Dainty K N, Debaty G, Waddick J, Vaillancourt C, Malta Hansen C, Olasveengen T, Bray J
North York General Hospital, Toronto Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto Canada.
Resusc Plus. 2024 Jul 23;19:100715. doi: 10.1016/j.resplu.2024.100715. eCollection 2024 Sep.
To review and summarize existing literature and knowledge gaps regarding interventions that have been tested to optimize dispatcher-assisted CPR (DA-CPR) instruction protocols for out-of-hospital cardiac arrest (OHCA).
This scoping review was undertaken by an International Liaison Committee on Resuscitation (ILCOR) Basic Life Support scoping review team and guided by the ILCOR methodological framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were published in peer-reviewed journals and evaluated interventions used to improve DA-CPR. The search was carried out in MEDLINE, EMBASE, Education Resources Information Center (ERIC), PsycINFO, the Cochrane Library, Evidence Based Medicine (EBM) Reviews, and the Campbell Library from 2000 to December 18, 2023.
After full text review, 31 studies were included in the final review. The interventions reviewed were use of video at the scene ( = 9), changes in terminology about compressions ( = 6), implementation of novel DA-CPR protocols ( = 4), advanced dispatcher training ( = 3), centralization of the dispatch center ( = 2), use of metronome or varied metronome rates ( = 2), change in CPR sequence and compression ratio ( = 1), animated audio-visual recording ( = 1), pre-recorded instructions vs. conversational live instructions ( = 1), inclusion of "undress patient" instructions ( = 1), and specific verbal encouragement ( = 1). Studies ranged in methodology from registry studies to randomized clinical trials with the majority being observational studies of simulated EMS calls for OHCA. Outcomes were highly variable but included rates of bystander CPR, confidence & willingness to perform CPR, time to initiation of bystander CPR, bystander CPR quality (including CPR metrics: chest compression depth and rate; chest compression fraction; full chest recoil, ventilation rate, overall CPR competency), rates of automated external defibrillator (AED) use, return of spontaneous circulation (ROSC) and survival. Overall, all interventions seem to be associated with potential improvement in bystander CPR and CPR metrics.
There appears to be trends towards improvement on key outcomes however more research is needed. This scoping review highlights the lack of high-quality clinical research on any of the tested interventions to improve DA-CPR. There is insufficient evidence to explore the effectiveness of any of these interventions via systematic review.
回顾和总结关于已测试的优化院外心脏骤停（OHCA）调度员辅助心肺复苏（DA-CPR）指导方案的现有文献及知识空白。
本范围综述由国际复苏联合会（ILCOR）基础生命支持范围综述小组开展，并以ILCOR方法框架和系统评价与Meta分析优先报告条目扩展版（PRISMA-ScR）为指导。若研究发表于同行评审期刊且评估了用于改善DA-CPR的干预措施，则有资格纳入。检索在MEDLINE、EMBASE、教育资源信息中心（ERIC）、PsycINFO、考克兰图书馆、循证医学（EBM）综述以及坎贝尔图书馆中进行，检索时间跨度为2000年至2023年12月18日。
经过全文评审，最终纳入31项研究。所综述的干预措施包括现场使用视频（n = 9）、按压术语的改变（n = 6）、实施新型DA-CPR方案（n = 4）、高级调度员培训（n = 3）、调度中心集中化（n = 2）、使用节拍器或不同的节拍器速率（n = 2）、心肺复苏顺序和按压比例的改变（n = 1）、动画视听记录（n = 1）、预录制指导与现场对话指导（n = 1）、纳入“为患者脱衣”指导（n = 1）以及特定的言语鼓励（n = 1）。研究方法从注册研究到随机临床试验不等，其中大多数是对模拟OHCA急救医疗服务呼叫的观察性研究。结果差异很大，但包括旁观者心肺复苏率、进行心肺复苏的信心和意愿、旁观者开始心肺复苏的时间、旁观者心肺复苏质量（包括心肺复苏指标：胸外按压深度和速率；胸外按压分数；完全胸廓回弹、通气速率、整体心肺复苏能力）、自动体外除颤器（AED）使用频率、自主循环恢复（ROSC）和生存率。总体而言，所有干预措施似乎都与旁观者心肺复苏及心肺复苏指标的潜在改善相关。
关键结果似乎有改善趋势，但仍需更多研究。本范围综述凸显了在任何已测试的改善DA-CPR的干预措施方面缺乏高质量临床研究。没有足够的证据通过系统评价来探究这些干预措施的有效性。
