Skip Ribbon Commands
Skip to main content
SharePoint

PublicComment

 Feedback

If you have any comments or questions on this page, please email us at:
 

Dispatcher instruction in CPR

Question Type:
Intervention
Full Question:
Among adults and children who are in cardiac arrest outside of a hospital (P), does the ability of a dispatch system to provide CPR instructions (I), compared with a dispatch system where no CPR instruction are ever provided  (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, ROSC, delivery of bystander CPR, time to first shock, time to commence CPR, CPR parameters (O)?
Consensus on Science:
For the critical outcome of survival with favorable neurologic outcome, we have identified very-low-quality evidence from 2 RCTs,(Hallstrom 2000, N190; Rea 2010, 423) 2 cohort studies,(Akahane 2012, 1410; Goto 2014, e000499) and 1 before-after study.(Tanaka 2012, 1235) The level of evidence was downgraded for risk of bias, indirectness, and imprecision. Four studies reported no benefit in neurologic outcomes.(Hallstrom 2000, N190; Rea 2010, 423) (Akahane 2012, 1410; Goto 2014, e000499) The before-after study, which included dispatcher instructions to start compression-only CPR as part of a bundle of interventions used as part of a quality improvement initiative, noted improved neurologic outcomes at 12 months (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.2–2.76).(Tanaka 2012, 1235) For the critical outcome of survival, we identified very-low-quality evidence from 3 RCTs.(Hallstrom 2000, N190; Rea 2010, 423; Svensson 2010, 434) The level of evidence was downgraded for risk of bias, indirectness, and imprecision. Meta-analysis of these trials found an absolute survival benefit of 2.4% (95% CI, 0.1%–4.9%) in favor of telephone-assisted continuous chest compressions over telephone-assisted traditional CPR (number needed to treat, 41; 95% CI, 20–1250; relative risk [RR], 1.22; 95% CI, 1.01–1.46).(Hupfl 2010, 1552)We also identified 6 before-after studies.(Eisenberg 1985, 47; Culley 1991, 362; Vaillancourt 2007, 877; Bray 2011, 1393; Tanaka 2012, 1235; Stipulante 2014, 177) One study was inconsistent with the others and found decreased survival, although it was not powered to evaluate survival outcomes.(Vaillancourt 2007, 877) One study showed a survival benefit at 1 year (population of 73 patients) from an educational program for dispatchers on continuous chest compressions and agonal breaths (adjusted OR, 1.81; 95% CI, 1.20–2.76).(Tanaka 2012, 1235) We also identified 5 cohort studies.(Bang 1999, 175; Rea 2001, 2513; Kuisma 2005, 89; Akahane 2012, 1410; Goto 2014, e000499) One study showed a survival benefit at 30 days when, after an educational program, telephone-assisted CPR was provided to a pediatric out-of-hospital cardiac arrest (OHCA) population versus not (adjusted OR, 1.46; 95% CI, 1.05–2.03).(Akahane 2012, 1410) A second cohort study in the pediatric (less than 18 years of age) population showed survival benefit at 30 days when telephone-assisted CPR was provided (adjusted OR for group not receiving CPR, 0.70; 95% CI, 0.56–0.88).(Goto 2014, e000499) For the critical outcome of ROSC, we identified very-low-quality evidence from 1 RCT(Rea 2010, 423) and 1 before-after study.(Vaillancourt 2007, 877) The studies were downgraded for indirectness and imprecision. Neither study showed a statistically significant benefit.For the important outcome of delivery of bystander CPR, we identified very-low-quality evidence from 6 before-after studies: 1 study compared 2 medical priority dispatch system versions,(Bray 2011, 1393) 3 studies compared telephone-assisted CPR versus not,(Eisenberg 1985, 47; Culley 1991, 362; Vaillancourt 2007, 877)and 2 studies(Tanaka 2012, 1235; Stipulante 2014, 177) compared various educational programs. In addition, we identified 1 cohort study.(Akahane 2012, 1410) The level of evidence was downgraded for indirectness and imprecision. All showed a strong association between telephone-assisted CPR and bystander CPR. The cohort study showed increased performed chest compressions (adjusted OR, 6.04; 95% CI, 4.72–7.72) and ventilation (adjusted OR, 3.10; 95% CI, 2.44–3.95) from telephone-assisted CPR, and an absolute increase in bystander CPR rate of 40.9% (95% CI, 36.1–45.5).(Akahane 2012, 1410) For the important outcome of time to commence CPR, we have identified very-low-quality evidence from 4 before-after studies(Eisenberg 1985, 47; Culley 1991, 362; Tanaka 2012, 1235; Stipulante 2014, 177) and 1 cohort study.(Rea 2001, 2513) The level of evidence was downgraded for risk of bias, inconsistency, indirectness, and imprecision. None of these reported a statistically significant benefit. For the important outcome of CPR parameter, assessed with initial rhythm of ventricular fibrillation (VF)/ventricular tachycardia (VT), we have identified very-low-quality evidence from 1 RCT(Svensson 2010, 434) and 1 before-after study.(Vaillancourt 2007, 877) The studies were downgraded for risk of bias, indirectness, and imprecision. Neither study showed a statistically significant benefit.
Treatment Recommendation:
We recommend that dispatchers provide chest compression–only CPR instructions to callers for adults with suspected OHCA (strong recommendation, low-quality evidence).Values, Preferences, and Task Force InsightsIn making these recommendations, we placed a higher value on the initiation of bystander CPR and a lower value on the harms of performing CPR on patients who are not in cardiac arrest. We recognize that the evidence in support of these recommendations comes from randomized trials and observational data of variable quality. However, the available evidence consistently favors telephone CPR protocols that use a compression-only CPR instruction set, suggesting a dose effect—that is, quick telephone instructions in chest compressions result in more compressions and faster administration of CPR to the patient.
CoSTR Attachments:
BLS 359 GRADE Evidence Table for Dispatch-CPR Instructions_Jan 30 2015 v3 DALLAS_n.docx    

 Contact Us

 
If you have any comments or questions on this page, please email us at: