Abstract
Background: Bystander CPR (BCPR) strongly influences survival from OHCA yet is provided in a minority of cases. The AHA has promulgated guidelines on provision of pre-arrival Hands-Only dispatcher-assisted telephone CPR (TCPR) instructions to increase the proportion of arrests receiving early BCPR; however, the impact of those guidelines is unknown. Objective: Evaluate the impact of implementing the TCPR guidelines on: recognition of OHCA by 911 dispatchers, time from call receipt to start of TCPR instructions, time to first chest compression (CC), prehospital ROSC, survival, and favorable neuro outcome (FNO). Methods: Dispatch audio records of OHCA in 3 large dispatch centers in Arizona (10/10-3/13) were reviewed using a standardized time-stamp methodology. Data were entered into a structured TCPR database linked to EMS and hospital outcome data. Intervention: Implementation of a 3.5-hour staff training and a guideline-based change in dispatch protocol. Results: There were 860 pre-implementation (P1) and 799 post-implementation (P2) cases. A total of 1265 cases met inclusion criteria. Outcome data collection and linkage is ongoing: ROSC, survival and neuro outcomes were available in 26%, 24% and 22% of cases, respectively. The proportion of cases receiving TCPR increased: P1 (28.7%); P2 (49.9%, p<0.001). Median time to beginning TCPR instructions decreased significantly: P1 (153 sec); P2 (129 sec, p<0.001) as did median time to first CC: P1 (198 sec); P2 (162 sec, p<0.001). Outcomes - see Table. Conclusion: The implementation of the AHA pre-arrival TCPR guidelines was associated with a significant improvement in the time-to-CPR instructions and time-to-first CCs and rate of provision of telephone-assisted bystander CPR. This small, preliminary analysis of prehospital ROSC, survival, and FNO revealed higher, but statistically non-significant, rates after the interventions.
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