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

Abstract

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.

Dispatcher-Assisted Cardiopulmonary Resuscitation: Disparity between Urban and Rural Areas

“…is may be attributed to urban citizens being younger in Taichung [17], which is similar to that observed in previous studies [3,5,12,13,18]. Additionally, the government implemented resuscitation curriculum in schools.…”

“…However, the time gap between the recognition of cardiac arrest to the arrival of emergency medical technicians (EMTs) is long, and the interventions from bystanders before an EMT's arrival could critically affect the prognosis in these patients [4]. A study showed that bystanders do not perform CPR before an EMT's arrival because of panic, concerns about not performing CPR accurately, fear of harming the individual, fear of legal consequences, and concern about mouth-to-mouth contact [5,6]. e survival rates of patients with OHCA have gradually increased recently through the promotion of the resuscitation training program, simplified CPR process, improved CPR quality by laypersons, and willingness [4].…”

Effect of using a home-bed mattress on bystander chest compression during out-of-hospital cardiac arrest

“…24 Moreover, continuous coaching for DA-CPR has helped bystanders perform CC properly. 25 As mentioned above, our study revealed that bystander fatigue was higher with using the SFM than with using the flat floor. Thus, bystanders need encouragement in increasing CC depth and rate through DA-CPR to help prevent the adverse effects of using home-bed mattresses.…”

A systematic review and meta-analysis of the effect of dispatcher-assisted CPR on outcomes from sudden cardiac arrest in adults and children

“…The OR was 0.74 (0.54-1) for the pediatric group (1 study 26 ) and 1.15 (1.10-1.19) for the adult studies 27,40,43,45 . The heterogeneity was not confirmed in a sensitivity analysis where Goto et al (2014) 25 was replaced by the overlapping study of Akahane et al (2012). 15 For the same outcome, two sensitivity analyses for the comparison of DA-CPR vs. no CPR indicated lower rates of initial shockable rhythm with DA-CPR, while the mainstream analysis and the other 3 of 5 relevant sensitivity analyses indicated higher rates of shockable rhythm with DA-CPR…”

“…Of the 33 included studies, 15 were conducted in the adult population only 16,20,22,25,27,31,34,37,[41][42][43][44][45]47,49 , five were conducted in the pediatric population ILCOR DA-CPR Systematic Review -Feb 19 2019 10 only 15,18,26,33,40 , and 13 included both adults and children 17,19,21,23,[28][29][30]32,[35][36][37]45,48 . The proportion of males ranged from 52% to 85% (average 66%).…”