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

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.