Elsevier

Resuscitation

Volume 82, Issue 12, December 2011, Pages 1490-1495
Resuscitation

Review article
In patients with out-of-hospital cardiac arrest, does the provision of dispatch cardiopulmonary resuscitation instructions as opposed to no instructions improve outcome: A systematic review of the literature

https://doi.org/10.1016/j.resuscitation.2011.09.004Get rights and content

Abstract

Context

Early bystander cardiopulmonary resuscitation (CPR) provides an essential bridge to successful defibrillation from sudden cardiac arrest (SCA) and there is a need to increase the prevalence and quality of bystander CPR. Emergency medical dispatchers can give CPR instructions to a bystander calling for an ambulance enabling even an inexperienced bystander to start CPR. The impact of these instructions has not been evaluated.

Objectives

To determine if, in adult and pediatric patients with out-of-hospital cardiac arrest, the provision of dispatch CPR instructions as opposed to no instructions improves outcome.

Methods

Two independent reviewers used standardized forms and procedures to review papers published between January, 1985 and December, 2009. Findings were peer-reviewed by the International Liaison Committee on Resuscitation.

Data synthesis

We identified 665 citations; five met the inclusion criteria. One retrospective cohort study reported improved survival with dispatch CPR instructions than without it. Three studies, two observational and one with retrospective controls showed trends toward increased survival after dispatcher-assisted CPR was implemented and one showed trend toward decreased survival. There were no randomised studies addressing the topic. No studies addressing dispatch CPR instructions in the pediatric population were found.

Conclusion

There is limited evidence supporting the survival benefit of dispatch-assisted CPR instructions. All studies comparing survival outcomes when CPR is provided with or without the assistance of dispatch-assisted CPR instructions lack the statistical power to draw significant conclusions. Since it has been demonstrated that such instructions can improve bystander CPR rates, it is reasonable to recommend they should be provided to all callers reporting a victim in cardiac arrest.

Introduction

In the European population, every year approximately 275,000 persons experiencing a cardiac arrest are treated by EMS, with 29,000 (10.7%) persons surviving to hospital discharge.1 Early, i.e., before EMS arrival, bystander-initiated CPR has been shown to increase survival significantly2, 3, 4 and this is believed to be because bystander CPR prolongs the electrical or shockable phase of ventricular fibrillation.5, 6 The benefit of bystander CPR seems to exist within a rather narrow time window to be most effective. It must be started within minutes from the moment of collapse and the earlier the bystander CPR starts the better the outcome.7

Dispatch CPR instructions via telephone was first conceived in the early 1970s.8 Emergency medical dispatchers are crucial in supporting and giving CPR-instructions to a bystander calling for an ambulance, enabling even an inexperienced bystander to start CPR.9, 10 Dispatcher-assisted CPR has been shown to improve the rates of bystander CPR in the community.10, 11, 12 Simulation studies suggest that bystanders without former CPR training who receive dispatcher-assisted instructions show comparable CPR skills to previously trained persons, although more time elapses before initiation of CPR for the untrained group.9 About 50–83% of cardiac arrest cases are identified by dispatchers13, 14, 15 and if they identify cardiac arrest it is associated with increased survival.16, 17

For adult and pediatric patients with out-of-hospital cardiac arrest (OHCA) we sought to determine if the provision of dispatch CPR instructions as opposed to no instructions improves outcome.

Section snippets

Methods

The systematic review was performed in accordance with the International Liaison Committee on Resuscitation (ILCOR) 2010 evidence evaluation process. Review of the search strategy and findings were conducted by the worksheet evaluation experts.18

Literature search results

The search strategy was completed in December 2009. Of 663 potentially relevant papers, 101 were retrieved using predetermined selection criteria; 79 of those were rejected based on manuscript title and abstract. For a more detailed evaluation, we used the same criteria for the full-text review of 22 papers. Of these, 17 were excluded as clearly not relevant. Further inspection of the remaining papers revealed five studies that met our inclusion criteria (Fig. 1). The most usual reasons for

Discussion

The results of this review showed one study with improved survival when dispatch CPR instructions were given,17 three studies showed trends toward increased survival with dispatch CPR instructions10, 20, 21 and one showed trend toward decreased survival.11 All were retrospective or before-after studies. However, there are several interesting aspects revealed in the included studies.

The implementation of a dispatch CPR instruction program appears to have several positive effects on the very

Conclusion

There is limited evidence supporting the survival benefit of dispatch-assisted CPR instructions. All studies comparing survival outcomes when CPR is provided with or without the assistance of dispatch-assisted CPR instructions lack the statistical power to draw significant conclusions. Studies comparing survival outcomes between groups where CPR is provided as a result of dispatch-assisted CPR instructions and those where CPR is not provided all show a survival benefit from dispatch-assisted

Conflict of interest

Katarina Bohm received unrestricted fundings from SOS Alarm Sverige AB. Dr. Christian Vaillancourt received funding from the Canadian Institutes of Health Research and the Heart and Stroke Foundation to study dispatch-assisted CPR instructions. Manya Charette has no conflicts of interest to declare. Dr. James Dunford has no conflicts of interest to declare. Dr. Maaret Castrén received unrestricted fundings from SOS Alarm Sverige AB.

Disclaimer

This review includes information on resuscitation questions developed through the C2010 Consensus on Science and Treatment Recommendations process, managed by the International Liaison Committee on Resuscitation (http://www.americanheart.org/ILCOR). The questions were developed by ILCOR Task Forces, using strict conflict of interest guidelines. In general, each question was assigned to two experts to complete a detailed structured review of the literature, and complete a detailed worksheet.

Acknowledgement

SOS Alarm Sverige AB.

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.09.004.

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