International multi-center real world implementation trial to increase out-of-hospital cardiac arrest survival with a dispatcher-assisted cardio-pulmonary resuscitation package (Pan-Asian resuscitation outcomes study phase 2)

Marcus Eng Hock Ong; Sang Do Shin; Patrick Chow-In Ko; Xinyi Lin; Matthew Huei-Ming Ma; Hyun Wook Ryoo; Kwanhathai Darin Wong; Jirapong Supasaowapak; Chih-Hao Lin; Chan-Wei Kuo; Ramana Rao; Wenwei Cai; Faith Joan Gaerlan; Munawar Khursheed; Do Ngoc Son; Karim Sarah; Mazen El Sayed; Saad Al Qahtani; Hideharu Tanaka

doi:10.1016/j.resuscitation.2021.12.032

International multi-center real world implementation trial to increase out-of-hospital cardiac arrest survival with a dispatcher-assisted cardio-pulmonary resuscitation package (Pan-Asian resuscitation outcomes study phase 2)

Resuscitation. 2022 Feb:171:80-89. doi: 10.1016/j.resuscitation.2021.12.032. Epub 2021 Dec 30.

Authors

Marcus Eng Hock Ong¹, Sang Do Shin², Patrick Chow-In Ko³, Xinyi Lin⁴, Matthew Huei-Ming Ma⁵, Hyun Wook Ryoo⁶, Kwanhathai Darin Wong⁷, Jirapong Supasaowapak⁸, Chih-Hao Lin⁹, Chan-Wei Kuo¹⁰, Ramana Rao¹¹, Wenwei Cai¹², Faith Joan Gaerlan¹³, Munawar Khursheed¹⁴, Do Ngoc Son¹⁵, Karim Sarah¹⁶, Mazen El Sayed¹⁷, Saad Al Qahtani¹⁸, Hideharu Tanaka¹⁹

Affiliations

¹ Prehospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore. Electronic address: marcus.ong@duke-nus.edu.sg.
² Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
³ Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁴ Singapore Clinical Research Institute, Singapore, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.
⁵ Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan.
⁶ Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
⁷ Emergency Department, Hospital Pulau Pinang, Penang, Malaysia.
⁸ Department of Emergency Medicine, Rajavithi Hospital, Bangkok, Thailand.
⁹ Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹⁰ Department of Emergency Medicine, Chang-Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
¹¹ GVK Emergency Management and Research Institute (GVK EMRI), Secunderabad, Telangana, India.
¹² Department of Emergency Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
¹³ Southern Philippines Medical Center, Davao, Philippines.
¹⁴ Emergency Department, National Institute of Cardiovascular Diseases, Karachi, Pakistan.
¹⁵ Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam.
¹⁶ Department of Emergency Medicine, Hospital Sungai Buloh, Sungai Buloh, Selangor, Malaysia.
¹⁷ Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon.
¹⁸ National Ambulance, Abu Dhabi, United Arab Emirates; Department of Health Science, Saudi Electronic University, Saudi Arabia.
¹⁹ Department of EMS System, Graduate School, Kokushikan University, Tokyo, Japan.

PMID: 34974143
DOI: 10.1016/j.resuscitation.2021.12.032

Abstract

Background: Dispatcher-assisted CPR (DA-CPR) has the potential to deliver early bystander CPR (BCPR) and improve out-of-hospital cardiac arrest (OHCA) survival. This study in the Asia-Pacific evaluated the impact of a DA-CPR program on BCPR rates and survival.

Methods: This was a three-arm, prospective, multi-national, population-based, community-level, implementation trial. Cases between January 2009 and June 2018 from the Pan-Asian Resuscitation Outcomes Study were included. Sites either implemented a comprehensive (with quality improvement tool) or a basic DA-CPR package, or served as controls. Primary outcome was survival-to-discharge/30th day post-arrest. Secondary outcomes were BCPR and favorable neurological outcome. A before-after comparison was made within each country; this before-after change was then compared across the three groups using logistic regression.

Results: 170,687 cases were analyzed. Before-after comparison showed that survival to discharge was higher in the 'implementation' period in all three groups: comprehensive odds ratio (OR) 1.09, 95% confidence interval (CI; [1.0-1.19]); basic OR 1.14, 95% CI (1.08-1.2); and control OR 1.25, 95% CI (1.02-1.53). Comparing between groups, the comprehensive group had significantly higher change in BCPR (comprehensive vs control ratio of OR 1.86, 95% CI [1.66-2.09]; basic vs control ratio of OR 0.94, 95% CI [0.85-1.05]; and comprehensive vs basic ratio of OR 1.97, 95% CI [1.87-2.08]) and survival with favorable neurological outcome (comprehensive vs basic ratio of OR 1.2, 95% CI [1.04-1.39]).

Conclusion: We evaluated the impact of a DA-CPR program across heterogeneous EMS systems and demonstrated that a comprehensive DA-CPR program had the most impact on BCPR and favorable neurological outcome.

Keywords: Asia-Pacific; Bystander CPR; Cardiopulmonary resuscitation; Dispatcher-assisted CPR; Emergency medical services, dispatch; Out-of-hospital cardiac arrest; Registry; Telephone CPR.

Publication types

Clinical Trial, Phase II
Research Support, Non-U.S. Gov't

MeSH terms

Cardiopulmonary Resuscitation*
Emergency Medical Services*
Humans
Out-of-Hospital Cardiac Arrest* / therapy
Patient Discharge
Prospective Studies
Quality Improvement