TY - JOUR
T1 - International multi-center real world implementation trial to increase out-of-hospital cardiac arrest survival with a dispatcher-assisted cardio-pulmonary resuscitation package (Pan-Asian resuscitation outcomes study phase 2)
AU - Ong, Marcus Eng Hock
AU - Shin, Sang Do
AU - Ko, Patrick Chow In
AU - Lin, Xinyi
AU - Ma, Matthew Huei Ming
AU - Ryoo, Hyun Wook
AU - Wong, Kwanhathai Darin
AU - Supasaowapak, Jirapong
AU - Lin, Chih Hao
AU - Kuo, Chan Wei
AU - Rao, Ramana
AU - Cai, Wenwei
AU - Gaerlan, Faith Joan
AU - Khursheed, Munawar
AU - Son, Do Ngoc
AU - Sarah, Karim
AU - El Sayed, Mazen
AU - Al Qahtani, Saad
AU - Tanaka, Hideharu
N1 - Funding Information:
Pan-Asian Resuscitation Outcomes Study Clinical Research Network. Participating Site Investigators: K Kajino (Kansai Medical University Hospital, Osaka, Japan), Ryu Hyun Ho (Chonnam National University Medical School and Hospital, Gwangju, Korea), P Khruekarnchana (Rajavithi Hospital, Bangkok, Thailand), NE Doctor (Sengkang General Hospital, Singapore), LP Tham (KK Women's & Children's Hospital, Singapore), MYC Chia (Tan Tock Seng Hospital, Singapore), HN Gan (Changi General Hospital, Singapore), Leong BSH (National University Hospital, Singapore), Ng WM (Ng Teng Fong General Hospital, Singapore), Mao DRH (Khoo Teck Puat Hospital, Singapore), Rao R (GVK Emergency Management and Research Institute, Telangana, India), Vimal M (GVK Emergency Management and Research Institute, Telangana, India), Velasco B (East Avenue Medical Center, Manila, Philippines), Zhou SA (Zhejiang Provincial People's Hospital, Zhejiang, China), Khan N (Aga Khan University Hospital, Karachi, Pakistan), Nguyen DA (Bach Mai Hospital, Hanoi, Vietnam), Ng YY (Tan Tock Seng Hospital, Singapore), Shalini A (Singapore Civil Defence Force, Singapore), Tagami T (Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan), We would like to thank Ms Pek Pin Pin, Ms Nur Shahidah, and the late Ms Susan Yap from the Health Services and Systems Research, Duke-NUS Medical School and Department of Emergency Medicine, Singapore General Hospital for coordination of the study. We would also like to thank Ms Patricia Tay from the Singapore Clinical Research Institute for her role as secretariat for the PAROS network. The study is supported by grants from the National Medical Research Council (NMRC/CSA/0049/2013) and Laerdal Foundation (20040). The funders have no involvement in the study design, collection, analysis, and interpretation of data, nor do they have a role in the writing of the paper and decision to submit the paper for publication. Study variables, data dictionary, collection form, and protocol will be shared at the study trial coordinating centre's webpage: https://www.scri.edu.sg/crn/pan-asian-resuscitation-outcomes-study-paros-clinical-research-network-crn/about-paros/. Data from the registry can only be shared among PAROS participating sites and members. MEH Ong, SD Shin, MHM Ma, and H Tanaka were responsible for conceptualizing, designing and planning the study. PCI Ko, HW Ryoo, KD Wong, S Jirapong, CH Lin, CW Kuo, R Rao, WW Cai, FJ Gaerlan, M Khursheed, DN Son, K Sarah, M El Sayed, and S Al Qahtani were involved in planning, execution and management of the study, including setting up data collection system in their respective site, data collection and cleaning, supervision of the study, obtaining ethics and institutional approval, engagement of stakeholders, etc. XY Lin performed all statistical analyses. All authors were involved in drafting the manuscript and revising it critically for important intellectual content and had given final approval of the version to be submitted; all authors endorse the data and conclusions. MEH Ong had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding Information:
The study is supported by grants from the National Medical Research Council (NMRC/CSA/0049/2013) and Laerdal Foundation (20040).
Funding Information:
MEH Ong reports funding from the Zoll Medical Corporation for a study involving mechanical cardiopulmonary resuscitation devices; grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation program to their Community CPR raining Centre Research Program in Norway. MEH Ong has a licensing agreement and patent filed (Application no: 13/047,348) with ZOLL Medical Corporation for a study titled “Method of predicting acute cardiopulmonary events and survivability of a patient. He is also the co-founder and scientific advisor of TIIM Healthcare, a commercial entity which develops real-time prediction and risk stratification solutions at triage. All other authors have no conflict of interest to declare.
Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2022/2
Y1 - 2022/2
N2 - Background: Dispatcher-assisted CPR (DA-CPR) has the potential to deliver early bystander CPR (BCPR) and improve out-of-hospital cardiac arrest (OHCA) survival. This study in the Asia-Pacific evaluated the impact of a DA-CPR program on BCPR rates and survival. Methods: This was a three-arm, prospective, multi-national, population-based, community-level, implementation trial. Cases between January 2009 and June 2018 from the Pan-Asian Resuscitation Outcomes Study were included. Sites either implemented a comprehensive (with quality improvement tool) or a basic DA-CPR package, or served as controls. Primary outcome was survival-to-discharge/30th day post-arrest. Secondary outcomes were BCPR and favorable neurological outcome. A before-after comparison was made within each country; this before-after change was then compared across the three groups using logistic regression. Results: 170,687 cases were analyzed. Before-after comparison showed that survival to discharge was higher in the ‘implementation’ period in all three groups: comprehensive odds ratio (OR) 1.09, 95% confidence interval (CI; [1.0–1.19]); basic OR 1.14, 95% CI (1.08–1.2); and control OR 1.25, 95% CI (1.02–1.53). Comparing between groups, the comprehensive group had significantly higher change in BCPR (comprehensive vs control ratio of OR 1.86, 95% CI [1.66–2.09]; basic vs control ratio of OR 0.94, 95% CI [0.85–1.05]; and comprehensive vs basic ratio of OR 1.97, 95% CI [1.87–2.08]) and survival with favorable neurological outcome (comprehensive vs basic ratio of OR 1.2, 95% CI [1.04–1.39]). Conclusion: We evaluated the impact of a DA-CPR program across heterogeneous EMS systems and demonstrated that a comprehensive DA-CPR program had the most impact on BCPR and favorable neurological outcome.
AB - Background: Dispatcher-assisted CPR (DA-CPR) has the potential to deliver early bystander CPR (BCPR) and improve out-of-hospital cardiac arrest (OHCA) survival. This study in the Asia-Pacific evaluated the impact of a DA-CPR program on BCPR rates and survival. Methods: This was a three-arm, prospective, multi-national, population-based, community-level, implementation trial. Cases between January 2009 and June 2018 from the Pan-Asian Resuscitation Outcomes Study were included. Sites either implemented a comprehensive (with quality improvement tool) or a basic DA-CPR package, or served as controls. Primary outcome was survival-to-discharge/30th day post-arrest. Secondary outcomes were BCPR and favorable neurological outcome. A before-after comparison was made within each country; this before-after change was then compared across the three groups using logistic regression. Results: 170,687 cases were analyzed. Before-after comparison showed that survival to discharge was higher in the ‘implementation’ period in all three groups: comprehensive odds ratio (OR) 1.09, 95% confidence interval (CI; [1.0–1.19]); basic OR 1.14, 95% CI (1.08–1.2); and control OR 1.25, 95% CI (1.02–1.53). Comparing between groups, the comprehensive group had significantly higher change in BCPR (comprehensive vs control ratio of OR 1.86, 95% CI [1.66–2.09]; basic vs control ratio of OR 0.94, 95% CI [0.85–1.05]; and comprehensive vs basic ratio of OR 1.97, 95% CI [1.87–2.08]) and survival with favorable neurological outcome (comprehensive vs basic ratio of OR 1.2, 95% CI [1.04–1.39]). Conclusion: We evaluated the impact of a DA-CPR program across heterogeneous EMS systems and demonstrated that a comprehensive DA-CPR program had the most impact on BCPR and favorable neurological outcome.
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U2 - 10.1016/j.resuscitation.2021.12.032
DO - 10.1016/j.resuscitation.2021.12.032
M3 - Article
C2 - 34974143
AN - SCOPUS:85122936354
VL - 171
SP - 80
EP - 89
JO - Resuscitation
JF - Resuscitation
SN - 0300-9572
ER -