title: Changing EMS dispatcher CPR instructions to 400 compressions before mouth-to-mouth improved bystander CPR rates.
abstract: BACKGROUND
  To examine the impact of changing dispatcher CPR instructions (400 compressions: 2 breaths, followed by 100:2 ratio) on rates of bystander CPR and survival in adults with presumed cardiac out-of-hospital arrest (OHCA) in Melbourne, Australia.
  
  
  METHODS
  The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for OHCA where Emergency Medical Services (EMS) attempted CPR between August 2006 and August 2009. OHCA included were: (1) patients aged ≥18 years old; (2) presumed cardiac etiology; and (3) not witnessed by EMS.
  
  
  RESULTS
  For the pre- and post-study periods, 1021 and 2101 OHCAs met inclusion criteria, respectively. Rates of bystander CPR increased overall (45-55%, p<0.001) and by initial rhythm (shockable 55-70%, p<0.001 and non-shockable 40-46%, p=0.01). In VF/VT OHCA, there were improvements in the number of patients arriving at hospital with a return of spontaneous circulation (ROSC) (48-56%, p=0.02) and in survival to hospital discharge (21-29%, p=0.002), with improved outcomes restricted to patients receiving bystander CPR. After adjusting for factors associated with survival, the period of time following the change in CPR instructions was a significant predictor of survival to hospital discharge in VF/VT patients (OR 1.57, 95% CI: 1.15-2.20, p=0.005).
  
  
  CONCLUSIONS
  Following changes to dispatcher CPR instructions, significant increases were seen in rates of bystander CPR and improvements were seen in survival in VF/VT patients who received bystander CPR, after adjusting for factors associated with survival.
authors.affiliation: Ambulance Victoria, Doncaster 3108, Victoria, Australia. janet.bray@ambulance.vic.gov.au
authors.forename: Janet E
authors.initials: JE
authors.lastname: Bray
authors.forename: Conor
authors.initials: C
authors.lastname: Deasy
authors.forename: Jamie
authors.initials: J
authors.lastname: Walsh
authors.forename: Andrew
authors.initials: A
authors.lastname: Bacon
authors.forename: Alex
authors.initials: A
authors.lastname: Currell
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate