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Understanding and improving low bystander CPR rates: a systematic review of the literature

Published online by Cambridge University Press:  21 May 2015

Christian Vaillancourt ,
Ian G. Stiell  and
George A. Wells
Christian Vaillancourt*
Affiliation:
Ottawa Health Research Institute, Ottawa, Ont. Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Ian G. Stiell
Affiliation:
Ottawa Health Research Institute, Ottawa, Ont. Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
George A. Wells
Affiliation:
Ottawa Health Research Institute, Ottawa, Ont. Department of Medicine, University of Ottawa, Ottawa, Ont.
*
The Ottawa Hospital, Civic Campus, Clinical Epidemiology Unit, Rm. F658, 1053 Carling Ave, Ottawa ON K1Y 4E9; cvaillancourt@ohri.ca

Abstract

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Objectives:

Cardiopulmonary resuscitation (CPR) is a crucial yet weak link in the chain of survival for out-of-hospital cardiac arrest. We sought to understand the determinants of bystander CPR and the factors associated with successful training.

Methods:

For this systematic review, we searched 11 electronic databases, 1 trial registry and 9 scientific websites. We performed hand searches and contacted 6 content experts. We reviewed without restriction all communications pertaining to who should learn CPR, what should be taught, when to repeat training, where to give CPR instructions and why people lack the motivation to learn and perform CPR. We used standardized forms to review papers for inclusion, quality and data extraction. We grouped publications by category and classified recommendations using a standardized classification system that was based on level of evidence.

Results:

We reviewed 2409 articles and selected 411 for complete evaluation. We included 252 of the 411 papers in this systematic review. Differences in their study design precluded a meta-analysis. We classified 22 recommendations; those with the highest scores were 1) 9-1-1 dispatch-assisted CPR instructions, 2) teaching CPR to family members of cardiac patients, 3) Braslow's self-training video, 4) maximizing time spent using manikins and 5) teaching the concepts of ambiguity and diffusion of responsibility. Recommendations not supported by evidence include mass training events, pulse taking prior to CPR by laymen and CPR using chest compressions alone.

Conclusion:

We evaluated and classified the potential impact of interventions that have been proposed to improve bystander CPR rates. Our results may help communities design interventions to improve their bystander CPR rates.

Résumé

RÉSUMÉObjectifs:

La réanimation cardio-respiratoire (RCR) est un maillon essentiel, quoique faible, de la chaîne de survie lors de la survenue d'un arrêt cardiaque hors de l'hôpital. Nous avons cherché à comprendre les déterminants du taux de passants pouvant administrer la RCR et les facteurs liés à une formation efficace.

Méthodes:

Dans le cadre de cette revue systématique, nous avons analysé 11 bases de données électroniques, un registre d'essais cliniques et neuf sites Web scientifiques. Nous avons réalisé des recherches manuelles et communiqué avec six experts du contenu. Nous avons examiné sans restriction toutes les communications portant sur les questions suivantes : qui devrait apprendre la RCR, ce qu'on devrait enseigner, QUAND la formation devrait être renouvelée, où les cours de RCR devraient être offerts et pourquoi les gens ne sont pas motivés à apprendre la RCR et à l'administrer. Nous avons utilisé des formulaires normalisés pour évaluer les articles selon des critères d'inclusion, de qualité et d'extraction de données. Nous avons regroupé les publications par catégorie et classé les recommandations selon un système de classification normalisé fondé sur le niveau de preuve.

Résultats:

Nous avons examiné 2409 articles et évalué le texte intégral de 411 d'entre eux. Notre revue systématique a porté sur 252 de ces 411 articles. En raison de différences dans la conception des études, nous n'avons pu réaliser une méta-analyse. Parmi les 22 recommandations que nous avons classées, voici celles qui ont obtenu la marque la plus élevée : 1) instructions de RCR données par un répartiteur 9-1-1; 2) enseignement de la RCR aux membres de la famille de cardiaques; 3) utilisation de la bande vidéo d'autoformation de Braslow; 4) augmentation du temps de pratique sur des mannequins; 5) enseignement des concepts d'ambiguïté et de diffusion de la responsabilité. Les recommandations non étayées par des preuves portaient sur les activités de formation en masse, la prise du pouls par un non-spécialiste avant de commencer la RCR et l'administration de la RCR avec compressions thoraciques seulement.

Conclusion:

Nous avons évalué et classé les diverses interventions proposées pour améliorer le taux de passants pouvant administrer la RCR ainsi que leur impact potentiel. Les résultats de l'étude aideront peut-être les collectivités à concevoir des modèles pour améliorer ce taux.

Keywords

cardiac arrestsystematic reviewcardiopulmonary resuscitation
Type
State of the Art • À la fine pointe
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 1 , January 2008 , pp. 51 - 65
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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