Effect of team-based cardiopulmonary resuscitation training for emergency medical service providers on pre-hospital return of spontaneous circulation in out-of-hospital cardiac arrest patients

Objective: This study aimed to assess whether team-based cardiopulmonary resuscitation (CPR) training for emergency medical service (EMS) providers improved the pre-hospital return of spontaneous circulation (ROSC) rates of non-traumatic adult out-of-hospital cardiac arrest (OHCA) patients. Methods: This was a before-and-after study an evaluating educational intervention for community EMS providers, which was conducted in Gyeonggi province, South Korea. Team-based CPR training was conducted from January to March 2016 for every level 1 and level 2 EMS provider in the study area. Non-traumatic EMS treated OHCA patients from July to December 2015 and from July to December 2016 were enrolled and used for the analysis. The primary outcome was pre-hospital ROSC rates before and after the training period. A multivariable logistic regression model with an interaction term (period × dispatch type) was used to determine the adjusted odds ratios (aORs) according to the dispatch type (single vs. multi-tiered). Results: Of the 2125 OHCA cases included, 1072 (50.4%) and 1053 (49.6%) were categorized in the before- and after-training groups, respectively, and the pre-hospital ROSC rates were 6.6% and 12.6%, respectively. In the multivariable logistic regression analysis, the aOR for pre-hospital ROSC was 2.07 (95% CI, 1.32–3.25) in the after-training period. In the interaction model (period × type of dispatch), the aORs for pre-hospital ROSC were 2.00 (95% CI, 1.01–3.98) and 2.13 (95% CI, 1.20–3.79) in the single- and multi-tiered dispatch groups, respectively, during the after-training period. Conclusion: Team-based CPR training for EMS providers in a large community EMS system improved the pre-hospital ROSC rates of OHCA patients.