title: Dispatcher-assisted bystander cardiopulmonary resuscitation in a metropolitan city: a before-after population-based study.
abstract: BACKGROUND
  The goal of this study was to determine the effects of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-CPR) on outcomes of out-of-hospital cardiac arrest (OHCA).
  
  
  METHODS
  All EMS in a metropolitan city with a population of 10 million are dispatched by a single, centralized, and physician-supervised center. Data on patients with adult OHCA with cardiac etiology were collected from the dispatch center registry and from EMS run sheets and hospital medical record review from 2009 to 2011. A standardized DA-CPR protocol (aligned with the 2010 AHA guidelines) we implemented as an intervention in January 2011. The end points were survival to discharge, good neurological outcome, and bystander CPR rate. Multivariate logistic analysis was used to compare between intervention group (2011) and historical control group (2009-2010).
  
  
  RESULTS
  Of 8.144 eligible patients, bystander CPR was performed for the patients in 5.7% (148/2600) of cases in 2009, 6.7% (190/2857) in 2010, and 12.4% (334/2686) in 2011 (p<0.001). The survival to discharge rates was 7.1% (2009), 7.1% (2010), and 9.4% (2011) (p=0.001). Good neurological outcomes occurred in 2.1% (2009), 2.0% (2010), and 3.6% (2011) of cases (p<0.001). The adjusted ORs (95% CIs) for survival to discharge compared with 2009 were 1.33 (1.07-1.66) in 2011 and 1.12 (0.89-1.41) in 2010. The adjusted ORs (95% CIs) for good neurological outcomes were 1.67 (1.13-2.45) in 2011 and 1.13 (0.74-1.72) in 2010.
  
  
  CONCLUSIONS
  An EMS intervention using the DA-CPR protocol was associated with a significant increase in bystander CPR and an improved survival and neurologic outcome after OHCA.
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: skciva@gmail.com.
authors.forename: Kyoung Jun
authors.initials: KJ
authors.lastname: Song
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: shinsangdo@medimail.co.kr.
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: ipanema2@medimail.co.kr.
authors.forename: Chang Bae
authors.initials: CB
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: blj01he@gmail.com.
authors.forename: Joo Yeong
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: birdbeak@naver.com.
authors.forename: Do Kyun
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Inje University College of Medicine, Seoul, South Korea. Electronic address: juliannnn@hanmail.net.
authors.forename: Chu Hyun
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: redkid00@naver.com.
authors.forename: So Young
authors.initials: SY
authors.lastname: Ha
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore; Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore. Electronic address: marcus.ong.e.h@sgh.com.sg.
authors.forename: Marcus
authors.initials: M
authors.lastname: Eng Hock Ong
authors.affiliation: Bureau of EMS and Trauma System, Arizona Department of Health Services, Phoenix, AZ, United States; Department of Emergency Medicine, Maricopa Medical Center, University of Arizona College of Medicine, United States. Electronic address: Bentley.Bobrow@azdhs.gov.
authors.forename: Bentley J
authors.initials: BJ
authors.lastname: Bobrow
authors.affiliation: Department of Emergency Medicine, Emory University School of Medicine, United States. Electronic address: mcnally.bryan@gmail.com.
authors.forename: Bryan
authors.initials: B
authors.lastname: McNally
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D065187:Controlled Before-After Studies; D004631:Emergency Medical Service Communication Systems; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D057209:Hospital Rapid Response Team; D006801:Humans; D008297:Male; D008875:Middle Aged; D014505:Urban Population
keywords: Bystander; Cardiopulmonary resuscitation; Heart arrest; Outcome