From call to home: The role of dispatcher-assisted CPR in patient survival

Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is a key strategy to reduce no-flow time in out-of-hospital cardiac arrest (OHCA), yet its impact on long-term survival remains various across emergency medical systems. Purpose: We aimed to evaluate the association between DA-CPR and resuscitation outcomes in a nationwide cohort of OHCA patients presenting with an initial shockable rhythm. Methods: We conducted a retrospective observational study including all adult OHCA cases with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) in which resuscitation was carried out by emergency medical services in Hungary during 2019, 2022, and 2023. Patients were stratified according to whether DA-CPR was ongoing upon ambulance arrival, or initiated by the ambulance crew. Primary outcomes were return of spontaneous circulation (ROSC) and hospital admission with sustained circulation. Utstein-style consensus reporting guidelines were followed. Results: A total of 3,674 VF/VT OHCA cases were included, of whom 1,744 (47.5%) received DA-CPR. Patients in the DA-CPR group had significantly higher rates of ROSC (92.0% vs. 12.4%), hospital admission with sustained circulation (90.8% vs. 11.7%), 30-day survival (54.6% vs. 7.1%), and one-year survival (45.8% vs. 6.2%) compared with those without DA-CPR (all P < 0.001). DA-CPR occurrence increased over time, while declined in 2022 followed by partial recovery in 2023. Conclusion: In this nationwide cohort of OHCA patients with shockable rhythms, dispatcher-assisted CPR was strongly associated with improved early resuscitation success and long-term survival. These findings support DA-CPR as a critical system-level intervention and highlight the importance of centralised protocols and continuous performance monitoring.