Copenhagen Emergency Medical Services, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Scand J Trauma Resusc Emerg Med. 2021 May 24;29(1):70. doi: 10.1186/s13049-021-00875-5.
Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) increases neurologically intact survival in out-of-hospital cardiac arrest (OHCA) according to several studies. This systematic review summarizes neurologically intact survival outcomes of DA-CPR in comparison with bystander-initiated CPR and no bystander CPR in OHCA.
The systematic review was conducted according to the PRISMA guidelines. All studies including adult and/or pediatric OHCAs that compared DA-CPR with bystander-initiated CPR or no bystander CPR were included. Primary outcome was neurologically intact survival at discharge, one-month or longer. Studies were searched for in PubMed (MEDLINE), EMBASE, and the Cochrane Library databases. The risk of bias was evaluated using the Newcastle-Ottawa Scale.
The search string generated 4742 citations of which 33 studies were eligible for inclusion. Due to overlapping study populations, the review included 14 studies. All studies were observational. The study populations were heterogeneous and included adult, pediatric and mixed populations. Some studies reported only witnessed cardiac arrests, arrests of cardiac ethiology, and/or shockable rhythm. The individual studies scored between six and nine on the Newcastle-Ottawa Scale of risk of bias. The median neurologically intact survival at hospital discharge with DA-CPR was 7.0% (interquartile range (IQR): 5.1-10.8%), with bystander-initiated CPR 7.5% (IQR: 6.6-10.2%), and with no bystander CPR 4.4% (IQR: 2.0-9.0%) (four studies). At one-month neurologically intact survival with DA-CPR was 3.1% (IQR: 1.6-3.4%), with bystander-initiated CPR 5.7% (IQR: 5.0-6.0%), and with no bystander CPR 2.5% (IQR: 2.1-2.6%) (three studies).
Both DA-CPR and bystander-initiated CPR increase neurologically intact survival compared with no bystander CPR. However, DA-CPR demonstrates inferior outcomes compared with bystander-initiated CPR. Early CPR is crucial, thus in cases where bystanders have not initiated CPR, DA-CPR provides an opportunity to improve neurologically intact survival following OHCA. Variability in OHCA outcomes across studies and multiple confounding factors were identified.
多项研究表明，调度员辅助心肺复苏（DA-CPR）可提高院外心脏骤停（OHCA）患者神经功能完整存活率。本系统评价总结了 DA-CPR 与旁观者启动 CPR 和 OHCA 中无旁观者 CPR 相比的神经功能完整存活率结果。
本系统评价按照 PRISMA 指南进行。纳入了比较 DA-CPR 与旁观者启动 CPR 或无旁观者 CPR 的成人和/或儿科 OHCA 的所有研究。主要结局为出院时、1 个月或更长时间的神经功能完整存活率。在 PubMed（MEDLINE）、EMBASE 和 Cochrane 图书馆数据库中检索研究。使用纽卡斯尔-渥太华量表评估偏倚风险。
搜索字符串生成了 4742 条引文，其中 33 项研究符合纳入标准。由于重叠的研究人群，本综述纳入了 14 项研究。所有研究均为观察性研究。研究人群存在异质性，包括成人、儿科和混合人群。一些研究仅报告了目击性心脏骤停、心脏病因引起的骤停和/或可除颤性节律。个别研究在纽卡斯尔-渥太华量表上的偏倚风险评分为 6-9 分。DA-CPR 下的院内心肺复苏神经功能完整存活率中位数为 7.0%（四分位距（IQR）：5.1-10.8%），旁观者启动 CPR 为 7.5%（IQR：6.6-10.2%），无旁观者 CPR 为 4.4%（IQR：2.0-9.0%）（四项研究）。DA-CPR 下 1 个月时的神经功能完整存活率为 3.1%（IQR：1.6-3.4%），旁观者启动 CPR 为 5.7%（IQR：5.0-6.0%），无旁观者 CPR 为 2.5%（IQR：2.1-2.6%）（三项研究）。
与无旁观者 CPR 相比，DA-CPR 和旁观者启动 CPR 均可提高神经功能完整存活率。然而，与旁观者启动 CPR 相比，DA-CPR 的结局较差。早期 CPR 至关重要，因此，在旁观者尚未启动 CPR 的情况下，DA-CPR 为 OHCA 后提高神经功能完整存活率提供了机会。研究之间的 OHCA 结局存在变异性，且存在多种混杂因素。
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