Abstract 133: Association Between Bystander Physical Limitations And Delays In Chest Compression During T-CPR

Abstract

Background: Promptly initiated bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest (OHCA). Many OHCA patients require repositioning (e.g., moved to hard surface) to improve chest compression (CC) quality, which can delay CC. We examined the association between repositioning, CC delay, and patient outcomes. Methods: We used quality improvement data from review of 911 dispatch audio recordings of OHCA in adults eligible for telephone CPR (T-CPR) in King County, WA between 2013 and 2021. OHCA was categorized into 3 groups: CC not delayed, CC delayed due to bystander-reported physical limitations to reposition the patient, or CC delayed for other reasons. The primary outcome was delay in CC defined as the interval between start of T-CPR instructions and CC onset. We performed Kruskal-Wallis and Chi Square tests to evaluate global differences and post-hoc analyses with Bonferroni correction for pairwise differences. Results: Of the 3,483 OHCA patients eligible for T-CPR, median age was 64, 35% were women, 45% were witnessed, 23% had an initial shockable rhythm, and 15% survived to discharge. T-CPR was not delayed between instructions and compressions in 1,618 patients (46%), was delayed due to bystander physical limitations in repositioning the patient in 1,218 (35%), and was delayed for other reasons in 647 (19%). The interval from T-CPR instruction to CC onset was longest for the physical limitations delay group (121 secs, IQR: 69) compared to the other delay group (88 secs, IQR: 65) and the no delay group (54 secs, IQR: 36) (all comparisons p<.05). Bystander CPR was less frequent in the physical limitations delay group (74%) versus no delay (100%) or the other delays group (81%, all comparisons p<.05). In the physical limitation delays group, 154 (13%) of patients ultimately received bystander CPR on a soft surface (e.g., bed). This group also had the lowest hospital discharge survival (11%, p<.05) versus the no delays (17%) and other delays group (17%). Conclusion: Bystander physical limitations are a common barrier to repositioning patients to begin CPR. Repositioning delays were associated with lower likelihood of receiving CPR, longer times to begin CC, and lower survival rates.