Implementation of a bundle of Utstein cardiopulmonary resuscitation programs to improve survival outcomes after out-of-hospital cardiac arrest in a metropolis: A before and after study

Introduction: The study aimed to determine the effect of community implementation of a bundles of cardiopulmonary resuscitation (CPR) programs on outcomes in out-of-hospital cardiac arrest (OHCA). Methods: A before-and after-intervention study was performed in a metropolis. Emergency medical services (EMS)-treated adults and cardiac OHCAs were included. Three new CPR programs was implemented in January 2015: 1) a high-quality dispatcher-assisted CPR program (DACPR), 2) a multi-tier response (MTR) program using fire engines or basic life support vehicles, and 3) a feedback CPR (FCPR) program with professional recording and feedback of CPR process. The outcomes (cerebral performance category 1 or 2, good CPC) and survival to discharge) were compared between study period (2015-2016) and control period (2013-2014). Results: Overall, 6201 and 6469 patients were included in the control period and the study period, respectively. During the post-intervention period, the proportion of OHCA patients who underwent three types of cardiopulmonary resuscitation programs increased significantly compared to those in the pre-intervention period. DACPR increased from 38.3% to 44.3%, MTR increased from 0.0% to 37.5%, and FCPR increased from 25.3% to 61.5%. (All p values < 0.001). Good neurological recovery and survival to discharge were significantly increased from 5.4% to 6.8%, and from 9.6% to 10.9%. The adjusted odds ratio (95% confidence intervals) of the study period was 1.45 (1.12-1.87) for good CPC, and 1.31 (1.09-1.58) for survival to discharge. Conclusions: The citywide implementation of a bundle of UTIS CPR programs was associated with significantly better OHCA outcomes.