When dispatcher assistance is not saving lives: assessment of process compliance, barriers and outcomes in out-of-hospital cardiac arrest in a metropolitan city in China

Abstract

BackgroundSeveral Chinese cities have implemented dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), although out-of-hospital cardiac arrest (OHCA) survival rates remain low. We aimed to assess the process compliance, barriers and outcomes of OHCA in one of the earliest implemented (DA-CPR) programmes in China.MethodsWe retrospectively reviewed OHCA emergency dispatch records of Suzhou emergency medical service from 2014 to 2015 and included adult OHCA victims (>18 years) with a bystander-witnessed atraumatic OHCA that was subsequently confirmed by on-site emergency physician. The circumstances and DA-CPR process related to the OHCA event were analysed. Dispatch audio records were reviewed to identify potential barriers to implementation during the DA-CPR process.ResultsOf the 151 OHCA victims, none survived. The median time from patient collapse to call for emergency services and that from call to provision of cardiopulmonary resuscitation instructions was 30 (IQR 20–60) min and 115 (IQR 90–153) s, respectively. Only 110 (80.3%) bystanders/rescuers followed the dispatcher instructions; of these, 51 (46.3%) undertook persistent chest compressions. Major barriers to following the DA-CPR instructions were present in 104 (68.9%) cases, including caller disconnection of the call, distraught mood or refusal to carry out either compressions or ventilations.ConclusionsThe OHCA survival rate and the DA-CPR process were far from optimal. The zero survival rate is disproportionally low compared with survival statistics in high-income countries. The prolonged delay in calling the emergency services negated and rendered futile any DA-CPR efforts. Thus, efforts targeted at developing public awareness of OHCA, calling for help and competency in DA-CPR should be increased.

Survival outcome among patients with out-of-hospital cardiac arrest who received cardiopulmonary resuscitation in China: a systematic review and meta-analysis

“…The outcomes reported in other cities in China were similar [4,5]. Therefore, the survival rate of out-of-hospital CA in China is estimated at less than 1%, which has been widely cited in many previous studies [2,[6][7][8][9][10][11]. Nevertheless, evidence from metaanalysis is still lacking.…”

Early mechanical cardiopulmonary resuscitation can improve outcomes in patients with non-traumatic cardiac arrest in the emergency department

“…Additionally, CPR directed by dispatchers has not been popularized. [28][29][30][31] The rate of defibrillation is much lower than that in developed countries, such as the USA and UK, especially when CA occurs outside the hospital. A 2016 multicenter cohort study of 310 patients with OHCA showed that 92.9% of patients with CA were witnessed, but only a small fraction (2.3%) received bystander CPR, and only 1% received defibrillation at the first evaluation.…”

Monitoring cardiopulmonary resuscitation quality in emergency departments: a national survey in China on current knowledge, attitudes, and practices

“…EMS operating mechanism in Chinese city was different. Several cities have implemented dispatcher-assisted CPR, while others would not [ 8 ]. The median interval from call receipt to ambulance arrival at the collapse location was usually more than 15 min [ 3 – 6 ].…”