Video-assisted vs audio-assisted and unassisted cardiopulmonary resuscitation in bystanders: a systematic review and meta-analysis of randomized controlled trials
Disaster and Emergency Medicine Journal · 2025-12-31 · Meta-analysis
Abstract
INTRODUCTION: Sudden cardiac arrest is a leading cause of prehospital death, and timely cardiopulmonary resuscitation is critical for survival. However, limited bystander proficiency often hinders effective response. This meta-analysis aimed to examine whether video-assisted cardiopulmonary resuscitation improves resuscitation quality compared to telephone-assisted and unassisted cardiopulmonary resuscitation in layperson interventions. MATERIAL AND METHODS: A systematic search across eight databases and three gray literatures was conducted in April 2025. Eligible randomized controlled trials were appraised using the Cochrane Risk-of-Bias 2 tool. Pooled risk ratios and mean differences were calculated using fixed and random-effects models. Subgroup analyses were used to compare the video-cardiopulmonary resuscitation, telephone cardiopulmonary resuscitation, and unassisted cardiopulmonary resuscitation groups. This study was registered with PROSPERO (CRD420251021694). RESULTS: Twelve randomized controlled trials comprising 938 participants met the inclusion criteria. Video-cardiopulmonary resuscitation significantly improved cardiopulmonary resuscitation performance in hand positioning [risk ratio (RR) = 1.32; 95% confidence interval (CI): 1.15–1.52; p < 0.0001] and compression rate [mean difference (MD) = 15.51 times per minute; 95% CI: 8.27–22.75; p < 0.001]. No significant differences were observed in compression depth, time to first rescue breath, and time to first chest compression. CONCLUSIONS: Video-assisted instruction significantly enhanced key cardiopulmonary resuscitation performance metrics in bystanders. Incorporating video technology into dispatcher protocols may represent a critical advancement in prehospital emergency care and resuscitation training.
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