title: Advantage of CPR-first over call-first actions for out-of-hospital cardiac arrests in nonelderly patients and of noncardiac aetiology.
abstract: OBJECTIVE
  To assess the benefit of immediate call or cardiopulmonary resuscitation (CPR) for survival from out-of-hospital cardiac arrests (OHCAs).
  
  
  METHODS
  Of 952,288 OHCAs in 2005-2012, 41,734 were bystander-witnessed cases without prehospital involvement of physicians but with bystander CPR (BCPR) on bystander's own initiative. From those OHCAs, we finally extracted the following three call/BCPR groups: immediate Call+CPR (N=10,195, emergency call/BCPR initiated at 0 or 1 min after witness, absolute call-BCPR time interval=0 or 1 min), immediate Call-First (N=1820, emergency call placed at 0 or 1 min after witness, call-to-BCPR interval=2-4 min), immediate CPR-First (N=5446, BCPR initiated at 0 or 1 min after witness, BCPR-to-call interval=2-4 min). One-month neurologically favourable survivals were compared among the groups. Critical comparisons between Call-First and CPR-First groups were made considering arrest aetiology, age, and bystander-patient relationship after confirming the interactions among variables.
  
  
  RESULTS
  The overall survival rates in immediate Call+CPR, Call-First, and CPR-First groups were 11.5, 12.4, and 11.5%, respectively without significant differences (p=0.543). Subgroup analyses by multivariate logistic regression following univariate analysis disclosed that CPR-first group is more likely to survive in subgroups of noncardiac aetiology (adjusted odds ratio; 95% confidence interval, 2.01; 1.39-2.98) and of nonelderly OHCAs (1.38; 1.09-1.76).
  
  
  CONCLUSIONS
  Immediate CPR-first action followed by an emergency call without a large delay may be recommended when a bystander with sufficient skills to perform CPR witnesses OHCAs in nonelderly people and of noncardiac aetiology.
authors.affiliation: Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan. Electronic address: kamitaka911@gmail.com.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kamikura
authors.affiliation: Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan. Electronic address: h_iwasaki18@yahoo.co.jp.
authors.forename: Hose
authors.initials: H
authors.lastname: Iwasaki
authors.affiliation: Emergency Medical Centre, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-Higashi, Kanazawa, Ishikawa 920-8201, Japan. Electronic address: yasuhiromyojo@yahoo.co.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Myojo
authors.affiliation: Department of Cardiology, Kanazawa Medical Centre, 1-1 Shimo-Ishibiki, Kanazawa 920-8650, Japan. Electronic address: afib@kinbyou.hosp.go.jp.
authors.forename: Satoru
authors.initials: S
authors.lastname: Sakagami
authors.affiliation: Department of Medical Science and Technology, Hiroshima International University, 555-36 Kurose-gakuendai, Higashi-hiroshima, 739-2695 Hiroshima, Japan; Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan. Electronic address: y-takei@hs.hirokoku-u.ac.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takei
authors.affiliation: Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan. Electronic address: hidinaba@med.kanazawa-u.ac.jp.
authors.forename: Hideo
authors.initials: H
authors.lastname: Inaba
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D004630:Emergencies / Q000453:epidemiology*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Cardiopulmonary resuscitation; Emergency call; Survival