Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 24;29(1):70.
doi: 10.1186/s13049-021-00875-5.

Impact of dispatcher-assisted cardiopulmonary resuscitation on neurologically intact survival in out-of-hospital cardiac arrest: a systematic review

Kristine Elisabeth Eberhard  1 , Gitte Linderoth  2   3   4 , Mads Christian Tofte Gregers  2   3 , Freddy Lippert  2   3 , Fredrik Folke  2   3   5
Affiliations

Impact of dispatcher-assisted cardiopulmonary resuscitation on neurologically intact survival in out-of-hospital cardiac arrest: a systematic review

Kristine Elisabeth Eberhard et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) increases neurologically intact survival in out-of-hospital cardiac arrest (OHCA) according to several studies. This systematic review summarizes neurologically intact survival outcomes of DA-CPR in comparison with bystander-initiated CPR and no bystander CPR in OHCA.

Methods: The systematic review was conducted according to the PRISMA guidelines. All studies including adult and/or pediatric OHCAs that compared DA-CPR with bystander-initiated CPR or no bystander CPR were included. Primary outcome was neurologically intact survival at discharge, one-month or longer. Studies were searched for in PubMed (MEDLINE), EMBASE, and the Cochrane Library databases. The risk of bias was evaluated using the Newcastle-Ottawa Scale.

Results: The search string generated 4742 citations of which 33 studies were eligible for inclusion. Due to overlapping study populations, the review included 14 studies. All studies were observational. The study populations were heterogeneous and included adult, pediatric and mixed populations. Some studies reported only witnessed cardiac arrests, arrests of cardiac ethiology, and/or shockable rhythm. The individual studies scored between six and nine on the Newcastle-Ottawa Scale of risk of bias. The median neurologically intact survival at hospital discharge with DA-CPR was 7.0% (interquartile range (IQR): 5.1-10.8%), with bystander-initiated CPR 7.5% (IQR: 6.6-10.2%), and with no bystander CPR 4.4% (IQR: 2.0-9.0%) (four studies). At one-month neurologically intact survival with DA-CPR was 3.1% (IQR: 1.6-3.4%), with bystander-initiated CPR 5.7% (IQR: 5.0-6.0%), and with no bystander CPR 2.5% (IQR: 2.1-2.6%) (three studies).

Conclusion: Both DA-CPR and bystander-initiated CPR increase neurologically intact survival compared with no bystander CPR. However, DA-CPR demonstrates inferior outcomes compared with bystander-initiated CPR. Early CPR is crucial, thus in cases where bystanders have not initiated CPR, DA-CPR provides an opportunity to improve neurologically intact survival following OHCA. Variability in OHCA outcomes across studies and multiple confounding factors were identified.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; DA-CPR; Dispatcher-assisted CPR; Emergency medical services; Medical dispatch; Out-of-hospital cardiac arrest; Systematic review; T-CPR; Telephone-assisted CPR.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of the study selection process
Fig. 2
Fig. 2
Forest plot of the unadjusted and adjusted neurologically intact survival outcomes at discharge and one-month. Red diamond represents the unadjusted/adjusted odds ratio of bystander CPR with DA with no bystander CPR as reference. Black star represents unadjusted/adjusted odds ratio between bystander CPR without DA and no bystander CPR. Black lines are confidence intervals. NB. The individual studies have adjusted for different factors. Details are provided in Table 3. CPC, Cerebral Performance Category; CPR, cardiopulmonary resuscitation; DA, dispatcher assistance
Fig. 3
Fig. 3
Median neurologically intact survival defined as Cerebral Performance Category (CPC) 1 or 2 at hospital discharge or one-month with interquartile range (IQR) and minimum/maximum range according to bystander CPR status. Horizontal line within boxes represents median, upper and lower border of boxes reflect IQR, and the black lines show the range of the observations. Details are reported in Table 3. DA, dispatcher assistance; CPC, Cerebral Performance Category; CPR, cardiopulmonary resuscitation
Fig. 4
Fig. 4
Median survival to hospital discharge or one-month survival with interquartile range (IQR) and minimum/maximum range according to bystander CPR status. Horizontal line within boxes represents median, upper and lower border of boxes reflect the IQR, and the black lines show the range of the observations. Details are provided in Table 5. DA, dispatcher assistance; CPR, cardiopulmonary resuscitation
See this image and copyright information in PMC

References

    1. World Health Organization. The top 10 causes of death. 2018. http://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death: [Accessed 10 Nov 2020].
    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Executive summary: heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133(4):447–454. doi: 10.1161/CIR.0000000000000366. - DOI - PubMed
    1. Atwood C, Eisenberg MS, Herlitz J, Rea TD. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation. 2005;67(1):75–80. doi: 10.1016/j.resuscitation.2005.03.021. - DOI - PubMed
    1. Berdowski J, Berg RA, Tijssen JGP, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010;81(11):1479–1487. doi: 10.1016/j.resuscitation.2010.08.006. - DOI - PubMed
    1. Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med. 1993;22(11):1652–1658. doi: 10.1016/S0196-0644(05)81302-2. - DOI - PubMed

Publication types