Elsevier

Resuscitation

Volume 144, November 2019, Pages 91-98
Resuscitation

Clinical paper
Effect 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

https://doi.org/10.1016/j.resuscitation.2019.08.032Get rights and content

Abstract

Aim

Cardiac arrest (CA) was considered irreversible until 1960, when basic cardiopulmonary resuscitation (CPR) was defined. CPR guidelines include early recognition of CA, rapid and effective CPR, effective defibrillation strategies and organized post-resuscitation to ensure a strengthening of the survival chain. Bystanders are the key to extremely early management, which is associated with the early medical care provided by EMS. This study aims to assess the prognosis of a bystander’s cardiac CPR when it is initiated by the Dispatch Centre (DC).

Methods

We included patients in 3 groups according to who initiated the CPR. The groups were matched according to multiple propensity partition methods. We presented our results in terms of 30-day survival and neurological prognosis.

Results

85,634 patients were included. Statistical study focused on 18,185 patients once the exclusion criteria were applied. 12,743 (70.1%) are men and the average age is 70.1 years. Survival at D30 was 5.11% in the absence of CPR, 8.86% with bystander initiation and 7.35% with DC initiation (p < 0.001). Survival at D30 with favourable neurologic prognosis (CPC 1–2) was 76.30%, 83.69% and 82.82%, respectively. Our results show a 3.75% increase in the chance of survival at D30 if CPR was initiated by bystanders compared to patients for whom CPR was not initiated, a 2.25% increase in survival in the group that received from CPR initiated by the DC compared to the group that did not receive CPR.

Conclusions

Bystander CPR initiated by the DC represents a suitable option following out-of-hospital cardiac arrest.

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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