Dispatcher-Assisted Resuscitation Trial - DART

Jul 28, 2010
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
Funded in part by the Laerdal Foundation for Acute Medicine and the Medic One Foundation.
Date Published:
01/01/2010
Date Updated:
07/28/2010
Original Posted Date:
07/28/2010
References

Description:

The goal of the trial was to evaluate cardiopulmonary bypass (CPR) with chest compressions alone compared with CPR with chest compressions plus rescue breathing among patients with an out-of-hospital arrest.

Hypothesis:

CPR with chest compressions alone would be more effective at improving survival.

Study Design

  • Randomized
  • Parallel

Patient Populations:

  • Patients at least 18 years of age with an out-of-hospital arrest, unconscious and not breathing
  • Number of enrollees: 1,941
  • Mean age: 63 years
  • Percentage female: 33%

Exclusions:

  • Trauma
  • Drowning
  • Asphyxiation
  • Signs of irreversible death

Primary Endpoints:

  • Survival to hospital discharge

Secondary Endpoints:

  • Survival to hospital discharge with a favorable neurological outcome

Drug/Procedures Used:

Patients with an out-of-hospital arrest were randomized to CPR with chest compressions alone (n = 981) versus CPR with chest compressions plus rescue breathing (n = 960).

Principal Findings:

Overall, 1,941 patients were randomized. In the chest compression alone group, the mean age was 63 years, 33% were women, time to advanced support was 9.8 minutes, a witnessed arrest occurred 43% of the time, and a shockable rhythm was present in 33%. The cause of arrest was determined to be cardiac in 71%.

The primary outcome, proportion of patients surviving to hospital discharge, was 12.5% in the compression alone group versus 11.0% in the compression and rescue breathing group (p = 0.31). In subgroup analysis, among those with a cardiac arrest, the primary outcome occurred in 15.5% versus 12.3% (p = 0.09) and among those with a shockable rhythm, the primary outcome occurred in 31.9% versus 25.7% (p = 0.09), respectively. The proportion of patients surviving to hospital discharge with a favorable neurological status was 14.4% versus 11.5% (p = 0.13), respectively.

Interpretation:

Among patients with an out-of-hospital arrest, CPR with chest compressions alone resulted in similar outcomes compared with CPR with chest compressions plus rescue breathing. The majority of patients in this trial had a nonwitnessed arrest, and one-third had arrest due to respiratory, overdose, neurologic, and other causes. There was a nonsignificant increase in survival among the subgroup of patients with cardiac arrest and those with a shockable rhythm. The overall prognosis of out-of-hospital arrest remains poor.

References:

Rea TD, Fahrenbruch C, Culley L, et al. CPR with chest compression alone or with rescue breathing. N Engl J Med 2010;363:423-33.

Keywords: Prognosis, Tachycardia, Ventricular, Cardiopulmonary Resuscitation, Ventricular Fibrillation, Heart Arrest, Cardiopulmonary Bypass


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