Mobile-Phone Dispatch of Laypersons for CPR | Journal Scan
What is the impact of the use of a mobile phone positioning system to dispatch lay responders who are trained in cardiopulmonary resuscitation (CPR) to assist patients with suspected out-of-hospital cardiac arrest?
The investigators conducted a blinded, randomized, controlled trial in Stockholm from April 2012 through December 2013. A mobile-phone positioning system that was activated when ambulance, fire, and police services were dispatched was used to locate trained volunteers who were within 500 m of patients with out-of-hospital cardiac arrest; volunteers were then dispatched to the patients (the intervention group) or not dispatched to them (the control group). The primary outcome was bystander-initiated CPR before the arrival of ambulance, fire, and police services.
A total of 5,989 lay volunteers who were trained in CPR were recruited initially, and overall, 9,828 were recruited during the study. The mobile-phone positioning system was activated in 667 out-of-hospital cardiac arrests: 46% (306 patients) in the intervention group and 54% (361 patients) in the control group. The rate of bystander-initiated CPR was 62% (188 of 305 patients) in the intervention group and 48% (172 of 360 patients) in the control group (absolute difference for intervention vs. control, 14 percentage points; 95% confidence interval, 6-21; p < 0.001).
The authors concluded that a mobile-phone positioning system to dispatch lay volunteers who were trained in CPR was associated with significantly increased rates of bystander-initiated CPR for persons with out-of-hospital cardiac arrest.
This study reports that bystander-initiated CPR was significantly higher in cases in which the mobile-phone positioning system was activated than in cases in which it was not activated. However, despite higher bystander-initiated CPR, there were no significant between-group differences in the secondary outcomes of return of spontaneous circulation and survival at 1 month. A more comprehensive identification of cardiac arrests by dispatchers, extension of the use of the mobile-phone positioning system to assist patients with cardiac arrest that occurs at night, technical improvements in the system, and enrollment of additional lay rescuers may increase the effect of the intervention and translate into survival benefit, which needs further study.
Keywords: Ambulances, Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Cellular Phone, Control Groups, Geriatrics, Heart Arrest, Out-of-Hospital Cardiac Arrest, Police, Primary Prevention, Survival, Volunteers
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