The role of dispatch-assisted cardiopulmonary resuscitation in out of hospital cardiac arrest = The role of dispatch-assisted cardiopulmonary resuscitation in out of hospital cardiac arrest

다국어 초록 (Multilingual Abstract)

Background: Role of layperson cardiopulmonary resuscitation(CPR) is critical in survival out-of hospital cardiac arrest(OHCA). We investigated the role of dispatcher-assisted bystander CPR(DA-BCPR) on the prehospital aspect. Method: DA-BCPR protocol was newly implemented in centralized single dispatch center in a metropolitan city where 114 ambulances and 1,200 EMS crew give service with intermediate level for 10 million people since Jan. 2011. The protocol was as follows if the dispatcher identifies the OHCA victim, the dispatcher transfers the call to medical control team (one nurse and one EMS physician for each duty) immediately. Pre-arrival instruction of hand-only CPR was provided by medical control team before ambulance arrived at the scene. We collected Utsteinerisk factors from ambulance run sheet and cardiac arrest registry from Jan. to August, 2011. The primary endpoint was initial electrocardiogram of the OHCA victim. We compared outcomes between those not received bystander CPR (NBCPR) with DA-BCPR and bystander CPR without dispatcher assistance (ND-BCPR). Multivariate logistic regression analysis was done. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for the association with adjusting for age, EMS response time, arrest place and witness state. Results: Of 3,812 patients of EMS assessed patients with OHCA, total 1,562 cases were analyzed, excluding 274 cases of unknown outcome, 817 case of non-cardiac origin, 212 cases of resuscitation-not attempted, 529 cases of those CPR instructed by other organizations, 246 cases of those without information about bystander cpr, and 172 cases of EMS-witnessed arrests. Of these, there remained 939 of Non-bystander CPR (NB-CPR, 60.1%), 469 of DA-BCPR (30.0%) and 127 of ND-BCPR (9.9%). Rate of shockable rhythm as an intial rhythm for total group was 19.9%, NB-CPR 16.0 %, DA-BCPR 23.0% and ND-BCPR 34.4%, respectively. When we compared the DA-BCPR and ND-BCPR compared to NB-CPR, OR (95% CI) was 1.43 (1.1-2.0) and 1.63(1.1-2.49), respectively.(Adjusted for sex, age, EMS response time, arrest place and witness) Conclusion: Dispatcher-assisted bystander CPR significantly resulted in shockable rhythm in OHCA victims. By performing DA-BCPR, OHCA victim`s chance of survival may improve. Further study needs to be done.