International multi-center real world implementation trial to increase out-of-hospital cardiac arrest survival with a dispatcher-assisted cardio-pulmonary resuscitation package (Pan-Asian resuscitation outcomes study phase 2)

Ong MEH 1 , Shin SD 2 , Ko PC 3 , Lin X 4 , Ma MH 5 , Ryoo HW 6 Show all authors , Wong KD 7 , Supasaowapak J 8 , Lin CH 9 , Kuo CW 10 , Rao R 11 , Cai W 12 , Gaerlan FJ 13 , Khursheed M 14 , Son DN 15 , Sarah K 16 , El Sayed M 17 , Al Qahtani S 18 , Tanaka H 19

Affiliations 

  • 1 Prehospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore. Electronic address: marcus.ong@duke-nus.edu.sg
  • 2 Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
  • 3 Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
  • 4 Singapore Clinical Research Institute, Singapore, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
  • 5 Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
  • 6 Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
  • 7 Emergency Department, Hospital Pulau Pinang, Penang, Malaysia
  • 8 Department of Emergency Medicine, Rajavithi Hospital, Bangkok, Thailand
  • 9 Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 10 Department of Emergency Medicine, Chang-Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
  • 11 GVK Emergency Management and Research Institute (GVK EMRI), Secunderabad, Telangana, India
  • 12 Department of Emergency Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
  • 13 Southern Philippines Medical Center, Davao, Philippines
  • 14 Emergency Department, National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • 15 Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Viet Nam
  • 16 Department of Emergency Medicine, Hospital Sungai Buloh, Sungai Buloh, Selangor, Malaysia
  • 17 Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon
  • 18 National Ambulance, Abu Dhabi, United Arab Emirates; Department of Health Science, Saudi Electronic University, Saudi Arabia
  • 19 Department of EMS System, Graduate School, Kokushikan University, Tokyo, Japan
Resuscitation, 2022 Feb;171:80-89.
PMID: 34974143 DOI: 10.1016/j.resuscitation.2021.12.032

Abstract

BACKGROUND: Dispatcher-assisted CPR (DA-CPR) has the potential to deliver early bystander CPR (BCPR) and improve out-of-hospital cardiac arrest (OHCA) survival. This study in the Asia-Pacific evaluated the impact of a DA-CPR program on BCPR rates and survival.

METHODS: This was a three-arm, prospective, multi-national, population-based, community-level, implementation trial. Cases between January 2009 and June 2018 from the Pan-Asian Resuscitation Outcomes Study were included. Sites either implemented a comprehensive (with quality improvement tool) or a basic DA-CPR package, or served as controls. Primary outcome was survival-to-discharge/30th day post-arrest. Secondary outcomes were BCPR and favorable neurological outcome. A before-after comparison was made within each country; this before-after change was then compared across the three groups using logistic regression.

RESULTS: 170,687 cases were analyzed. Before-after comparison showed that survival to discharge was higher in the 'implementation' period in all three groups: comprehensive odds ratio (OR) 1.09, 95% confidence interval (CI; [1.0-1.19]); basic OR 1.14, 95% CI (1.08-1.2); and control OR 1.25, 95% CI (1.02-1.53). Comparing between groups, the comprehensive group had significantly higher change in BCPR (comprehensive vs control ratio of OR 1.86, 95% CI [1.66-2.09]; basic vs control ratio of OR 0.94, 95% CI [0.85-1.05]; and comprehensive vs basic ratio of OR 1.97, 95% CI [1.87-2.08]) and survival with favorable neurological outcome (comprehensive vs basic ratio of OR 1.2, 95% CI [1.04-1.39]).

CONCLUSION: We evaluated the impact of a DA-CPR program across heterogeneous EMS systems and demonstrated that a comprehensive DA-CPR program had the most impact on BCPR and favorable neurological outcome.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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