Abstract
Background
Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) has been reported in individual
studies to significantly increase the rate of bystander CPR and survival from cardiac
arrest.
Methods
We undertook a systematic review and meta-analysis to evaluate the impact of DA-CPR
programs on key clinical outcomes following out-of-hospital cardiac arrest. We searched
the PubMED, EMBASE, CINAHL, ERIC and Cochrane Central Register of Controlled Trials
databases from inception until July 2018. Eligible studies compared systems with and
without dispatcher-assisted CPR programs. The results of included studies were classified
into 3 categories for the purposes of more accurate analysis: comparison of outcomes
in systems with DA-CPR programs, case-based comparison of DA-CPR to bystander CPR,
and case-based comparisons of DA-CPR to no CPR before EMS arrival. The GRADE system
was used to assess certainty of evidence at an outcome level. We used random-effects
models to produce summary effect sizes across all outcomes.
Results
Of 5531 citations screened, 33 studies were eligible for inclusion. All included studies
were observational. Evidence certainty across all outcomes was assessed as low or
very low. In system-level and patient-level comparisons, the provision of DA-CPR compared
with no DA-CPR was consistently associated with improved outcome across all analyses.
Comparison of DA-CPR to bystander CPR produced conflicting results. Findings were
consistent across sensitivity analyses and the pediatric sub-group.
Conclusion
These results support the recommendation that dispatchers provide CPR instructions
to callers for adults and children with suspected OHCA.
Review registration: PROSPERO- CRD42018091427.
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Article info
Publication history
Published online: March 07, 2019
Accepted:
February 24,
2019
Received in revised form:
February 20,
2019
Received:
February 6,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
