Abstract 18: Dispatcher-Assisted Bystander Cardiopulmonary Resuscitation in a Metropolitan City: A Before-and-After Population Study
The goal of this study is to determine the effect of the dispatcher-assisted bystander cardiopulmonary resuscitation (D-CPR) on the outcomes of out-of-hospital cardiac arrest (OHCA).
Methods and Results
This study was performed in an emergency medical service (EMS) system with a single-tiered basic-to-intermediate service level and with about 65 destination hospitals in a metropolitan city with 10 millions of population. All EMS are dispatched by single centralized and physician-supervised center. An OHCA database including demographic, Utstein, EMS, and hospital factors, and outcomes was collected from dispatch center registry and EMS run sheets, and followed by medical record review for outcome survey during 2009 to 2011. Cases with unknown outcome, less than 15 years, and non-cardiac causes were excluded. Intervention was the novel D-CPR method (in 2010 AHA guideline) which was implemented in Jan, 2011. The primary and secondary end points were survival to discharge and good neurologic outcome (cerebral performance category 1 to 2). Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for estimating the effect size of the D-CPR period compared previous two years were calculated for outcomes, adjusting for potential predictors (age, gender, witness, response time, transport time, initial ECG, emergency department level (1 to 4)).
There were 8,143 EMS-assessed adult OHCAs with presumed cardiac cause. Of these, the bystander CPRs were performed for patients of 5.7% (148/ 2600) in 2009, 6.7% (190/2857) in 2010, and 37.8% (1016/2686) in 2010, respectively (p<0.001). The survival to discharge was 7.1% (2009), 7.1% (2010) and 9.5% (2011), respectively (p=0.001). Good neurologic outcome was 2.1% (2009), 2.0% (2010), and 3.6% (2011), respectively (p<0.001). Adjusted ORs (95% CIs) for survival to discharge of 2011 and 2010 comparing with 2009 was 1.53 (1.24-1.90) in 2011, 1.16 (0.93-1.45) in 2010, respectively. Adjusted ORs (95% CIs) for good neurologic outcome was 2.12 (1.47-3.05) in 2011, 1.21 (0.81-1.80) in 2010, respectively.
In this metropolitan before and after study, an EMS intervention of D-CPR protocol showed significant increase of bystander CPR and results in improved survival and neurologic outcome.
- © 2012 by American Heart Association, Inc.