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

Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.