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Does dispatcher-assisted CPR generate the same outcomes as spontaneously delivered bystander CPR in Japan?

Hiroyuki Takahashi1, Ryo Sagisaka2, Yoshiki Natsume3

  • 1Department of Sports Medicine, Kokushikan University, Japan; Research Institute of Disaster Management and EMS, Kokushikan University, Japan.

The American Journal of Emergency Medicine
|August 29, 2017
PubMed

Insights

Dispatcher-assisted CPR (DA-CPR) showed outcomes nearly equivalent to spontaneously-delivered bystander CPR (BCPR). This finding supports enhanced dispatcher training for improving out-of-hospital cardiac arrest survival rates.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Public Health

Background:

  • Out-of-hospital cardiac arrest (OHCA) survival is critically dependent on timely interventions.
  • Bystander CPR and dispatcher assistance are crucial initial steps.
  • The comparative effectiveness of dispatcher-assisted CPR (DA-CPR) versus spontaneous bystander CPR (BCPR) requires investigation.

Purpose of the Study:

  • To compare the effectiveness of DA-CPR with spontaneously-delivered BCPR in witnessed cardiogenic OHCA.
  • To evaluate the impact of DA-CPR on initial ECG rhythm, return of spontaneous circulation (ROSC), and neurological outcomes.

Main Methods:

  • Analysis of 37,899 witnessed cardiogenic OHCA cases from a Japanese nationwide database (2008-2012).
  • Categorization into four groups: DA-CPR, DA-No CPR, BCPR, and No BCPR-No DA.
  • Multivariable logistic regression to assess associations with shockable rhythm, field ROSC, and 1-month neurological outcomes.

Main Results:

  • DA-CPR implementation has increased since 2005.
  • Both DA-CPR and BCPR were significantly associated with higher rates of shockable rhythm (AOR 1.72-1.75) compared to DA-No CPR.
  • Both interventions improved field ROSC (AOR 1.40-1.42) and 1-month favorable neurological outcomes (AOR 1.72-1.80).

Conclusions:

  • Spontaneously-delivered BCPR demonstrated favorable outcomes.
  • DA-CPR yielded nearly equivalent effects to BCPR when compared to the DA-No BCPR group.
  • Standardized dispatcher education is recommended to further optimize OHCA management.
Abstract

Keywords:
Bystander CPRCardiopulmonary resuscitationDispatcher-assisted CPRFavorable neurological outcomeResuscitation

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