Department of Cardiology and Cardiac Intensive Care, Konstantopouleio General Hospital, Agias Olgas 3-5, Nea Ionia, Athens, 142 33, Greece.
Office of Research & Innovation, North York General Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Resuscitation. 2019 May;138:82-105. doi: 10.1016/j.resuscitation.2019.02.035. Epub 2019 Mar 8.
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.
调度员辅助心肺复苏（DA-CPR）在个别研究中已被报道可显著提高旁观者 CPR 的比例和心脏骤停患者的存活率。
我们进行了系统评价和荟萃分析，以评估 DA-CPR 方案对院外心脏骤停后关键临床结局的影响。我们从建库起至 2018 年 7 月检索了 PubMED、EMBASE、CINAHL、ERIC 和 Cochrane 对照试验中心注册数据库。合格的研究比较了有和没有调度员辅助 CPR 方案的系统。为了更准确地分析，将纳入研究的结果分为 3 类：有和没有 DA-CPR 方案的系统中结果的比较、DA-CPR 与旁观者 CPR 的病例比较，以及 EMS 到达前 DA-CPR 与无 CPR 的病例比较。使用 GRADE 系统评估结局水平的证据确定性。我们使用随机效应模型产生所有结局的综合效应量。
在筛选出的 5531 条引文中，有 33 项研究符合纳入标准。所有纳入的研究均为观察性研究。所有结局的证据确定性均评估为低或极低。在系统水平和患者水平的比较中，与没有 DA-CPR 相比，提供 DA-CPR 与所有分析的改善结局一致相关。DA-CPR 与旁观者 CPR 的比较产生了相互矛盾的结果。敏感性分析和儿科亚组的结果一致。
这些结果支持建议调度员为怀疑发生院外心脏骤停的成人和儿童拨打者提供 CPR 指导。审查注册：PROSPERO-CRD42018091427。
