Video-based Dispatch System: BLS TF Systematic Review

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This CoSTR is a draft version prepared by ILCOR, with the purpose to allow the public to comment and is labeled “Draft for Public Comment". The comments will be considered by ILCOR. The next version will be labelled “draft" to comply with copyright rules of journals. The final COSTR will be published on this website once a summary article has been published in a scientific Journal and labeled as “final”.

Conflict of Interest Declaration

The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: (none applicable)

The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: (none applicable)

CoSTR Citation

Chung S, Avis S, Castren M, Considine J, Folke F, Hung K, Ikeyama T, Kudenchuk P, Lagina A, Malta-Hansen C, Nishiyama C, Perkins G, Ristagno G, Semeraro F, Smith M, Smyth C, Wigginton J, Morley PT, Olasveengen TM -on behalf of the International Liaison Committee on Resuscitation Basic Life Support Task Force. Video-based Dispatch System Consensus on Science with Treatment Recommendations [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) Basic Life Support Task Force, 2021 Feb. Available from: http://ilcor.org

Methodological Preamble (and Link to Published Systematic Review if applicable)

The continuous evidence evaluation process for the production of Consensus on Science with Treatment Recommendations (CoSTR) started with a systematic review of basic life support conducted by Sung Phil Chung and Theresa M. Olasveengen with involvement of clinical content experts. Evidence for adult literature was sought and considered by the Basic Life Support Adult Task Force. These data were taken into account when formulating the Treatment Recommendations.

PICOST

The PICOST (Population, Intervention, Comparator, Outcome, Study Designs and Timeframe)

Population: Adults and children with presumed cardiac arrest in out-of-hospital setting

Intervention: Patients/cases or EMS systems where dispatch assisted CPR is offered by video and audio communication between dispatcher center and scene.

Comparators: Patients/cases or EMS systems where dispatch assisted CPR is offered by audio only communication between dispatcher center and scene.

Outcomes: Any clinical outcome (Survival with favorable neurologic outcome, Survival, ROSC, and CPR quality).

Study Designs: Randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies) are eligible for inclusion. Unpublished studies (e.g., conference abstracts, trial protocols) are excluded.

Timeframe: All years and all languages are included as long as there is an English abstract. Literature search updated to Feb 8, 2021.

PROSPERO Registration CRD42020219112

Consensus on Science

Only one human study addressing the critical outcomes criteria of favourable neurologic outcome or survival, or the important outcome prehospital ROSC was identified.1

For the critical outcome of good neurological function at discharge, we have identified very-low-certainty evidence (downgraded for risk of bias) from 1 observational study1 enrolling 1720 adult out-of-hospital cardiac arrests, which showed benefit from the use of the video-based dispatch when compare with standard audio-based dispatch (OR, 1.89; 95%CI, 1.18–3.04; P<0.01). However, the benefit is not observed from multivariable statistical adjustment (OR, 1.28; 95%CI, 0.73–2.26) or propensity score matching analysis (OR, 0.91; 95%CI, 0.51–1.64).

For the critical outcome of survival at discharge, we have identified very-low-certainty evidence (downgraded for risk of bias) from 1 observational study1 enrolling 1720 adult out-of-hospital cardiac arrests, which showed benefit from the use of the video-based dispatch when compare with standard audio-based dispatch (OR, 1.71; 95%CI, 1.14–2.58; P<0.01). However, the benefit is not observed from multivariable statistical adjustment (OR, 1.20; 95%CI, 0.74–1.94) or propensity score matching analysis (OR, 1.0; 95%CI, 0.59–1.68).

For the critical outcome of prehospital ROSC, we have identified very-low-certainty evidence (downgraded for risk of bias) from 1 observational study1 enrolling 1720 adult out-of-hospital cardiac arrests, which showed benefit from the use of the video-based dispatch when compare with standard audio-based dispatch (OR, 1.73; 95%CI, 1.16–2.59; P<0.01). However, the benefit is not observed from propensity score matching analysis (OR, 0.85; 95%CI, 0.52–1.40).

We also identified 13 manikin simulation studies2-14 that compared video vs. audio-based dispatch. However, these were not included in our formal review according to a priori exclusion criteria. The simulation studies showed improved CPR quality parameters such as compression rate and time to compression in the video-based dispatch group, but did not show any significant differences in chest compression depth, correct compression depth, correct hand position, correct chest release, or time to defibrillation.

Treatment Recommendations

We suggest that the usefulness of video-based dispatch system be assessed in clinical trials or research initiatives (weak recommendation, very-low-certainty evidence).

Justification and Evidence to Decision Framework Highlights

Only a single human observational study was identified, so the evidence informing the guideline is very uncertain. As new communication technologies offer promising new avenues in emergency medical dispatch, the Basic Life Support Task Force felt it was important to encourage research in this important area and therefore provided conditional recommendation for video-based dispatch system to be assessed in clinical trials or research initiatives.

Several manikin simulation studies were identified evaluating video vs audio-based dispatch. Lin et al. published a systematic review comparing the effect of video-based and audio-based dispatch on quality of dispatcher-assisted CPR.15 The review included 6 simulation studies that showed that video-based dispatcher-assisted CPR significantly improved the chest compression rate compared to the audio-based dispatch, and a trend for more correct hand position was also observed. However, video-based dispatch caused a delay in the commencement of bystander-initiated CPR.15 While not directly informing clinical practice, these simulation studies provide important information about the aspects that need to be addressed and evaluated in future clinical studies evaluating video-dispatch.

Knowledge Gaps

  • No RCT has compared video-based vs audio-based dispatch in any patient population.
  • Further observation studies evaluating the use of video communication in emergency medical dispatch will provide important new insight.
  • Two rescuers may be needed to effectively process video-based DA-CPR, one to provide chest compressions and one to handle the mobile phone and assist with communication. This might lead to varying feasibility of implementing video-based dispatcher CPR according to location of arrest (crowded public place vs. at home) etc.

Atttachment: BLS-new-Video-based-dispatch-Et D

References

1. Lee SY, Song KJ, Shin SD, Hong KJ and Kim TH. Comparison of the effects of audio-instructed and video-instructed dispatcher-assisted cardiopulmonary resuscitation on resuscitation outcomes after out-of-hospital cardiac arrest. Resuscitation. 2020;147:12-20.

2. Atkinson PR, Bingham J, McNicholl BP, Loane MA and Wootton R. Telemedicine and cardiopulmonary resuscitation: the value of video-link and telephone instruction to a mock bystander. Journal of Telemedicine & Telecare. 1999;5:242-5.

3. Bang JY, Cho Y, Cho GC, Lee J and Kim IY. Can Mobile Videocall Assist Laypersons' Use of Automated External Defibrillators? A Randomized Simulation Study and Qualitative Analysis. BioMed Research International. 2020;2020:4069749.

4. Bolle SR, Scholl J and Gilbert M. Can video mobile phones improve CPR quality when used for dispatcher assistance during simulated cardiac arrest? Acta Anaesthesiologica Scandinavica. 2009;53:116-20.

5. Dong X, Zhang L, Myklebust H, Birkenes TS and Zheng ZJ. Effect of a real-time feedback smartphone application (TCPRLink) on the quality of telephone-assisted CPR performed by trained laypeople in China: a manikin-based randomised controlled study. BMJ Open. 2020;10:e038813.

6. Ecker H, Wingen S, Hamacher S, Lindacher F, Bottiger BW and Wetsch WA. Evaluation Of CPR Quality Via Smartphone With A Video Livestream - A Study In A Metropolitan Area. Prehospital Emergency Care. 2020:1-6.

7. Hunt EA, Heine M, Shilkofski NS, Bradshaw JH, Nelson-McMillan K, Duval-Arnould J and Elfenbein R. Exploration of the impact of a voice activated decision support system (VADSS) with video on resuscitation performance by lay rescuers during simulated cardiopulmonary arrest. Emergency Medicine Journal. 2015;32:189-94.

8. Lee JS, Jeon WC, Ahn JH, Cho YJ, Jung YS and Kim GW. The effect of a cellular-phone video demonstration to improve the quality of dispatcher-assisted chest compression-only cardiopulmonary resuscitation as compared with audio coaching. Resuscitation. 2011;82:64-8.

9. Marquez-Hernandez VV, Gutierrez-Puertas L, Garrido-Molina JM, Garcia-Viola A, Granados-Gamez G and Aguilera-Manrique G. Using a Mobile Phone Application Versus Telephone Assistance During Cardiopulmonary Resuscitation: A Randomized Comparative Study. Journal of Emergency Nursing. 2020;46:460-467.e2.

10. Perry O, Wacht O, Jaffe E, Sinuany-Stern Z and Bitan Y. Using a filming protocol to improve video-instructed cardiopulmonary resuscitation. Technology & Health Care. 2020;28:213-220.

11. Plata C, Stolz M, Warnecke T, Steinhauser S, Hinkelbein J, Wetsch WA, Bottiger BW and Spelten O. Using a smartphone application (PocketCPR) to determine CPR quality in a bystander CPR scenario - A manikin trial. Resuscitation. 2019;137:87-93.

12. Stipulante S, Delfosse AS, Donneau AF, Hartsein G, Haus S, D'Orio V and Ghuysen A. Interactive videoconferencing versus audio telephone calls for dispatcher-assisted cardiopulmonary resuscitation using the ALERT algorithm: a randomized trial. European Journal of Emergency Medicine. 2016;23:418-424.

13. Yang CW, Wang HC, Chiang WC, Chang WT, Yen ZS, Chen SY, Ko PC, Ma MH, Chen SC, Chang SC and Lin FY. Impact of adding video communication to dispatch instructions on the quality of rescue breathing in simulated cardiac arrests--a randomized controlled study. Resuscitation. 2008;78:327-32.

14. Yang CW, Wang HC, Chiang WC, Hsu CW, Chang WT, Yen ZS, Ko PC, Ma MH, Chen SC and Chang SC. Interactive video instruction improves the quality of dispatcher-assisted chest compression-only cardiopulmonary resuscitation in simulated cardiac arrests. Critical Care Medicine. 2009;37:490-5.

15. Lin YY, Chiang WC, Hsieh MJ, Sun JT, Chang YC and Ma MH. Quality of audio-assisted versus video-assisted dispatcher-instructed bystander cardiopulmonary resuscitation: A systematic review and meta-analysis. Resuscitation. 2018;123:77-85.


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