Review articleIn 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☆
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.
References (29)
- et al.
Incidence of EMS-treated out-of-hospital cardiac arrest in Europe
Resuscitation
(2005) - et al.
Effect of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients in Sweden
Resuscitation
(2000) - et al.
Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden
Am Heart J
(2005) - et al.
Out-of-hospital cardiac arrests in Amsterdam and its surrounding areas: results from the Amsterdam resuscitation study (ARREST) in ‘Utstein’ style
Resuscitation
(1998) - et al.
Prevention of deterioration of ventricular fibrillation by basic life support during out-of-hospital cardiac arrest
Resuscitation
(2002) - et al.
Dispatcher-assisted telephone CPR: common delays and time standards for delivery
Ann Emerg Med
(1991) - et al.
Effect of protocol compliance to cardiac arrest identification by emergency medical dispatchers
Resuscitation
(2006) - et al.
Emergency call processing and survival from out-of-hospital ventricular fibrillation
Resuscitation
(2005) - et al.
Part 3. Evidence evaluation process 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
Resuscitation
(2010) - et al.
Emergency Medical Dispatch expert group at the Utstein Consensus Symposium 2005. Recommended guidelines for reporting on emergency medical dispatch when conducting research in emergency medicine: the Utstein style
Resuscitation
(2008)
Dispatcher-assisted cardiopulmonary resuscitation. An evaluation of efficacy amongst elderly
Resuscitation
To blow or not to blow: a randomised controlled trial of compression-only and standard telephone CPR instructions in simulated cardiac arrest
Resuscitation
European Resuscitation Council Guidelines for Resuscitation 2010. Section 2. Adult basic life support and use of automated external defibrillators
Resuscitation
Factors impending dispatcher-assisted telephone cardiopulmonary resuscitation
Ann Emerg med
Cited by (84)
Dispatcher-assisted BLS for lay bystanders: A pilot study comparing video streaming via smart glasses and telephone instructions
2023, American Journal of Emergency MedicineCaller resistance to perform cardio-pulmonary resuscitation in emergency calls for cardiac arrest
2020, Social Science and MedicineUsing a Mobile Phone Application Versus Telephone Assistance During Cardiopulmonary Resuscitation: A Randomized Comparative Study
2020, Journal of Emergency Nursing
- ☆
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.