A before-after interventional trial of dispatcher-assisted cardio-pulmonary resuscitation for out-of-hospital cardiac arrests in Singapore

Abstract

Aim: To evaluate the effects of a comprehensive dispatcher-assisted CPR (DACPR) training program on bystander CPR (BCPR) rate and the outcomes of out-of-hospital cardiac arrest (OHCA) in Singapore.

Methods: This is an initial program evaluation of a national DACPR intervention. A before-after analysis was conducted using OHCA cases retrieved from a local registry and DACPR information derived from audio recordings and ambulance notes. The primary outcomes were survival to admission, survival at 30 days post-arrest and good functional recovery.

Results: Data was collected before the intervention (April 2010 to December 2011), during the run-in period (January 2012 to June 2012) and after the intervention (July 2012 to February 2013). A total of 2968 cases were included in the study with a mean age of 65.6. Overall survival rate was 3.9% (116) with good functional recovery in 2.2% (66) of the patients. BCPR rate increased from 22.4% to 42.1% (p<0.001) with odds ratio (OR) of 2.52 (95% confidence interval [CI]: 2.09-3.04) and ROSC increased significantly from 26.5% to 31.2% (p=0.02) with OR of 1.26 (95%CI: 1.04-1.53) after the intervention. Significantly higher survival at 30 days was observed for patients who received BCPR from a trained person as compared to no BCPR (p=0.001, OR=2.07 [95%CI: 1.41-3.02]) and DACPR (p=0.04, OR=0.30 [95%CI: 0.04-2.18]).

Conclusion: A significant increase in BCPR and ROSC was observed after the intervention. There was a trend to suggest improved survival outcomes with the intervention pending further results from the trial.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Dispatcher-assisted; Survival.