Clinical paperEffect of bystander CPR initiated by a dispatch centre following out-of-hospital cardiac arrest on 30-day survival: Adjusted results from the French National Cardiac Arrest Registry
Introduction
Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality in the industrialized world.1, 2, 3 Epidemiological data estimate the global incidence of OHCA at 95.9 cases per 100.000 person-years.1, 4 OHCA affects 40.000 to 50.000 people per year in France5 and approximately 300.000 in Europe,6 where OHCA survival can range from 3% to 31%. In France, survival rates vary from 4.9% to 11.4% according to the context (initial rhythm, location, bystander,…).1, 6, 7 Importantly, we also note variations on telephone directed CPR.8 The key elements of the treatment include early recognition of CA, rapid and effective CPR, effective defibrillation strategies, and post-resuscitation care.9 The early initiation of CPR followed by rapid intervention of emergency services that provide high quality CPR is essential.
It has been reported that bystander-initiated CPR increases survival and favourable neurologic outcomes for patients presenting with OHCA.10, 11 Therefore, the impact of early CPR initiation has been widely documented.1, 6, 12 However, it is not known whether outcomes differ when resuscitation has been specifically encouraged or not by the Dispatch Centre (DC).
In this context, the aim of this study was to assess the effect of dispatch-directed (DD) telephonic cardiopulmonary resuscitation (TCPR) on patients’ survival. We compared survival and neurological outcomes of three groups of patients: (1) patients who have not received from bystander CPR; (2) patients who received from bystander-initiated CPR; and (3) patients who received from bystander CPR initiated following the advice of the DC.
Section snippets
Study setting
In France, the EMS13 is a two-tiered, physician-based system with a Fire Department ambulance for prompt intervention and basic life support (BLS), a single DC in each county, and several prehospital Emergency Departments, which are called Mobile Emergency and Resuscitation Services (MERS; “Service Mobile d’Urgence et de Réanimation” - SMUR) and are responsible for out-of-hospital emergencies. Each MERS unit includes one or more mobile medical teams (MMTs) that operate at the scene. These teams
Results
RéAC database identified 85,634 OHCAs between January 1st, 2012, and May 1st, 2018. In line with inclusion and exclusion criteria, 18,185 OHCAs were finally included in the study (Fig. 1)
Discussion
First, our study highlights the favourable 30-day survival outcome of patients who received bystander CPR initiated by the DC providing TCPR advice when the onsite bystander(s) did not initiate CPR on their own. Second, these results point out favourable effects of early CPR initiated spontaneously by bystanders and emphasize the necessity of ongoing generalized CPR training at the population-wide level.
Conclusion
Immediate bystander CPR is the most favourable case for a patient’s prognosis. However, our study highlights the effectiveness of dispatch- directed telephonic CPR by bystanders.
Conflict of interest statement
No conflicts of interest to declare.
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The understandability and quality of telephone-guided bystander cardiopulmonary resuscitation in the Western Cape province of South Africa: A manikin-based study
2023, African Journal of Emergency MedicineEffect of Coaching with Repetitive Verbal Encouragements on Dispatch-Assisted Cardiopulmonary Resuscitation: A Randomized Simulation Study
2022, Journal of Emergency MedicineCitation Excerpt :Many studies showed that the frequency of telephone CPR or dispatch-assisted CPR (DACPR) has increased, and it accounts for the majority of BCPR (6–8). The impact of DACPR on survival after OHCA is reported to be equivalent or superior to that of BCPR without dispatch assistance (9–11). Other sources, however, claim that its impact on survival is as low as that of no BCPR (8,12).
Increasing the shockable rhythm and survival rate by dispatcher-assisted cardiopulmonary resuscitation in Japan
2021, Resuscitation PlusCitation Excerpt :However, compared to the Only-BCPR group, the DA-BCPR group showed a greater correlation with the shockable rhythm rate improvement regardless of the time course. Dispatch assistance has been described worldwide, and BCPR with dispatch assistance demonstrates good post-OHCA outcomes, such as improving the survival rate, similar to BCPR without dispatch assistance.26–29 In a study investigating the correlation between DA-BCPR and survival rate, Rea et al. found that reducing the time from patient collapse to initiation of CPR improved the survival rate in both DA-BCPR and Only-BCPR groups compared to the No-BCPR group.22
Is anyone there?: Yes, The Call of Hope: Dispatcher-assisted CPR
2020, ResuscitationSurvival after dispatcher-assisted cardiopulmonary resuscitation in out-of-hospital cardiac arrest
2020, ResuscitationCitation Excerpt :We found spontaneous CPR to be associated with a significantly higher survival compared with dispatcher-assisted CPR. This is in line with a recent large study from France.11 However, our finding is slightly different from some previous reports showing no statistically significant difference between spontaneous CPR and DA-CPR.