The Effect Of Bystander Cardiopulmonary Resuscitation On The Survival Of Out-of-Hospital Cardiac Arrests

Objectives: Modern cardiopulmonary resuscitation has been around for 60 years.During these 60 years,although different countries and regions have developed different cardiopulmonary resuscitation guidelines and treatment strategies,bystander cardiopulmonary resuscitation(BCPR)is still the most important factor to improve the survival rate of out-of-hospital cardiac arrests(OHCAs).And with the development of the times,traffic congestion and lack of medical resources make BCPR as the starting part of the rescue of patients becomes more important.Some studies have shown that BCPR can prolong the time of ventricular fibrillation(VF)and ventricular tachycardia(VT)in patients with OHCA,and strive for defibrillation.But for patients with shockable rhythm when emergency personnel arrived,whether BCPR also plays an indispensable role,scholars have not reached a unified view.Therefore,our aim is to systematically evaluate the efficacy of BCPR in patients with OHCA using a systematic review and Meta-analysis,and by limiting the initial rhythm in OHCAs,further discussion of the mechanism by which BCPR improves survival.Methods: Computer and manual searching were used to search the relevant literature.Relevant studies were searched in PubMed and EMBASE databases by computer from the date of inception until March,2018,and relevant journals on resuscitation and first aid were searched by hand.And reading the reference of the relevant studies,find the eligible studies.According to inclusion and exclusion criteria,all observational studies that assessed the effects of BCPR in OHCAs were included.The literature search,data extraction,literature quality evaluation and data synthesis were performed by two researchers.The results will be cross-checked,and if there is a disagreement,it will be decided by discussion or a third researcher.OR(OR)and 95%Confidence intervals(95%CI)were used to present the treatment effect.Random effect model or fixed effect model was selected according to the heterogeneity results.We used Stata 12.0 for data analysis and drawing the funnel plot and Egger regression diagram to evaluate the potential publication bias.Results: Data were extracted from 19 studies involving 232 703 patients.Firstly,pooled odds ratio(OR)from 16 cohort studies showed that BCPR was associated with improved chance of survival of OHCAs compared with NO-BCPR(OR 1.95,95%confidence interval [CI]: 1.66-2.30).Secondly,from 8 cohort studies of OHCAs whose initial rhythm is classified,the pooled OR was 2.10(95%CI: 1.68-2.63)of 6articles for shockable rhythm and 1.07(95%CI: 0.37-3.13)of 2 articles for non-shockable rhythm.Meta-regression showed a relation between the survival of OHCAs and BCPR was influenced by area(p<0.05).Conclusions: BCPR increases the survival of OHCAs,and it also help OHCAs whose initial rhythm is shockable.That is to say BCPR is also helpful when emergency department response time is short.Therefore global priority should be given to increasing the incidence of BCPR by evidence-based best practice.