Review| Volume 138, P82-105, May 2019

A systematic review and meta-analysis of the effect of dispatcher-assisted CPR on outcomes from sudden cardiac arrest in adults and children



      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.


      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.


      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.


      These results support the recommendation that dispatchers provide CPR instructions to callers for adults and children with suspected OHCA.
      Review registration: PROSPERO- CRD42018091427.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • World Health Organization
        The top 10 causes of death. Media centre 2014.
        • Berdowski J.
        Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies.
        Resuscitation. 2010; 81: 1479-1487
      1. Committee on the Treatment of Cardiac Arrest: Current Status and Future Directions; Board on Health Sciences Policy; Institute of Medicine Graham R. McCoy M.A. Schultz A.M. Strategies to improve cardiac arrest survival: a time to act. National Academies Press (US), Washington (DC)2015 (Sep 29)
        • Stiell I.G.
        • Wells G.A.
        • Field B.
        • et al.
        Advanced cardiac life support in out-of-hospital cardiac arrest.
        N Engl J Med. 2004; 351 (647-65635% bystander CPR)
        • Herlitz J.
        • Eek M.
        • Holmberg M.
        • et al.
        Characteristics and outcome among patients having out of hospital cardiac arrest at home compared with elsewhere.
        Heart. 2002; 88: 579-582
        • Sasson C.
        • Rogers M.A.M.
        • Dahl J.
        • Kellerman A.L.
        Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.
        Circ Cardiovasc Qual Outcomes. 2010; 3: 63-81
        • Anderson M.L.
        • Cox M.
        • Al-Khatib S.M.
        • et al.
        Rates of cardiopulmonary resuscitation training in the United States.
        JAMA Intern Med. 2014; 174: 194-201
        • Rea T.D.
        • Eisenberg M.S.
        • Culley L.L.
        • Becker L.
        Dispatcher-assisted cardiopulmonary resuscitation and survival in cardiac arrest.
        Circulation. 2001; 104: 2513-2516
        • Bohm K.
        • Vaillancourt C.
        • Charette M.L.
        • Dunford J.
        • Castrén M.
        In patients with out-of-hospital cardiac arrest, does the provision of dispatch cardiopulmonary resuscitation instructions as opposed to no instructions improve outcome: a systematic review of the literature.
        Resuscitation. 2011; 82: 1490-1495
      2. ILCOR Continuous Evidence Evaluation (CEE) and Consensus on Science and Treatment Recommendations (CoSTRs) process. [Last accessed 17 July 2018].

        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339b2700
      3. Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. [Last accessed 17 July 2018].

      4. Cochrane methods group Tool to Assess Risk of Bias in Cohort Studies. [Last accessed 17 July 2018].

        • Higgins J.P.
        • Thompson S.G.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Akahane M.
        • Ogawa T.
        • Tanabe S.
        • et al.
        Impact of telephone dispatcher assistance on the outcomes of pediatric out-of-hospital cardiac arrest.
        Crit Care Med. 2012; 40: 1410-1416
        • Bang A.
        • Biber B.
        • Isaksson L.
        • Lindqvist J.
        • Herlitz J.
        Evaluation of dispatcher-assisted cardiopulmonary resuscitation.
        Eur J Emerg Med. 1999; 6: 175-183
        • Besnier E.
        • Damm C.
        • Jardel B.
        • Veber B.
        • Compere V.
        • Dureuil B.
        Dispatcher-assisted cardiopulmonary resuscitation protocol improves diagnosis and resuscitation recommendations for out-of-hospital cardiac arrest.
        Emerg Med Australas. 2015; 27: 590-596
        • Chang I.
        • Lee S.C.
        • Shin S.D.
        • et al.
        Effects of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological recovery in pediatric patients with out-of-hospital cardiac arrest based on the pre-hospital emergency medical service response time interval.
        Resuscitation. 2018; 130: 49-56
        • Culley L.L.
        • Clark J.J.
        • Eisenberg M.S.
        • Larsen M.P.
        Dispatcher-assisted telephone CPR: common delays and time standards for delivery.
        Ann Emerg Med. 1991; 20: 362-366
        • Dami F.
        • Heymann E.
        • Pasquier M.
        • Fuchs V.
        • Carron P.N.
        • Hugli O.
        Time to identify cardiac arrest and provide dispatch-assisted cardio-pulmonary resuscitation in a criteria-based dispatch system.
        Resuscitation. 2015; 97: 27-33
        • Dami F.
        • Carron P.N.
        • Praz L.
        • Fuchs V.
        • Yersin B.
        Why bystanders decline telephone cardiac resuscitation advice.
        Acad Emerg Med. 2010; 17: 1012-1015
        • Eisenberg M.S.
        • Hallstrom A.P.
        • Carter W.B.
        • Cummins R.O.
        • Bergner L.
        • Pierce J.
        Emergency CPR instruction via telephone.
        Am J Public Health. 1985; 75: 47-50
        • Fujie K.
        • Nakata Y.
        • Yasuda S.
        • Mizutani T.
        • Hashimoto K.
        Do dispatcher instructions facilitate bystander-initiated cardiopulmonary resuscitation and improve outcomes in patients with out-of-hospital cardiac arrest? A comparison of family and non-family bystanders.
        Resuscitation. 2014; 85: 315-319
        • Fukushima H.
        • Imanishi M.
        • Iwami T.
        • et al.
        Abnormal breathing of sudden cardiac arrest victims described by laypersons and its association with emergency medical service dispatcher-assisted cardiopulmonary resuscitation instruction.
        Emerg Med J. 2015; 32: 314-317
        • Fukushima H.
        • Kawai Y.
        • Asai H.
        • et al.
        Performance review of regional emergency medical service pre-arrival cardiopulmonary resuscitation with or without dispatcher instruction: a population-based observational study.
        Acute Med Surg. 2017; 4: 293-299
        • Goto Y.
        • Maeda T.
        • Goto Y.
        Impact of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological outcomes in children with out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study.
        J Am Heart Assoc. 2014; 3e000499
        • Gotz J.
        • Petutschnigg B.
        • Wasler A.
        • Wran-Schumer D.
        • Hansak P.
        Bystander resuscitation as a measure of success.
        Notf Rett Med. 2017; 20: 470-476
        • Harjanto S.
        • Na M.X.
        • Hao Y.
        • et al.
        A before-after interventional trial of dispatcher-assisted cardio-pulmonary resuscitation for out-of-hospital cardiac arrests in Singapore.
        Resuscitation. 2016; 102: 85-93
        • Hiltunen P.V.
        • Silfvast T.O.
        • Jantti T.H.
        • Kuisma M.J.
        • Kurola J.O.
        • FINNRESUSCI Prehospital Study Group
        Emergency dispatch process and patient outcome in bystander-witnessed out-of-hospital cardiac arrest with a shockable rhythm.
        Eur J Emerg Med. 2015; 22: 266-272
        • Iwamura T.
        • Sakamoto Y.
        • Kutsukata N.
        • et al.
        An Utstein-style examination of out-of-hospital cardiac arrest patients in Saga Prefecture, Japan.
        J Nippon Med Sch. 2013; 80: 184-191
        • Japanese Circulation Society Resuscitation Science Study Group
        Chest-compression-only bystander cardiopulmonary resuscitation in the 30:2 compression-to-ventilation ratio era. Nationwide observational study.
        Circ J. 2013; 77: 2742-2750
        • Kuisma M.
        • Boyd J.
        • Vayrynen T.
        • Repo J.
        • Nousila-Wiik M.
        • Holmstrom P.
        Emergency call processing and survival from out-of-hospital ventricular fibrillation.
        Resuscitation. 2005; 67: 89-93
        • Lee Y.J.
        • Song K.J.
        • Shin S.D.
        • et al.
        Dispatcher-assisted cardiopulmonary resuscitation program and outcomes after pediatric out-of-hospital cardiac arrest.
        Pediatric Emerg Care. 2017; (Epub ahead of print)
        • Lewis M.
        • Stubbs B.A.
        • Eisenberg M.S.
        Dispatcher-assisted cardiopulmonary resuscitation: time to identify cardiac arrest and deliver chest compression instructions.
        Circulation. 2013; 128: 1522-1530
        • Moriwaki Y.
        • Tahara Y.
        • Kosuge T.
        • Suzuki N.
        The effect of telephone advice on cardiopulmonary resuscitation (CPR) on the rate of bystander CPR in out-of-hospital cardiopulmonary arrest in a typical urban area.
        Hong Kong J Emerg Med. 2016; 23: 220-226
        • Oman G.
        • Bury G.
        Use of telephone CPR advice in Ireland: uptake by callers and delays in the assessment process.
        Resuscitation. 2016; 102: 6-10
        • Park J.H.
        • Ro Y.S.
        • Shin S.D.
        • Song K.J.
        • Hong K.J.
        • Kong S.Y.
        Dispatcher-assisted bystander cardiopulmonary resuscitation in rural and urban areas and survival outcomes after out-of-hospital cardiac arrest.
        Resuscitation. 2018; 125: 1-7
        • Rea T.D.
        • Fahrenbruch C.
        • Culley L.
        • et al.
        CPR with chest compression alone or with rescue breathing.
        N Engl J Med. 2010; 363: 423-433
        • Ro Y.S.
        • Shin S.D.
        • Song K.J.
        • et al.
        Effects of dispatcher-assisted cardiopulmonary resuscitation on survival outcomes in infants, children, and adolescents with out-of-hospital cardiac arrests.
        Resuscitation. 2016; 108: 20-26
        • Ro Y.S.
        • Shin S.D.
        • Lee Y.J.
        • et al.
        Effect of dispatcher-assisted cardiopulmonary resuscitation program and location of out-of-hospital cardiac arrest on survival and neurologic outcome.
        Ann Emerg Med. 2017; 69 (52-61.e1)
        • Shah M.
        • Bartram C.
        • Irwin K.
        • et al.
        Evaluating dispatch-assisted CPR using the CARES registry.
        Prehosp Emerg Care. 2018; 22: 222-228
        • Song K.J.
        • Shin S.D.
        • Park C.B.
        • et al.
        Dispatcher-assisted bystander cardiopulmonary resuscitation in a metropolitan city: a before-after population-based study.
        Resuscitation. 2014; 85: 34-41
        • Stipulante S.
        • Tubes R.
        • El Fassi M.
        • et al.
        Implementation of the ALERT algorithm, a new dispatcher-assisted telephone cardiopulmonary resuscitation protocol, in non-Advanced Medical Priority Dispatch System (AMPDS) Emergency Medical Services centres.
        Resuscitation. 2014; 85: 177-181
        • Takahashi H.
        • Sagisaka R.
        • Natsume Y.
        • Tanaka S.
        • Takyu H.
        • Tanaka H.
        Does dispatcher-assisted CPR generate the same outcomes as spontaneously delivered bystander CPR in Japan?.
        Am J Emerg Med. 2018; 36: 384-391
        • Takei Y.
        • Kamikura T.
        • Nishi T.
        • et al.
        Recruitments of trained citizen volunteering for conventional cardiopulmonary resuscitation are necessary to improve the outcome after out-of-hospital cardiac arrests in remote time-distance area: a nationwide population-based study.
        Resuscitation. 2016; 105: 100-108
        • Vaillancourt C.
        • Verma A.
        • Trickett J.
        • et al.
        Evaluating the effectiveness of dispatch-assisted cardiopulmonary resuscitation instructions.
        Acad Emerg Med. 2007; 14: 877-883
        • Viereck S.
        • Palsgaard Moller T.
        • Kjaer Ersboll A.
        • Folke F.
        • Lippert F.
        Effect of bystander CPR initiation prior to the emergency call on ROSC and 30day survival — an evaluation of 548 emergency calls.
        Resuscitation. 2017; 111: 55-61
        • Wu Z.
        • Panczyk M.
        • Spaite D.W.
        • et al.
        Telephone cardiopulmonary resuscitation is independently associated with improved survival and improved functional outcome after out-of-hospital cardiac arrest.
        Resuscitation. 2018; 122: 135-140
        • Olasveengen T.M.
        • de Caen A.R.
        • Mancini M.E.
        • et al.
        International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations summary.
        Resuscitation. 2017; 121: 201-214
        • Gräsner J.T.
        • Lefering R.
        • Koster R.W.
        • et al.
        EuReCa ONE-27 Nations, ONE Europe, ONE Registry: a prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe.
        Resuscitation. 2016; 105 (Epub 2016 Jun 16. Erratum in: Resuscitation. 2016 Dec; 109 :145-146): 188-195
        • Riou M.
        • Ball S.
        • Whiteside A.
        • Bray J.
        • et al.
        ‘We’re going to do CPR’: a linguistic study of the words used to initiate dispatcher-assisted CPR and their association with caller agreement.
        Resuscitation. 2018; 133: 95-100
        • Tsunoyama T.
        • Nakahara S.
        • Yoshida M.
        • Kitamura M.
        • Sakamoto T.
        Effectiveness of dispatcher training in increasing bystander chest compression for out-of-hospital cardiac arrest patients in Japan.
        Acute Med Surg. 2017; 4: 439
        • Haywood K.
        • Whitehead L.
        • Nadkarni V.M.
        • et al.
        COSCA (Core Outcome Set for Cardiac Arrest) in adults: an advisory statement from the international liaison committee on resuscitation.
        Resuscitation. 2018; 127: 147-163