Impact of Dispatcher‐Assisted Bystander Cardiopulmonary Resuscitation on Neurological Outcomes in Children With Out‐of‐Hospital Cardiac Arrests: A Prospective, Nationwide, Population‐Based Cohort Study

Abstract

Background The impact of dispatcher‐assisted bystander cardiopulmonary resuscitation ( CPR ) on neurological outcomes in children is unclear. We investigated whether dispatcher‐assisted bystander CPR shows favorable neurological outcomes (Cerebral Performance Category scale 1 or 2) in children with out‐of‐hospital cardiac arrest ( OHCA ). Methods and Results Children (n=5009, age<18 years) with OHCA were selected from a nationwide Utstein‐style Japanese database (2008–2010) and divided into 3 groups: no bystander CPR (n=2287); bystander CPR with dispatcher instruction (n=2019); and bystander CPR without dispatcher instruction (n=703) groups. The primary endpoint was favorable neurological outcome at 1 month post‐ OHCA . Dispatcher CPR instruction was offered to 53.9% of patients, significantly increasing bystander CPR provision rate (adjusted odds ratio [ aOR ], 7.51; 95% confidence interval [ CI ], 6.60 to 8.57). Bystander CPR with and without dispatcher instruction were significantly associated with improved 1‐month favorable neurological outcomes (aOR, 1.81 and 1.68; 95% CI, 1.24 to 2.67 and 1.07 to 2.62, respectively), compared to no bystander CPR. Conventional CPR was associated with increased odds of 1‐month favorable neurological outcomes irrespective of etiology of cardiac arrest ( aOR , 2.30; 95% CI, 1.56 to 3.41). However, chest‐compression‐only CPR was not associated with 1‐month meaningful outcomes ( aOR , 1.05; 95% CI , 0.67 to 1.64). Conclusions In children with OHCA , dispatcher‐assisted bystander CPR increased bystander CPR provision rate and was associated with improved 1‐month favorable neurological outcomes, compared to no bystander CPR . Conventional bystander CPR was associated with greater likelihood of neurologically intact survival, compared to chest‐compression‐only CPR, irrespective of cardiac arrest etiology.