Association between video-assisted cardiopulmonary resuscitation and return of spontaneous circulation in out-of-hospital cardiac arrest: a retrospective study

The effect of different pre-emergency medical service bystander resuscitation strategies, particularly telephone-assisted versus video-assisted dispatcher cardiopulmonary resuscitation (CPR), on return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest remains unclear. This retrospective cohort study utilized data from the Suzhou Prehospital Emergency Dispatch Center in China, covering the period from January 2022 to April 2025. Patients were categorized into three groups based on pre-emergency medical service interventions: non-CPR, lay rescuer CPR, and dispatcher-assisted CPR. The dispatcher-assisted CPR group was further stratified into telephone-assisted CPR and video-assisted CPR. The primary outcome was the rate of ROSC, assessed during the resuscitation period from EMS arrival at the scene to the initial resuscitation phase in the emergency department. Multivariable logistic regression was used to identify factors associated with ROSC. Among 4,683 out-of-hospital cardiac arrest patients included, 572 (12.21%) achieved ROSC. Compared to non-ROSC patients, those who achieved ROSC had significantly shorter EMS response times [10 (8–14) min vs 12 (9–16) min], on-scene treatment durations [7 (4–11) min vs 7 (4–11) min], and total emergency medical service times [29 (23–35) min vs 31 (25–39) min, p < 0.05]. In addition, rates of tracheal intubation [113 (19.76%) vs 532 (12.94%)], mechanical ventilation [56 (9.79%) vs 248 (6.03%)], and defibrillation [48 (8.57%) vs 199 (4.84%)] were higher in the ROSC group ( p < 0.05). Compared with the non-CPR group [445 (11.79%)], both lay rescuer CPR [49 (13.32%)] and dispatcher-assisted CPR [78 (14.44%)] were associated with higher ROSC rates; however, the differences did not reach statistical significance. Notably, the ROSC rate in the video-assisted CPR subgroup [37 (19.58%)] was significantly higher than in the telephone-assisted CPR subgroup [40 (11.46%)] ( χ 2 = 6.584, p = 0.01). Univariate logistic regression analysis showed that age, emergency medical service response time, and scene time were associated with ROSC. Younger age and shorter EMS response time were associated with ROSC in out-of-hospital cardiac arrest. VA-CPR showed a non-significant trend toward improved ROSC after multivariable adjustment, suggesting a potential benefit that warrants further investigation.