Dispatcher-Directed Cardiopulmonary Resuscitation Improves Survival in Pediatric Out-of-Hospital Cardiac Arrest
In a population-based Japanese study, dispatcher assistance increased 1-month survival but had no effect on neurological outcomes.
In addition to sending help, emergency medical dispatchers provide prearrival instructions for the lay public. Researchers used a nationwide population-based database of all out-of-hospital cardiac arrests in Japan from 2004 through 2008 to analyze the effect of dispatcher assistance on 1-month survival and neurological outcomes in pediatric patients (age, <20 years).
Among 1780 pediatric patients with witnessed collapse, bystanders performed chest compressions in 40% and mouth-to-mouth ventilation in 26%. Dispatchers provided cardiopulmonary resuscitation (CPR) instructions in 28% of cases. Dispatcher assistance was associated with significantly higher rates of bystander-performed chest compressions and ventilations (adjusted odds ratios, 6.04 and 3.10, respectively). Dispatcher assistance was associated with significantly improved 1-month survival rates (AOR, 1.46) but had no effect on rates of favorable neurological outcomes (cerebral performance category 1 or 2). Among adolescents (age range, 12–19 years), but not infants or younger children, survival rates were significantly higher in those with cardiac etiologies than in those with noncardiac etiologies (33% vs. 5%).
Bystander CPR improves survival, and dispatcher instruction increases the likelihood that CPR is performed. Although no improvement in neurological outcome was noted in this study, the data support dispatcher-directed CPR for pediatric patients and continued advocacy for public CPR training.
Kristi L. Koenig, MD, FACEP
Published in Journal Watch Emergency Medicine March 30, 2012
Citation(s): Akahane M et al. Impact of telephone dispatcher assistance on the outcomes of pediatric out-of-hospital cardiac arrest. Crit Care Med 2012 Mar 20; [e-pub ahead of print]. (http://dx.doi.org/10.1097/CCM.0b013e31823e99ae)