Outcomes of audio-instructed and video-instructed dispatcher-assisted cardiopulmonary resuscitation: a systematic review and meta-analysis

Background The present meta-analysis of clinical and simulation trials aimed to compare video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation (V-DACPR) with conventional audio-instructed dispatcher-assisted bystander cardiopulmonary resuscitation (C-DACPR). Methods We searched PubMed, Embase, Web of Science, Cochrane Collaboration databases and Scopus from inception until June 10, 2021. The primary outcomes were the prehospital return of spontaneous circulation (ROSC), survival to hospital discharge, and survival to hospital discharge with a good neurological outcome for clinical trials, and chest compression quality for simulation trials. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) indicated the pooled effect. The analyses were performed with the RevMan 5.4 and STATA 14 software. Results Overall, 2 clinical and 8 simulation trials were included in this meta-analysis. In clinical trials, C-DACPR and V-DACPR were characterised by, respectively, 11.8% vs. 24.3% of prehospital ROSC (OR = 0.46; 95% CI: 0.30, 0.69; I (2) = 66%; p < .001), 10.7% vs. 22.3% of survival to hospital discharge (OR = 0.46; 95% CI: 0.30, 0.70; I (2) = 69%; p < .001), and 6.3% vs. 16.0% of survival to hospital discharge with a good neurological outcome (OR = 0.39; 95% CI: 0.23, 0.67; I (2) = 73%; p < .001). In simulation trials, chest compression rate per minute equalled 91.3 +/- 22.6 for C-DACPR and 107.8 +/- 12.6 for V-DACPR (MD = -13.40; 95% CI: -21.86, -4.95; I (2) = 97%; p = .002). The respective values for chest compression depth were 38.7 +/- 14.3 and 41.8 +/- 12.5 mm (MD = -2.67; 95% CI: -8.35, 3.01; I (2) = 98%; p = .36). Conclusions As compared with C-DACPR, V-DACPR significantly increased prehospital ROSC and survival to hospital discharge. Under simulated resuscitation conditions, V-DACPR exhibited a higher rate of adequate chest compressions than C-DACPR. Key messages Bystander cardiopulmonary resuscitation parameters significantly depend on the dispatcher's support and the manner of the support provided. Video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation can increase the rate of prehospital return of spontaneous circulation and survival to hospital discharge. Video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation improves the quality of chest compressions compared with dispatcher-assisted resuscitation without video instruction.

Automated summary

Compared to conventional audio-instructed dispatcher-assisted bystander cardiopulmonary resuscitation (C-DACPR), video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation (V-DACPR) significantly improves prehospital return of spontaneous circulation and survival to hospital discharge. Under simulated resuscitation conditions, V-DACPR also demonstrates better quality of chest compressions.