difference in initiation of chest compressions or in time until initiation of chest compressions in the two groups. However, the dispatchers were overall more encouraging and motivating, and likely to instruct on speed and depth of chest compressions when the caller was emotionally stressed. Furthermore, barriers to CPR were more often reported in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller.Trial registrationWe applied for ethical approval from The Danish National Committee on Health Research Ethics, but formal approval was waived. We received permission for storage of data and to use these for research of OHCAs in the Capital Region of Denmark by Danish Data Protection Agency (P-2021-670) and Danish Health Authorities (R-2,005,114). The study is registered at ClinicalTrials (NTC05113706).

Temporal trends in neurologically intact survival after paediatric out-of-hospital cardiac arrest: a nationwide population-based observational study in Japan

Abstract Background/Introduction Out-of-hospital cardiac arrest (OHCA) in children is associated with poor outcomes. However, the temporal trends in survival, especially neurologically intact survival in paediatric patients with OHCA, remain unclear. Purpose To examine temporal trends in neurologically intact survival in paediatric patients with OHCA for over 16 years. Methods We reviewed the data of 27,202 children (age &amp;lt;18 years) who experienced OHCA and were treated by emergency medical service providers. Data were obtained from the All-Japan Utstein Registry from January 2005 to December 2020. We analysed the temporal trends in the 1-month neurologically intact survival (cerebral performance category scale 1 or 2: CPC 1–2) rate over time. Subgroup analyses for outcomes were performed by type of bystander cardiopulmonary resuscitation (CPR), dispatcher-assisted CPR, age group (infant [&amp;lt;1 year], child [1–11 years], adolescent [12–17 years]), witnessed status, and cause of arrest. The primary endpoint was the 1-month neurologically intact survival. Results The frequency of bystander CPR significantly increased from 50.0% in 2005 to 63.1% in 2020 and the frequency of dispatcher-assisted chest compression-only CPR (CC-CPR) significantly increased from 7.7% to 40.6% (both p for trend &amp;lt;0.0001). The rate of initial shockable rhythm significantly decreased from 5.0% to 3.4% (p for trend &amp;lt;0.0001). The multivariate logistic regression model showed that calendar year, age, witnessed arrest, presence of bystander CPR, initial shockable rhythm, and non-cardiac causes were associated with increased odds of CPC 1–2. The overall crude rates of 1-month CPC 1–2 significantly increased from 4.9% in 2005 to 11.0% in 2020 (p for trend &amp;lt;0.0001). In patients who received standard CPR with rescue breathing and CC-CPR, the 1-month CPC 1–2 rate significantly increased from 8.0% to 24.2% and 4.7% to 10.8% (p for trend &amp;lt;0.0001), respectively. The rate of CPC 1–2 in patients who underwent dispatcher-assisted CPR also increased from 4.4% to 9.2% (p for trend &amp;lt;0.0001). With regards to patient age groups, the rate of 1-month CPC 1–2 significantly increased from 2.4% in 2005 to 7.5% in 2020 for infants, 6.0% to 14.8% for children, and 6.5% to 11.4% for adolescents (all p for trend &amp;lt;0.0001). For witnessed arrest, the rate of 1-month CPC 1–2 significantly increased from 9.9% to 24.9% for witnessed arrest and 2.7% to 3.1% for unwitnessed arrest. The rate of 1-month CPC 1–2 significantly increased from 4.9% to 13.8% for presumed cardiac causes and 5.0% to 9.6% for non-cardiac causes. Conclusions The 1-month neurologically intact survival rate significantly increased from 2005 to 2020 for paediatric patients with OHCA in Japan, regardless of bystander CPR type, age, witnessed status, and cause of arrest. A frequency of dispatcher-assisted CC-CPR rate increase of almost five-fold over time was associated with a two-fold increase in the overall 1-month CPC 1–2 rate over time.

378 Dispatcher-assisted cardiopulmonary resuscitation for traumatic cardiac arrest

378 Dispatcher-assisted cardiopulmonary resuscitation for traumatic cardiac arrest

Telephone cardiopulmonary resuscitation, first responder systems, cardiac arrest centers, and global campaigns to save lives.

The latest resuscitation guidelines contain a new chapter, which focuses on systems improving care for patients with out-of-hospital cardiac arrest (OHCA). In this article, we describe recent developments regarding telephone cardiopulmonary resuscitation (CPR), first responder systems, cardiac arrest centers, and global campaigns. Telephone CPR has been implemented in many countries, and recent developments include artificial intelligence and video calls to improve dispatch assisted CPR. However, the degree of implementation is not yet satisfying. Smartphone alerting systems are effective in reducing the resuscitation-free interval, but many regions do not yet use this technology. Further improvements are needed to reduce response times. Cardiac arrest centers increase the survival chance after OHCA. Specific criteria need to be defined and professional societies should establish a certification process. Global campaigns are effective in reaching people around the world. However, we need to evaluate the effects of the campaigns. Telephone CPR, first responder systems, cardiac arrest centers, and global campaigns are highlighted in the recent resuscitation guidelines. However, the degree of implementation is not yet sufficient. We do not only need to implement these measures, but we should also aim to monitor the systems regarding their performance and further improve them.

201 Difference of Dispatcher-Assisted Cardiopulmonary Resuscitation in Private Homes Versus Public Locations Among Patients Following Out-of-Hospital Cardiac Arrest

201 Difference of Dispatcher-Assisted Cardiopulmonary Resuscitation in Private Homes Versus Public Locations Among Patients Following Out-of-Hospital Cardiac Arrest

Enhancing the detection of out-of-hospital cardiac arrest: a study of emergency medical system in Thailand

Background: Globally, survival rates for out-of-hospital cardiac arrest remain low. Implementing a dispatch-assisted cardiopulmonary resuscitation protocol in evolving emergency medical services systems has shown potential for improving OHCA detection and reducing the time to initiate chest compressions. Methods: In this study, audio recordings of OHCA emergency calls from different regions of Thailand were analyzed from January 2021 to December 2021. The study aimed to assess OHCA detection efficiency and provide CPR recommendations, including OHCA discrimination rates, time from call initiation to OHCA identification, and time to start CPR following dispatcher guidance. Results: There were 280 OHCA cases, with 170 (60.7%) successfully identified and excluded by dispatchers. OHCA detection took an average of 39 seconds (compared to a benchmark of 60 seconds), while the mean time from notification to chest compression initiation was 298 seconds (compared to a benchmark of 220 seconds). However, OHCA discrimination and phone-based resuscitation advice were highly sensitive (81.18%), accurate (85.72%), and specific (92.73%). Conclusions: OHCA presents challenges, with the need for faster CPR initiation. Improving reporting processes, enhancing caller understanding, and refining dispatcher skills are crucial to enhance OHCA detection and DA-CPR, ultimately improving survival rates.

Incidence, process of care, and outcomes of out-of-hospital cardiac arrest in China: a prospective study of the BASIC-OHCA registry

Out-of-hospital cardiac arrest (OHCA) is an important global public health issue, but its epidemiology and outcomes in low-income and middle-income countries remain largely unknown. We aim to comprehensively describe the incidence, process of care, and outcomes of OHCA in China. In the prospective, multicentre, population-based Baseline Investigation of Out-of-hospital Cardiac Arrest (BASIC-OHCA) registry study, participating sites were selected from both urban and rural areas in all seven geographical regions across China. All patients with OHCA assessed by emergency medical service (EMS) staff were consecutively enrolled from Aug 1, 2019, to Dec 31, 2020. Patients with suspected cardiac arrest assessed by bystanders whose return of spontaneous circulation was achieved without the need for defibrillation or EMS personnel cardiopulmonary resuscitation were excluded. Patients with all key variables missing were excluded, including resuscitation attempt, age, sex, witnessed status, cause, all process of care indicators, and all outcome measures. In this analysis, we included data for EMS agencies serving 25 monitoring sites (20 urban and five rural) that included the entire serving population, data for the whole of 2020, and at least 50 OHCA patients in 2020. Data were collected and reported using the Utstein template. We calculated the crude incidence of EMS-assessed OHCA in 2020. We also report data on baseline characteristics (including sex, cause, location of OHCA, and presence of shockable rhythm), process of care (including EMS response time, cardiopulmonary resuscitation, defibrillation, and advanced life support), and outcomes of non-traumatic OHCA between Aug 1, 2019, and Dec 31, 2020, including survival and survival with favourable neurological outcomes at discharge or 30 days, and at 6 and 12 months. Of 115·1 million people served by the 25 participating sites, 132 262 EMS-assessed patients with OHCA were enrolled, and resuscitation was attempted for 42 054 (31·8%) patients between Aug 1, 2019, and Dec 31, 2020. The crude incidence of EMS-assessed OHCA was 95·7 per 100 000 population (95% CI 95·6-95·8) in 2020. Among 38 227 individuals with non-traumatic OHCA, 25 958 (67·9%) were male, 30 282 (79·2%) had a cardiac arrest at home, 32 523 (85·1%) had a presumed cardiac cause, and 2297 (6·0%) presented with an initial shockable rhythm. 4049 (11·5%) of 35 090 patients with an unwitnessed or bystander-witnessed OHCA received dispatcher-assisted cardiopulmonary resuscitation and 7121 (20·3%) received bystander cardiopulmonary resuscitation; only 14 (<0·1%) patients were assessed by bystanders with an automated external defibrillator. The median EMS response time was 12 min (IQR 9-16). At hospital discharge or 30 days, 441 (1·2%) of 38 227 survived, 304 (0·8%) survived up to 6 months, and 269 (0·7%) up to 12 months. At hospital discharge or 30 days, 309 (0·8%) survived with favourable neurological outcomes, 257 (0·7%) had favourable neurological outcomes at 6 months, and 236 (0·6%) at 12 months. Our findings revealed a high burden of EMS-assessed OHCA with a low proportion of resuscitation attempts. The suboptimal implementation of chain of survival and unsatisfactory prognosis call for national efforts to improve the care and outcomes of patients with OHCA in China. The National Science & Technology Fundamental Resources Investigation Program of China, the State Key Program of the National Natural Science Foundation of China, Taishan Pandeng Scholar Program of Shandong Province, the Key Research & Development Program of Shandong Province, the Interdisciplinary Young Researcher Groups Program of Shandong University, the Clinical Research Center of Shandong University, the ECCM Program of Clinical Research Center of Shandong University, and the Natural Science Foundation of Shandong Province.

Managing aspects of the implementation of the practice of dispatcher-assisted first aid for cardiac arrest in the Russian Federation (literature review)

High death rates in out-of-hospital cardiac arrest are mainly associated with failure of bystanders to provide lifesaving help before arrival of medical professionals. This constitutes a major problem for present-day Russia and determines the urgent need to take managing measures aimed at maximizing involvement of the lay public into the process of resuscitation and first aid provision. Based on an analysis of contemporary scientific literature, this paper provides a justification for creation and implementation of a unified coordinated program of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), when dispatchers of emergency services provide witnesses of cardiac arrest with instructions on how to perform resuscitation over the telephone in Russia. In particular, the article describes the foreign experience of implementation of DA-CPR programs that confirms a high effectiveness of the dispatcher support as it applies to outcomes of out-of-hospital cardiac arrest; it discusses a place of DA-CPR in current international guidelines on management of cardiac arrest; and it gives an analysis of managing and legal prerequisites for implementation of DA-CPR into the daily work of emergency medical services and 112-emergency system in Russia, including the existing dispatching infrastructure for implementation of the DA-CPR program, and current legal framework that regulates management and operation of the emergency services that provide remote consultations on health protection for the public. Based on the analysis, priority managing measures were identified aimed at effective and unified implementation of the DA-CPR in Russia. For relevant literature, we searched Medline, Scopus, Web of Science, Google Scholar and Russian Science Citation Index.

Impact of post-dispatch advice on bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest in Hong Kong

Background: In Hong Kong, the post-dispatch advice on cardiopulmonary resuscitation has been implemented since October 2018. Our study aimed to (1) evaluate the impact of post-dispatch advice on the bystander cardiopulmonary resuscitation rate and out-of-hospital cardiac arrest survival and (2) characterise the reasons for not providing dispatch-assisted cardiopulmonary resuscitation, which have important implications in public cardiopulmonary resuscitation education. Method: We retrospectively analysed the records of 749 adult patients with out-of-hospital cardiac arrest between 1 September 2021 and 31 October 2021. The primary outcome was survival to hospital discharge. The secondary outcomes included return of spontaneous circulation and survival to hospital admission. Results: The overall dispatch-assisted cardiopulmonary resuscitation rate was 49.6%. Patients who received dispatch-assisted cardiopulmonary resuscitation had a higher proportion of witnessed cardiac arrest (37.7% vs 24.7%, p &lt; 0.001) and a shorter time interval from recognition of cardiac arrest to chest compression (median 3.0 min vs 13.0 min, p &lt; 0.001) compared with patients without dispatch-assisted cardiopulmonary resuscitation. 16.8% of out-of-hospital cardiac arrest victims had return of spontaneous circulation before or upon arrival at the hospital. Patients who received dispatch-assisted cardiopulmonary resuscitation had a higher return of spontaneous circulation (18.3% vs 15.4%), survival to hospital admission (15.9% vs 13.3%) and survival to hospital discharge (2.7% vs 1.3%) rates compared with those who did not. However, the differences did not reach statistical significance. Conclusion: Post-dispatch advice improved the overall bystander cardiopulmonary resuscitation rate in out-of-hospital cardiac arrest and shortened the time from out-of-hospital cardiac arrest recognition to chest compression, but the improvement in survival did not reach statistical significance. Further public education on cardiac arrest recognition and dispatch-assisted cardiopulmonary resuscitation is necessary.

Community Interventions for Out-of-Hospital Cardiac Arrest in Resource-Limited Settings: A Scoping Review Across Low, Middle, and High-Income Countries

Background: Out-of-hospital cardiac arrest (OHCA) is a major global health challenge, characterized by poor survival outcomes worldwide. Resource-limited settings are burdened with suboptimal emergency response and worse outcomes than high-resource areas. Engaging the community in the response to OHCA has the potential to improve outcomes, although an overview of community interventions in resource-limited settings has not been provided. Objective: This review evaluated the scope of community-based OHCA interventions in resource-limited settings. Methods: Literature searches in electronic databases (MEDLINE, EMBASE, Global Health, CINAHL, Cochrane Central Register of Controlled Clinical Trials) and grey literature sources were performed. screening, full-text review, and data extraction of eligible studies were conducted independently by two reviewers. The PCC (Population, Concept, and Context) framework was used to assess study eligibility. Studies that evaluated community-based interventions for laypeople (Population), targeting emergency response activation, cardiopulmonary resuscitation (CPR), or automated external defibrillator (AED) use (Concept) in resource-limited settings (Context) were included. Resource-limited settings were identified by financial pressures (low-income or lower-middle-income country, according to World Bank data on year of publication) or geographical factors (setting described using keywords indicative of geographical remoteness in upper-middle-income or high-income country). Results: Among 14,810 records identified from literature searches, 60 studies from 28 unique countries were included in this review. Studies were conducted in high-income (n = 35), upper-middle-income (n = 2), lower-middle-income (n = 22), and low-income countries (n = 1). Community interventions included bystander CPR and/or AED training (n = 34), community responder programs (n = 8), drone-delivered AED networks (n = 6), dispatcher-assisted CPR programs (n = 4), regional resuscitation campaigns (n = 3), public access defibrillation programs (n = 3), and crowdsourcing technologies (n = 2). CPR and/or AED training were the only interventions evaluated in low-income, lower-middle-income, and upper-middle-income countries. Conclusions: Interventions aimed at improving the community response to OHCA in resource-limited settings differ globally. There is a lack of reported studies from low-income countries and certain continental regions, including South America, Africa, and Oceania. Evaluation of interventions other than CPR and/or AED training in low- and middle-income countries is needed to guide community emergency planning and health policies.