Dispatcher-assisted Cardiopulmonary Resuscitation Research Articles

Epidemiology, Process of Care, and Associated Outcomes of Pediatric Out-of-Hospital Cardiac Arrest in China: Results From a Prospective, Multicenter, Population-Based Registry

Objectives: To comprehensively describe the incidence, process of care, outcomes, and variation among different age groups of pediatric out-of-hospital cardiac arrest (OHCA) in China. Design: The Baseline Investigation of Out-of-Hospital Cardiac Arrest (BASIC-OHCA) is a prospective, multicenter, population-based registry of emergency medical services (EMS)-assessed OHCA in China. Setting: A total of 25 monitoring sites of all seven geographical regions were included, covering a pediatric population (age ≤ 19) of around 22.3 million in China. Patients: Pediatric patients enrolled in BASIC-OHCA from August 2019 to December 2020 were included. Interventions: None. Measurements and Main Results: A total of 1493 pediatric patients with EMS-assessed OHCA were enrolled, and resuscitation was attempted in 651 cases (43.6%). The crude incidence of EMS-assessed and EMS-treated OHCA was 5.5 (95% CI, 5.2–5.9) and 2.4 (95% CI, 2.2–2.6) per 100,000 pediatric population. Among 651 EMS-treated OHCA cases, 434 patients (66.7%) were male, and 353 (54.2%) had nonmedical causes (trauma, asphyxia, and drowning being the most common). There were 396 patients (60.8%) who collapsed at home, and the proportion of cases that occurred in public places such as streets and schools increased with age. There were 26 patients (4.0%) who had an initial shockable rhythm. For 626 non-EMS-witnessed patients, 152 patients (24.3%) received bystander cardiopulmonary resuscitation (CPR), 68 (10.9%) received dispatcher-assisted CPR, and 3 (0.5%) had automated external defibrillator applied. The survival to discharge or 30 days was 3.5% (23/651), and the favorable neurologic prognosis was 3.1% (20/651), with no differences among age groups. Conclusions: This study provides the first national exploration of pediatric OHCA in China. The high proportion of nonmedical causes underscores the importance of preventing accidents in children. Gaps in the chain of survival and patient outcomes provide a focus for improving the treatment of pediatric OHCA in China and other developing countries.

Effectiveness of dispatcher-assisted cardiopulmonary resuscitation in private home versus public locations for out-of-hospital cardiac arrest patients − A retrospective cohort study

BackgroundDispatcher-assisted cardiopulmonary resuscitation (DACPR) significantly improves the survival of out-of-hospital cardiac arrest (OHCA) patients. However, the effectiveness of DACPR may vary depending on the location of the cardiac arrest. This study compares DACPR outcomes in private homes versus public places. MethodsThis retrospective cohort study included all OHCA incidents with emergency medical service (EMS) activation in Taichung City, Taiwan, from May 1, 2021, to April 30, 2022. Trained dispatch reviewers analyzed audio recordings of the included cases to extract DACPR indicators. The primary outcome was the number of successful chest compressions performed. Secondary outcomes included the proportion of OHCA recognition, call-to-chest compression time, call-to-OHCA recognition time, reasons for failure to identify OHCA, and reasons for failure to perform chest compressions or complete instructions. A subgroup analysis examined the caller-patient relationship in both locations. ResultsThe study included 1,160 OHCA patients, with 1,009 cases occurring in private homes and 151 in public places. Patients in public places were younger (60 vs 75 years), more often male (81.5 % vs 59.9 %), and had a higher rate of witnessed collapse compared to those in private homes (40.4 % vs 26.7 %, p < 0.001). Chest compressions were less frequently administered in public places (41.1 % vs 65.5 %, adjusted odds ratio [aOR]: 0.48 [0.31 to 0.75]). Public place cases had a lower proportion of OHCA recognition (51.9 % vs 76.9 %) and longer call-to-OHCA recognition times (108 vs 79 s) than those in private homes. Callers in public places more often encountered hazardous environments or physical barriers (16.4 % vs 8.3 %) and refused to execute instructions (11.0 % vs 4.1 %), but faced fewer emotional or psychological obstacles (0 % vs 8.3 %). Family members in private homes had a higher proportion of chest compressions (67.1 % vs 53.8 %, aOR: 1.81 [1.15 to 2.83]) and shorter times to chest compression (160 s vs 171 s, adjusted beta: −30 s [-55.6 to −6.3]) compared to non-family members. ConclusionThis study demonstrated reduced DACPR effectiveness in public places compared to private homes, potentially influenced by caller factors, environmental conditions, and the caller-patient relationship. Developing location-specific strategies is essential to enhance DACPR effectiveness.

Examining the impact of dispatch-assisted CPR on bystander CPR performing

Background: Dispatcher-assisted CPR involves emergency medical dispatchers (EMD) delivering real-time CPR instructions to callers during emergencies. This method aims to enable timely bystander CPR before the arrival of emergency medical services, improving survival rates and neurological outcomes of out-of-hospital cardiac arrest (OHCA). This study evaluates the effectiveness of telephone-guided CPR instructions using retrospective audio data. Methods: A retrospective study analyzed OHCA incidents in Mahasarakham, Songkhla, and Prachinburi within a metropolitan EMS system. Audiotapes from emergency calls between January and December 2021 were reviewed. Included were OHCA patients who called the dispatch center and were transported to the hospital by EMS. Exclusions included cardiac arrests in nursing homes, doctors' offices, and jails, as well as cases where EMS witnessed the OHCA or callers initiated CPR before receiving instructions. Results: The study analyzed 280 patients, with 146 callers (52.1%) agreeing to perform CPR. Among the provided DA-CPR instructions, 18 items were significantly associated with bystander CPR performance. Five items that could be omitted to reduce OHCA recognition time delay include the introduction, requesting contact numbers, inquiring about the number of patients, assessing scene safety, and advising tilting the patient in case of vomiting. Conclusions: To reduce the delay in identifying cardiac arrest and promptly initiating chest compressions during OHCA, it is suggested to employ a video call system for early detection of abnormal breathing and unconsciousness. Additionally, integrating automatic geolocation can expedite EMS response.

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

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.

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.

Ventilation efficacy during paediatric cardiopulmonary resuscitation (PEDIVENT): simulation-based comparative study.

This simulation-based study aimed to evaluate the efficacy of ventilation during paediatric cardiopulmonary resuscitation (CPR) provided by healthcare professionals (HCPs) and lay rescuers (LRs). The objective was to assess the number of effective breaths delivered during the initial sequence of CPR. Effective ventilation plays a critical role during paediatric CPR as most cardiac arrests are secondary to hypoxia in origin. The recommendations on initial resuscitation in unresponsive, non-breathing children differ worldwide. The European Resuscitation Council (ERC) guidelines recommend five breaths before starting the chest compressions. Yet, this recommendation was based on the expert consensus historically and has not changed since 2000 because of the lack of evidence. This research addresses the identified knowledge gap, with potential implications for improving resuscitation practices and ultimately enhancing patient outcomes. HCPs and LRs performed 90 s of CPR involving two mannequins: 5-kg Baby and 20-kg Junior. Both groups (HCPs and LRs) performed the task before and after structured CPR training, and the efficacy of ventilation before and after the training was compared. The HCPs provided bag-mask ventilation; LR performed dispatcher-assisted CPR with mouth-to-mouth ventilation. The number of participants that reached the primary outcome before and after the training in Baby was 26 (65%) vs. 40 (100%) in HCPs and 28 (60.9%) vs. 45 (97.8%) in LRs (improvement in both p < 0.001), respectively. The number of participants that reached the primary outcome before and after the training in the Junior mannequin was 31 (77.5%) vs. 32 (82.1%) in HCPs (p = 0.77) and 32 (82.1%) vs. 37 (94.9%) in LRs (p = 0.005), respectively. This simulation-based study is the first to investigate ventilation efficacy during paediatric CPR provided by HCPs and LRs. Ventilation represents an important aspect of good-quality CPR in children. The concept of initiating paediatric CPR with initial breaths, as stated in ERC guidelines 2021, is justifiable. Trained HCPs and LRs providing dispatcher-assisted CPR could deliver effective ventilation to paediatric mannequins. These findings can contribute to future research in this area and address identified knowledge gaps concerning resuscitation guidelines, given the unique practical application of simulation as a research tool.

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.