Implementation of a dispatch-instruction protocol for cardiopulmonary resuscitation according to various abnormal breathing patterns: a population-based study

Abstract

BackgroundWe modified the dispatch protocol for cardiopulmonary resuscitation (CPR) using results of a retrospective analysis that identified descriptions by laypersons of possible patterns of agonal respiration. The purpose of this study was to assess the effectiveness of this modified protocol by comparing the frequency of dispatch instructions for CPR and bystander CPR before and after protocol implementation. We also identified descriptions of abnormal breathing patterns among ‘Not in cardiac arrest (CA)’ unresponsive cases.MethodsThis study was conducted prospectively using the population-based registry of out-of-hospital cardiac arrests (OHCAs). For 8 months we implemented this modified protocol in cooperation with 4 fire departments that cover regions with a total population of 840,000.ResultsThere were 478 and 427 OHCAs before and after implementation, respectively. Among them, 69 and 71 layperson-witnessed OHCAs for pre- and post-implementation, respectively, were analyzed. Dispatchers provided CPR instructions more frequently after protocol implementation than before (55/71 [77.5 %] vs. 41/69 [59.4 %], p < 0.05). Based on breathing patterns described by emergency callers, dispatchers assessed 143 ‘Not in CA’ unresponsive cases and provided CPR instruction for 45 cases. Sensitivity and specificity of this protocol was 93 % and 50 %, respectively.ConclusionsThis modified protocol based on abnormal breathing described by laypersons significantly increased CPR instructions. Considering high sensitivity and low specificity for abnormal breathing to identify CA and the low risk of chest compression for ‘Not in CA’ cases, our study suggested that dispatchers can provide CPR instruction assertively and safely for those unresponsive individuals with various abnormal breathing patterns.

The accuracy of medical dispatch - a systematic review

“… Retrospective observational Very low United Kingdom Emergency calls due to CA, adult 469,400/8830 emergency calls, adult NHS Pathways Using ambulance crew’s decision as reference Moller T. P. et al (2016) [ 18 ]. Retrospective observational Very low Denmark and Sweden Patients from national cardiac arrest registers and connected emergency calls 776 patients from Denmark and 346 from Sweden Criteria Based Dispatch The information from the ambulance crew (cardiac arrest register) was reference Fukushima H. et al (2015) [ 19 ]. Before/after comparison Very low Japan Patients from national cardiac arrest register and connected emergency calls 478 patients (before) and 427 (after) “Regional system” The information from the ambulance crew (cardiac arrest register) was reference Tanaka Y. et al (2014) [ 20 ].…”

Dispatcher-Assisted Telephone Cardiopulmonary Resuscitation Using a French-Language Compression-Ventilation Pediatric Protocol

“…24 As a consequence, the American Heart Association has claimed for a simplification of the procedures involved in the evaluation of normal breathing. 10 Such a simplified approach might significantly increase OHCA detection by telephone, 25 with few adverse effects in the case of CPR undertaken in patients who are not in cardiac arrest. 26 Adopting this simplified procedure in our protocol could increase OHCA detection by telephone, with first chest compressions and ventilations that could occur earlier.…”

“…Among these, 115 met the inclusion criteria and were randomly distributed in the 4 study groups as depicted in Figure 1. According to the inclusion criteria, mean age was higher in the untrained groups (31 [24][25][26][27][28][29][30][31][32][33][34][35]years in U-NG and 27 [24-34.5]years in U-G) than in the previously trained groups (20.5 [20][21][22]years in T-NG and 21.5 [20][21][22][23][24]years in T-G), respectively (P < 0.001).…”

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

“…If the patient is not responsive, they then ask whether the victim is breathing normally. Depending on the breathing descriptions obtained, such as “breathing abnormally”, “snoring weakly” or “not breathing”, EMS dispatchers consider the possibility of CA 13. Once CA is suspected, the dispatchers instruct the caller to unlock the door if appropriate, so that the EMS crew can immediately gain access to the patient.…”