Abstract 14288: Implementation of a Multidimensional Bundle for Dispatcher Telephone CPR in a Horizontal Dispatch System is Associated With Increased Bystander CPR and Good Neurological Survival From Out-of-Hospital Cardiac Arrest

Abstract

Background: The resuscitation guidelines indicate pre-arrival dispatcher-assisted telephone CPR (DATCPR) instructions and measurement to increase the proportion of bystander CPR (BCPR), however the impact of those guidelines on survival is not well known. Objective: To describe the impact of a comprehensive bundle of DATCPR on BCPR and survival from OHCA in a horizontal computerized-aided dispatch (CAD) system. Methods: A centralize CAD system in a metropolitan EMS is studied. Routinely in system the time from call to ambulance dispatch should be within 60 seconds. The audio recordings of confirmed OHCAs were reviewed using a standardized format linked with EMS and hospital process and outcome data. The proportions of BCPR and survival six months after implementation (P1) of a bundle that included guideline-based protocol changes, staff training, computerized audit, feedback to providers and leadership rebuilt are compared with that of the same month period in the prior year as control group (P0), using regression analysis for statistics. Results: There were 1437 OHCAs [665 P0, 772 P1; 64% male, median age 62 (IQR: 47-74)](Table 1). The rate of BCPR went from 20.6% in P0 to 35.0% in P1 (p<0.001). Outcome of ROSC (return to spontaneous circulation) upon hospital arrival was significantly higher in P1 (10.4%) compared to P0 (6.6% p=0.037), as was good neurological outcome (CPC 1or2: 5.5% in P1 vs. 2.6% in P0 p=0.029). Survival to hospital discharge was higher in P1 (8.3%, vs. P0: 6.4%) but not statistically significant. After adjusting for witnessed arrest, shockable rhythms, age, sex, and pre-hospital time intervals, good neurological outcome were still significantly higher in P1 vs. P0 [adjusted odds ratios: 2.1 (95% 1.1-4.4)]. Conclusions: The implementation of a comprehensive bundle of DATCPR in a metropolitan horizontal dispatch system was associated with significant improvements in the rates of BCPR and good neurologic outcome after OHCA.