Abstract 228: Evaluation of Telephone-Assisted Cardiopulmonary Resuscitation Performance Recommendations for Out-Of-Hospital Sudden Cardiac Arrest

Abstract

Introduction: Telephone-assisted CPR (T-CPR) may improve bystander CPR (B-CPR) rates and survival from sudden cardiac arrest (SCA). The American Heart Association (AHA) has specified performance measures to ensure rapid provision of T-CPR instructions. Few studies have examined whether these individual T-CPR recommendations are associated with SCA outcomes. Objectives: We sought to assess whether the 2012 AHA Scientific Statement’s T-CPR evaluation metrics are associated with increased B-CPR and survival from SCA. We hypothesized that recognition of arrest and compliance with the T-CPR protocol will result in increased likelihood of B-CPR. Methods: We conducted a retrospective assessment of non-traumatic SCAs from the Singapore T-CPR Pan-Asian Resuscitation Outcomes Study. We modeled the likelihood of receipt of B-CPR and survival to hospital discharge controlling for potential confounders. Exposure variables were identified from the Scientific Statement including adherence to T-CPR algorithms, dispatcher recognition of need for CPR, barriers to CPR (yes/no), and time intervals. Results: From 7/2012-2016, the Singapore T-CPR registry contained 3,224 adjudicated SCA events. Mean age was 67±19, 62% of the patients were male, and 87% of the arrests occurred in the home; of these arrests, 75% received T-CPR and 4% survived to hospital discharge. Compliance with the T-CPR protocol algorithm was not associated with an increased likelihood of B-CPR and survival (p=ns, both). Dispatcher recognition of the need for CPR was associated with a 24.9 (12.9-47.9) increased likelihood of B-CPR p<0.01, but was not associated with survival (OR: 1.77(0.37-8.45)). Recognized barriers to CPR were associated with a lower likelihood of B-CPR and survival (p<0.05, both). B-CPR was associated with a 2.40 (1.04-5.45) increased likelihood of survival (p=0.04). Call time to dispatch of EMS of <2 min was associated with a 1.33 (1.07-1.67) p=0.01 increased likelihood of receipt of B-CPR. Conclusion: Rapid dispatch of EMS (<2 min) and successful recognition of need for CPR increased the likelihood of B-CPR. B-CPR was associated with a two-fold increased likelihood of survival. Future work should consider refining T-CPR evaluation metrics using a data driven approach.