title: In out-of-hospital cardiac arrest patients, does the description of any specific symptoms to the emergency medical dispatcher improve the accuracy of the diagnosis of cardiac arrest: a systematic review of the literature.
abstract: OBJECTIVE
  We sought to determine if, in patients with out-of-hospital cardiac arrest (OHCA), the description of any specific symptoms to the emergency medical dispatcher (EMD) improved the accuracy of the diagnosis of cardiac arrest.
  
  
  METHODS
  For this systematic review, we searched MEDLINE, EMBASE and the Cochrane Library with no restrictions, and hand-searched the gray literature. Eligible studies included dispatcher interaction with callers reporting OHCA, and reported diagnosis of cardiac arrest. Two independent reviewers used standardized forms and procedures to review papers for inclusion, quality, and to extract data from eligible studies. Findings were peer-reviewed by the International Liaison Committee on Resuscitation.
  
  
  RESULTS
  We identified 494 citations; 74 were selected for full evaluation (kappa=0.70) and 23 were included (kappa=0.68), including six before-after, two case-control, and 15 descriptive studies. One before-after study and ten descriptive studies report that inquiring about consciousness and breathing status can help dispatchers recognize cardiac arrest with moderate sensitivity [ranging from 38% to 97%], and high specificity [ranging from 95% to 99%]. One case-control study, three before-after studies, and four observational studies report that abnormal breathing is a significant barrier to cardiac arrest recognition. One before-after study and two descriptive studies report that seizure activity can be a manifestation of cardiac arrest.
  
  
  CONCLUSIONS
  Dispatchers should recognize cardiac arrest when a victim is described as unconscious and not breathing or not breathing normally, and consider cardiac arrest when generalized seizure is described. They should receive specific instructions on how to best recognize the presence of abnormal breathing.
authors.affiliation: Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada. cvaillancourt@ohri.ca
authors.forename: Christian
authors.initials: C
authors.lastname: Vaillancourt
authors.forename: Manya L
authors.initials: ML
authors.lastname: Charette
authors.forename: Katarina
authors.initials: K
authors.lastname: Bohm
authors.forename: James
authors.initials: J
authors.lastname: Dunford
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration*; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis* / Q000628:therapy; D015203:Reproducibility of Results