The effect of dispatcher-assisted cardiopulmonary resuscitation on early defibrillation and return of spontaneous circulation with survival

Research output: Contribution to journalArticle

Abstract

Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) programs are implemented to augment bystander CPR and improve outcomes of patients with out-of-hospital cardiac arrest (OHCA). To understand the pathway of how DA-CPR improves outcomes of OHCA, we aimed to evaluate the effect of DA-CPR on defibrillation and return of spontaneous circulation (ROSC) with survival to hospital discharge within 90 min. Methods: We conducted a population-based observational study of all adults with OHCA with presumed cardiac aetiology treated by emergency medical services (EMS) between 2013 and 2016, using a national OHCA registry. We excluded cases without a witness, those that occurred in hospital, were witnessed by an EMS provider, or defibrillated by a layperson. The exposure was bystander CPR status: no bystander CPR (No BCPR), bystander CPR without dispatcher assistance (NDA-BCPR), and bystander CPR with dispatcher assistance (DA-BCPR). The observation time was set to a maximum of 90 min for survival analysis. The primary outcome was ROSC within 90 min leading to being discharged alive (ROSC with survival). The secondary outcomes were ROSC within 90 min leading to being discharged with cerebral performance category I or II (ROSC with good CPC) and first defibrillation within 90 min (defibrillation). Multivariable Cox proportional hazards analysis was performed to calculate adjusted hazard ratios (AHRs), according to bystander CPR status adjusted for potential confounders. Results: Of 25,450 eligible OHCAs, NDA-BCPR was provided for 3193 cases (12.5%) and DA-BCPR was provided for 12,154 cases (47.8%). ROSC with survival was observed in 13.2% of cases with NDA-BCPR and 12.0% with DA-BCPR. Compared with No BCPR, both type of bystander CPR were associated with 44% and 55% increases in ROSC with survival to discharge (AHR, 95% confidence interval (CI): 1.44, 1.27–1.63 for NDA-BCPR and 1.55, 1.41–1.69 for DA-BCPR). DA-BCPR was also associated with defibrillation compared with No-BCPR, accounting for ROSC as a competing risk (AHR 1.16, 95% CI 1.12–1.21). Conclusions: Compared with no bystander CPR provided, both bystander CPR with or without dispatcher assistance were associated with defibrillation and ROSC leading to survival to discharge in patients with witnessed OHCA.

Original languageEnglish
Pages (from-to)21-29
Number of pages9
JournalResuscitation
Volume135
DOIs
StatePublished - Feb 2019

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Cardiopulmonary Resuscitation
Survival
Out-of-Hospital Cardiac Arrest
Emergency Medical Services
Confidence Intervals
Patient Discharge
Survival Analysis
Observational Studies
Registries
Observation

Keywords

  • Bystander cardiopulmonary resuscitation
  • Cardiac arrest
  • Defibrillation
  • Dispatcher

Cite this

@article{f693cbf987204d96b9edfdafd7051758,
title = "The effect of dispatcher-assisted cardiopulmonary resuscitation on early defibrillation and return of spontaneous circulation with survival",
abstract = "Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) programs are implemented to augment bystander CPR and improve outcomes of patients with out-of-hospital cardiac arrest (OHCA). To understand the pathway of how DA-CPR improves outcomes of OHCA, we aimed to evaluate the effect of DA-CPR on defibrillation and return of spontaneous circulation (ROSC) with survival to hospital discharge within 90 min. Methods: We conducted a population-based observational study of all adults with OHCA with presumed cardiac aetiology treated by emergency medical services (EMS) between 2013 and 2016, using a national OHCA registry. We excluded cases without a witness, those that occurred in hospital, were witnessed by an EMS provider, or defibrillated by a layperson. The exposure was bystander CPR status: no bystander CPR (No BCPR), bystander CPR without dispatcher assistance (NDA-BCPR), and bystander CPR with dispatcher assistance (DA-BCPR). The observation time was set to a maximum of 90 min for survival analysis. The primary outcome was ROSC within 90 min leading to being discharged alive (ROSC with survival). The secondary outcomes were ROSC within 90 min leading to being discharged with cerebral performance category I or II (ROSC with good CPC) and first defibrillation within 90 min (defibrillation). Multivariable Cox proportional hazards analysis was performed to calculate adjusted hazard ratios (AHRs), according to bystander CPR status adjusted for potential confounders. Results: Of 25,450 eligible OHCAs, NDA-BCPR was provided for 3193 cases (12.5{\%}) and DA-BCPR was provided for 12,154 cases (47.8{\%}). ROSC with survival was observed in 13.2{\%} of cases with NDA-BCPR and 12.0{\%} with DA-BCPR. Compared with No BCPR, both type of bystander CPR were associated with 44{\%} and 55{\%} increases in ROSC with survival to discharge (AHR, 95{\%} confidence interval (CI): 1.44, 1.27–1.63 for NDA-BCPR and 1.55, 1.41–1.69 for DA-BCPR). DA-BCPR was also associated with defibrillation compared with No-BCPR, accounting for ROSC as a competing risk (AHR 1.16, 95{\%} CI 1.12–1.21). Conclusions: Compared with no bystander CPR provided, both bystander CPR with or without dispatcher assistance were associated with defibrillation and ROSC leading to survival to discharge in patients with witnessed OHCA.",
keywords = "Bystander cardiopulmonary resuscitation, Cardiac arrest, Defibrillation, Dispatcher",
author = "Lee, {Sun Young} and Hong, {Ki Jeong} and Shin, {Sang Do} and Ro, {Young Sun} and Song, {Kyoung Jun} and Park, {Jeong Ho} and Kong, {So Yeon} and Kim, {Tae Han} and Lee, {Seung Chul}",
year = "2019",
month = "2",
doi = "10.1016/j.resuscitation.2019.01.004",
language = "English",
volume = "135",
pages = "21--29",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - The effect of dispatcher-assisted cardiopulmonary resuscitation on early defibrillation and return of spontaneous circulation with survival

AU - Lee, Sun Young

AU - Hong, Ki Jeong

AU - Shin, Sang Do

AU - Ro, Young Sun

AU - Song, Kyoung Jun

AU - Park, Jeong Ho

AU - Kong, So Yeon

AU - Kim, Tae Han

AU - Lee, Seung Chul

PY - 2019/2

Y1 - 2019/2

N2 - Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) programs are implemented to augment bystander CPR and improve outcomes of patients with out-of-hospital cardiac arrest (OHCA). To understand the pathway of how DA-CPR improves outcomes of OHCA, we aimed to evaluate the effect of DA-CPR on defibrillation and return of spontaneous circulation (ROSC) with survival to hospital discharge within 90 min. Methods: We conducted a population-based observational study of all adults with OHCA with presumed cardiac aetiology treated by emergency medical services (EMS) between 2013 and 2016, using a national OHCA registry. We excluded cases without a witness, those that occurred in hospital, were witnessed by an EMS provider, or defibrillated by a layperson. The exposure was bystander CPR status: no bystander CPR (No BCPR), bystander CPR without dispatcher assistance (NDA-BCPR), and bystander CPR with dispatcher assistance (DA-BCPR). The observation time was set to a maximum of 90 min for survival analysis. The primary outcome was ROSC within 90 min leading to being discharged alive (ROSC with survival). The secondary outcomes were ROSC within 90 min leading to being discharged with cerebral performance category I or II (ROSC with good CPC) and first defibrillation within 90 min (defibrillation). Multivariable Cox proportional hazards analysis was performed to calculate adjusted hazard ratios (AHRs), according to bystander CPR status adjusted for potential confounders. Results: Of 25,450 eligible OHCAs, NDA-BCPR was provided for 3193 cases (12.5%) and DA-BCPR was provided for 12,154 cases (47.8%). ROSC with survival was observed in 13.2% of cases with NDA-BCPR and 12.0% with DA-BCPR. Compared with No BCPR, both type of bystander CPR were associated with 44% and 55% increases in ROSC with survival to discharge (AHR, 95% confidence interval (CI): 1.44, 1.27–1.63 for NDA-BCPR and 1.55, 1.41–1.69 for DA-BCPR). DA-BCPR was also associated with defibrillation compared with No-BCPR, accounting for ROSC as a competing risk (AHR 1.16, 95% CI 1.12–1.21). Conclusions: Compared with no bystander CPR provided, both bystander CPR with or without dispatcher assistance were associated with defibrillation and ROSC leading to survival to discharge in patients with witnessed OHCA.

AB - Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) programs are implemented to augment bystander CPR and improve outcomes of patients with out-of-hospital cardiac arrest (OHCA). To understand the pathway of how DA-CPR improves outcomes of OHCA, we aimed to evaluate the effect of DA-CPR on defibrillation and return of spontaneous circulation (ROSC) with survival to hospital discharge within 90 min. Methods: We conducted a population-based observational study of all adults with OHCA with presumed cardiac aetiology treated by emergency medical services (EMS) between 2013 and 2016, using a national OHCA registry. We excluded cases without a witness, those that occurred in hospital, were witnessed by an EMS provider, or defibrillated by a layperson. The exposure was bystander CPR status: no bystander CPR (No BCPR), bystander CPR without dispatcher assistance (NDA-BCPR), and bystander CPR with dispatcher assistance (DA-BCPR). The observation time was set to a maximum of 90 min for survival analysis. The primary outcome was ROSC within 90 min leading to being discharged alive (ROSC with survival). The secondary outcomes were ROSC within 90 min leading to being discharged with cerebral performance category I or II (ROSC with good CPC) and first defibrillation within 90 min (defibrillation). Multivariable Cox proportional hazards analysis was performed to calculate adjusted hazard ratios (AHRs), according to bystander CPR status adjusted for potential confounders. Results: Of 25,450 eligible OHCAs, NDA-BCPR was provided for 3193 cases (12.5%) and DA-BCPR was provided for 12,154 cases (47.8%). ROSC with survival was observed in 13.2% of cases with NDA-BCPR and 12.0% with DA-BCPR. Compared with No BCPR, both type of bystander CPR were associated with 44% and 55% increases in ROSC with survival to discharge (AHR, 95% confidence interval (CI): 1.44, 1.27–1.63 for NDA-BCPR and 1.55, 1.41–1.69 for DA-BCPR). DA-BCPR was also associated with defibrillation compared with No-BCPR, accounting for ROSC as a competing risk (AHR 1.16, 95% CI 1.12–1.21). Conclusions: Compared with no bystander CPR provided, both bystander CPR with or without dispatcher assistance were associated with defibrillation and ROSC leading to survival to discharge in patients with witnessed OHCA.

KW - Bystander cardiopulmonary resuscitation

KW - Cardiac arrest

KW - Defibrillation

KW - Dispatcher

UR - http://www.scopus.com/inward/record.url?scp=85060090441&partnerID=8YFLogxK

U2 - 10.1016/j.resuscitation.2019.01.004

DO - 10.1016/j.resuscitation.2019.01.004

M3 - Article

C2 - 30639789

AN - SCOPUS:85060090441

VL - 135

SP - 21

EP - 29

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

ER -