Cardiac arrest patients rarely receive chest compressions before ambulance arrival despite the availability of pre-arrival CPR instructions

Lerner, E. Brooke; Sayre, Michael R.; Brice, Jane H.; White, Lynn J.; Santin, Amy J.; Billittier, Anthony J.; Cloud, Samuel D.

doi:10.1016/j.resuscitation.2007.10.020

Cited by 32 publications

(35 citation statements)

References 17 publications

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“…These rates in Japan are much higher than those reported from three cities in the United States [30] and comparable with those reported from other cities [31,32]. Although various reasons for callers not providing BCPR have been reported [30,32], the proportion of bystanders to follow DA-CPR is also dependent on the skill of dispatchers to provide a quick just-in-time instruction [33] encouraging the callers. Considerable regional variations in bystander's performance of CPR without instruction and number of BLS training course participants were observed.…”

Section: Discussionsupporting

confidence: 52%

Are regional variations in activity of dispatcher-assisted cardiopulmonary resuscitation associated with out-of-hospital cardiac arrests outcomes? A nation-wide population-based cohort study

et al. 2016

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Aim: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) impacts the rates of bystander CPR (BCPR) and survival after out-of-hospital cardiac arrests (OHCAs). This study aimed to elucidate whether regional variations in indexes for BCPR and emergency medical service (EMS) may be associated with OHCA outcomes. Methods:We conducted a population-based observational study involving 157,093 bystander-witnessed, resuscitation-attempted OHCAs without physician involvement between 2007 and 2011. For each index of BCPR and EMS, we classified the 47 prefectures into the following three groups: advanced, intermediate, and developing regions. Nominal logit analysis followed by multivariable logistic regression including OHCA backgrounds was employed to examine the association between neurologically favourable 1-month survival,

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Section: Discussionsupporting

confidence: 52%

Are regional variations in activity of dispatcher-assisted cardiopulmonary resuscitation associated with out-of-hospital cardiac arrests outcomes? A nation-wide population-based cohort study

et al. 2016

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“…However, prior investigation indicates that some patients with cardiac arrest are not identified with the 2-question approach. 6,7,9,15 Moreover, additional efforts to decrease false-positive CPR would likely delay and further reduce the yield of true arrests. For example, the current question asks whether the patient is breathing normally.…”

Section: Discussionmentioning

confidence: 99%

Dispatcher-Assisted Cardiopulmonary Resuscitation

et al. 2010

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Background-Dispatcher-assisted cardiopulmonary resuscitation (CPR) instructions can increase bystander CPR and thereby increase the rate of survival from cardiac arrest. The risk of bystander CPR for patients not in arrest is uncertain and has implications for how assertive dispatch is in instructing CPR. We determined the frequency of dispatcherassisted CPR for patients not in arrest and the frequency and severity of injury related to chest compressions. Methods and Results-The investigation was a prospective cohort study of adult patients not in cardiac arrest for whom dispatchers provided CPR instructions in King County, Washington, between June 1, 2004, and January 31, 2007. The study focused on those who received chest compressions. Information was collected through review of the audio and written dispatch report, written emergency medical services report, hospital record, and telephone survey. Of the 1700 patients for whom dispatcher CPR instructions were initiated, 55% (938 of 1700) were in arrest, 45% (762 of 1700) were not in arrest, and 18% (313 of 1700) were not in arrest and received bystander chest compressions. Of the 247 not in arrest who received chest compressions and had complete outcome ascertainment, 12% (29 of 247) experienced discomfort, and 2% (6 of 247) sustained injuries likely or possibly caused by bystander CPR. Only 2% (5 of 247) suffered a fracture, and no patients suffered visceral organ injury. Conclusions-In this prospective study, the frequency of serious injury related to dispatcher-assisted bystander CPR among nonarrest patients was low. When coupled with the established benefits of bystander CPR among those with arrest, these results support an assertive program of dispatcher-assisted CPR. (Circulation. 2010;121:91-97.)Key Words: cardiopulmonary resuscitation Ⅲ complications Ⅲ dispatcher Ⅲ epidemiology Ⅲ morbidity R apid initiation of cardiopulmonary resuscitation (CPR) can increase the chance of survival from cardiac arrest. 1,2 Nevertheless, in many communities, fewer than a quarter of cardiac arrest victims receive bystander CPR before emergency medical services (EMS) arrival, which indicates an opportunity to improve the survival rate if bystanders initiated CPR more frequently. 3,4 CPR instructions provided over the telephone by the 9-1-1 emergency dispatcher, called dispatcher-assisted CPR, can substantially increase bystander-initiated CPR and thereby increase the chance for survival from out-of-hospital cardiac arrest. 5 Editorial see p 10 Clinical Perspective on p 97Identification of cardiac arrest by dispatchers and bystanders can sometimes be challenging. 6,7 A number of conditions, including syncope, seizure, hypoglycemia, overdose, and cerebrovascular accident, can resemble cardiac arrest. 8 As a consequence, patients who are not in cardiac arrest can receive CPR. Indeed, strict compliance with common dispatch protocols for arrest identification would more often result in CPR for patients not in cardiac arrest than for the true arrest patient. 9 Although CPR can b...

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“…Dispatchers chose barriers described on the sheet when they encountered obstacles to provision of CPR instruction. These barriers were: the caller rejected CPR instruction, the caller was emotionally distressed, the caller left or hung up the phone, the caller was not with the patient, the caller had difficulty accessing the patient, the caller had physical limitations preventing CPR, the caller was unable to move the patient to a hard, flat surface, the caller knew how to perform CPR, and rigor mortis 14, 15, 16…”

Section: Methodsmentioning

confidence: 99%

Performance review of regional emergency medical service pre‐arrival cardiopulmonary resuscitation with or without dispatcher instruction: a population‐based observational study

Fukushima

Kawai

Asai

et al. 2017

Acute Medicine & Surgery

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BackgroundTo investigate variations in emergency medical service (EMS) pre‐arrival cardiopulmonary resuscitation (CPR), including both bystander CPR without dispatch assistance and dispatch‐assisted CPR (DACPR).MethodsWe carried out an observational study by implementing EMS pre‐arrival CPR reports in three fire agencies. We included adult, non‐traumatic, and non‐EMS witnessed out‐of‐hospital cardiac arrests. This reporting system comprised the dispatch instruction process and bystander CPR quality based on evaluations by EMS crews who arrived on the scene. Bystander CPR was categorized as “ongoing CPR” if the bystander was performing CPR when the EMS reached the patient's side and “good‐quality CPR” if the CPR was performed proficiently. We compared the frequencies of ongoing and good‐quality CPR in the bystander CPR already started without dispatch assistance (CPR in progress) group and DACPR group.ResultsOf 688 out‐of‐hospital cardiac arrests, CPR was already started in 150 cases (CPR in progress group). Dispatcher CPR instruction was provided in 368 cases. Among these, callers started chest compressions in 162 cases (DACPR group). Ongoing CPR was performed in 220 cases and was more frequent in the DACPR group (128/162 [79.0%] versus 92/150 [61.3%], P < 0.001). Good‐quality CPR was more frequent in the CPR in progress group, but the difference was not statistically significant (36/92 [39.1%] versus 42/128 [29.0%], P = 0.888).ConclusionsOngoing CPR and good‐quality CPR were not frequent in EMS pre‐arrival CPR. Detailed analysis of dispatch instructions and bystander CPR can contribute to improvement in EMS pre‐arrival CPR.

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Cardiac arrest patients rarely receive chest compressions before ambulance arrival despite the availability of pre-arrival CPR instructions

Cited by 32 publications

References 17 publications

Are regional variations in activity of dispatcher-assisted cardiopulmonary resuscitation associated with out-of-hospital cardiac arrests outcomes? A nation-wide population-based cohort study

Are regional variations in activity of dispatcher-assisted cardiopulmonary resuscitation associated with out-of-hospital cardiac arrests outcomes? A nation-wide population-based cohort study

Dispatcher-Assisted Cardiopulmonary Resuscitation

Performance review of regional emergency medical service pre‐arrival cardiopulmonary resuscitation with or without dispatcher instruction: a population‐based observational study

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