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

Figures & data

Figure 1. Meta-analysis flow chart of included and excluded studies.

Table 1. Characteristics of included studies.

			C-DACPR			V-DACPR
Study	Country	Study design	No.	Age, years	Male sex, n (%)	No.	Age, years	Male sex, n (%)
Clinical trials
Lee et al. 2020 [11]	Korea	A retrospective cohort study	1482	73.5 ± 5.8	925 (62.4)	231	72.5 ± 5.8	156 (67.5)
Lee et al. 2021 [12]	Korea	A retrospective cohort study	1722	72.2 ± 14.7	1087 (63.1)	387	64.9 ± 16.2	263 (68.0)
Simulation trials
Bolle et al. 2009 [13]	Norway	A randomised controlled simulation study	26	20.95 ± 4.7	9 (34.6)	29	20.9 ± 5.5	8 (27.8)
Choa et al. 2008 [14]	Korea	A single-blind cluster randomised trial	41	32.95 ± 9.5	20 (48.8)	44	31.3 ± 8.4	20 (45.5)
Ecker et al. 2020 [10]	Germany	A randomised controlled simulation study	50	37.6 ± 13.9	15 (30.0)	50	32.92 ± 12.5	19 (38.0)
Hunt et al. 2015 [15]	USA	A prospective randomised controlled study	15	29.0 ± 1.6	5 (33.3)	16	34.4 ± 3.5	4 (25.0)
Lee et al. 2011 [16]	Korea	A randomised controlled simulation study	39	55.3 ± 6.2	19 (48.7)	39	56.6 ± 7.2	20 (51.3)
Lee et al. 2021 [17]	Korea	A randomised controlled simulation study	43	30.8 ± 12.1	9 (20.9)	88	29.8 ± 11.1	21 (23.9)
Stipulante et al. 2016 [18]	Belgium	A prospective randomised study	60	NR	29 (48.3)	60	NR	28 (46.7)
Yang et al. 2009 [19]	Taiwan	A randomised controlled simulation study	53	50.4 ± 12.7	NR	43	50.1 ± 11.5	NR

C-DACPR: conventional audio-instructed dispatcher-assisted bystander cardiopulmonary resuscitation; V-DACPR: video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation; NR: not reported.

Figure 2. Forest plot of resuscitation outcomes: prehospital ROSC, survival to discharge, good CPC outcome. The centre of each square represents the weighted odds ratios for individual trials, and the corresponding horizontal line stands for 95% CI. The diamonds represent pooled results. C-DACPR: conventional audio-instructed dispatcher-assisted bystander cardiopulmonary resuscitation; V-DACPR: video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation; M–H:? ??; CI: confidence interval; ROSC: return of spontaneous circulation; CPC: Cerebral Performance Categories Scale.

Table 2. Characteristics of patients with out-of-hospital cardiac arrest involved in the analysed studies.

Parameter	No. of studies	Events/participants		Events		Heterogeneity between trials		p-value for differences across groups
		C-DACPR	V-DACPR	OR	95% CI	p-value	I^2 statistic
Male sex	2	2019/3204	419/618	0.81	0.67, 0.97	.96	0%	.02
Comorbidities
Diabetes	2	830/3204	142/618	1.15	0.94, 1.41	.55	0%	.18
Hypertension	2	1213/3204	213/618	1.14	0.95, 1.37	.99	0%	.16
Heart disease	2	613/3204	119/618	0.99	0.79, 1.23	.53	0%	.91
Cerebrovascular disease	2	336/3204	58/618	1.12	0.83, 1.52	.31	5%	.45
Cancer	1	245/1722	54/387	1.02	0.74, 1.41	NA	NA	.89
ECG
VF/pVT	2	581/3204	208/618	0.47	0.34, 0.65	.11	62%	<.001
PEA	2	736/3204	136/618	1.07	0.76, 1.52	.11	60%	.68
Asystole	2	1894/3204	274/618	1.73	1.45, 2.06	.58	0%	<.001

C-DACPR: conventional audio-instructed dispatcher-assisted bystander cardiopulmonary resuscitation; V-DACPR: video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation; OR: odds ratio; CI: confidence interval; ECG: electrocardiogram; VF: ventricular fibrillation; pVT: pulseless ventricular tachycardia; PEA: pulseless electrical activity; NA: not applicable.

Figure 3. Forest plot for chest compression rate in the C-DACPR and V-DACPR groups. The centre of each square represents the weighted odds ratios for individual trials, and the corresponding horizontal line stands for 95% CI. The diamonds represent pooled results. C-DACPR: conventional audio-instructed dispatcher-assisted bystander cardiopulmonary resuscitation; V-DACPR: video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation; SD: standard deviation; CI: confidence interval.

Table 3. Results of the simulation trials.

Parameter	No. of studies	Value		Events		Heterogeneity between trials		p-value for differences across groups
		C-DACPR	V-DACPR	OR	95% CI	p-value	I^2 statistic
Mean chest compression depth, mm	6	38.7 ± 14.3	41.8 ± 12.5	–2.67	–8.35, 3.01	<.001	98%	.36
Mean chest compression rate, /min	7	91.3 ± 22.6	107.8 ± 12.6	–13.40	–21.86, −4.95	<.001	97%	.002
Total no-flow time, s	3	126.2 ± 158.3	88.2 ± 117.7	3.28	–0.61, 7.17	.76	0%	.10
Adequate chest compression rate, n/total (%)	4	52/178 (29.2)	94/171 (55.0)	0.30	0.16, 0.57	.19	37%	<.001
Adequate chest compression depth, n/total (%)	4	39/178 (21.9)	53/171 (31.0)	0.69	0.32, 1.51	.16	42%	.36
Adequate hands position, n/total (%)	5	153/228 (67.1)	173/221 (78.3)	0.62	0.21, 1.81	<.001	79%	.39

C-DACPR: conventional audio-instructed dispatcher-assisted bystander cardiopulmonary resuscitation; V-DACPR: video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation; OR: odds ratio; CI: confidence interval.

Figure 4. Forest plot for chest compression depth in the C-DACPR and V-DACPR groups. The centre of each square represents the weighted odds ratios for individual trials, and the corresponding horizontal line stands for 95% CI. The diamonds represent pooled results. C-DACPR: conventional audio-instructed dispatcher-assisted bystander cardiopulmonary resuscitation; V-DACPR: video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation; SD: standard deviation; CI: confidence interval.

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Data availability statement

The data will be made available on request from the corresponding author.