Abstract 228: Quality Measurement of Dispatcher-Assisted Cardiopulmonary Resuscitation; A Nationwide Observational Study

Abstract

Introduction: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is an effective community intervention program to increase bystander CPR rate after cardiac arrest. The 2010 American Heart Association guidelines recommended a very easy, simplified DA-CPR protocol which is composed of two key questions and hands-only CPR. However, there have been few reports on quality of dispatchers’ performance in DA-CPR when the protocol is implemented. This study aimed to evaluate the quality of dispatchers’ performance in DA-CPR. Methodology: All patients with cardiac arrest with presumed cardiac etiology transported by emergency medical service (EMS) were enrolled from Aug.13, to October 8, 2012 in Korea. We used a quality measurement protocol and document which was developed from a medical directors’ workshop of Asian EMS Council in Aug, 2012. Sixteen provinces’ medical directors reviewed cardiac arrest registries, DA-CPR registries, and records of conversation between dispatchers and bystanders, and evaluated according to the developed protocol. Primary end pints such as the detection rate, instruction rate, compliance rate, time intervals from call to each process, and barriers to prevent bystanders from performing CPR were analyzed. Results: A total 4,601 of cardiac arrest were analyzed. Of these, 709 cases (15.4%) were detected by primary dispatcher (range 4.4%-34.0%), and 590 cases (12.8%) received bystander CPR instruction. Median time (Q1-Q3) from call to detection and to initiation of bystander CPR was 91 seconds (57-118) and 147 seconds (82-206), respectively. Compliance rate for the protocol (on asking key questions) was 37.0%. The CPR instruction failed in 74 cases due to rejection by bystanders, prolonged death, and communication disruption. The number of aborted bystander CPR after initiation of DA-CPR by bystander was 257, who stopped to receive CPR prior to arrival of ambulances at the field due to request by family, disruption of communication, and other reasons. Finally successful DA-CPR was 233 (5.0%) among 4,601. Conclusion: Quality of dispatcher performance on DA-CPR protocol was very poor and a few patients received successful DA-CPR. A continuous quality management program should be applied to improve the quality DA-CPR.