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

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.