Dispatcher-assisted bystander cardiopulmonary resuscitation in rural and urban areas and survival outcomes after out-of-hospital cardiac arrest.

Abstract

We investigated the impact of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) on survival outcomes after out-of-hospital cardiac arrests (OHCAs) that occurred in rural and urban areas. This study was a cross-sectional study using nationwide emergency medical services (EMS)-based OHCA registry in Korea. All EMS-treated adults with OHCAs and with presumed cardiac etiology were enrolled between 2012 and 2015, excluding cases witnessed by an EMS provider. BCPR was categorized into 3 groups: BCPR-with-DA, BCPR-without-DA, and No-BCPR. The endpoint was good neurologic recovery at discharge. We compared the effects of BCPR on outcomes between rural and urban areas, using a multivariable logistic regression with an interaction term. A total of 53,240 patients (36.3% BCPR-with-DA and 12.8% BCPR-without-DA) were included. Among OHCAs that occurred in rural areas (32.3% BCPR-with-DA and 14.0% BCPR-without-DA) and urban areas (36.9% BCPR-with-DA and 12.5% BCPR-without-DA), good neurological recovery was demonstrated in 1.6% and 6.8% of the patients in rural and urban areas, respectively (p < 0.01). The patients with OHCAs who received BCPR in both rural and urban areas were more likely to have good neurologic recovery than the No-BCPR group (AORs, 3.53 (1.84-6.77) BCPR-with-DA and 2.56 (1.23-5.32) BCPR-without-DA in rural; and 1.59 (1.41-1.79) BCPR-with-DA and 1.37 (1.18-1.60) BCPR-without-DA in urban). The effects of the measures of BCPR-with-DA on the outcome were more apparent in rural areas compared to urban areas. BCPR, regardless of DA, was associated with improved neurologic recovery after OHCA in rural and urban areas. However, the effect of BCPR-with-DA was prominent for OHCA that occurred in rural areas.