Status of Dispatcher‐Provided Instructions to Bystanders of Out‐of‐Hospital Cardiac Arrest in Japan: An Analysis of the JAAM‐OHCA Registry

Cardiopulmonary resuscitation (CPR) education for schoolchildren is emphasized, as bystander CPR is a vital key to increasing the survival rate of out-of-hospital cardiac arrest (OHCA) victims. This study was conducted to verify the effect of CPR education on knowledge, attitudes, self-efficacy, and confidence of Korean elementary school students in performing CPR. Data were collected through structured questionnaires before and after CPR education and analyzed using descriptive statistics, T-tests, and hierarchical regression. Significant improvements in CPR knowledge, attitudes, self-efficacy, and confidence in performing CPR were found after CPR education, with the greatest increase observed in confidence (p = 0.000). The influencing factors on confidence in performing CPR were school grade, attitude, and self-efficacy. Although a significant increase in schoolchildren's CPR knowledge after education was shown, knowledge did not affect confidence in performing CPR. Therefore, early CPR education which focuses on improving confidence in performing CPR is recommended. CPR education might raise attitude and self-efficacy leading to increased confidence in performing bystander CPR. In conclusion, early and regular CPR education for elementary school students is crucial and should be conducted repeatedly.

AimTo determine whether dispatcher‐provided cardiopulmonary resuscitation (CPR) instructions improve the outcomes of out‐of‐hospital cardiac arrest (OHCA).MethodsCases registered in the Japanese Association for Acute Medicine Out‐of‐Hospital Cardiac Arrest (JAAM‐OHCA) Registry between June 2014 and December 2019 were included. Cases in which the dispatcher provided CPR instructions to the bystander were included in the “Instructions” group”, and cases without CPR instructions were included in the “No Instructions” group. The primary outcome was the proportion of patients with a favorable neurological outcome, defined as a Glasgow–Pittsburgh cerebral performance category scale of 1 to 2 at 1 month after OHCA.ResultsOverall, 51,199 patients with OHCA were registered in the JAAM‐OHCA Registry during the study period. Of these, 33,745 were eligible for the study, with 16,509 in the Instructions group and 17,236 in the No Instructions group. The proportion of patients with a favorable neurological outcome at 1 month after OHCA was inferior in the Instructions group than in the No Instructions group (2.3% versus 3.0%, p < 0.001). After adjustment for patient background characteristics, no association was found between CPR instructions provided by a dispatcher and favorable neurological outcomes at 1 month after OHCA (adjusted odds ratio, 1.000; 95% confidence interval, 0.869–1.151, p = 0.996).ConclusionThe present study found no clear clinical benefit of dispatcher‐provided CPR instructions on the neurological outcomes of cases with OHCA.

As with other Parts of the 2015 American Heart Association (AHA) Guidelines Update for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC), Part 5 is based on the International Liaison Committee on Resuscitation (ILCOR) 2015 international evidence review process. ILCOR Basic Life Support (BLS) Task Force members identified and prioritized topics and questions with the newest or most controversial evidence, or those that were thought to be most important for resuscitation. This 2015 Guidelines Update is based on the systematic reviews and recommendations of the 2015 International Consensus on CPR and ECC Science With Treatment Recommendations , “Part 3: Adult Basic Life Support and Automated External Defibrillation.”1,2 In the online version of this document, live links are provided so the reader can connect directly to the systematic reviews on the ILCOR Scientific Evidence Evaluation and Review System (SEERS) website. These links are indicated by a combination of letters and numbers (eg, BLS 740). We encourage readers to use the links and review the evidence and appendix. As with all AHA Guidelines, each 2015 recommendation is labeled with a Class of Recommendation (COR) and a Level of Evidence (LOE). The 2015 Guidelines Update uses the newest AHA COR and LOE classification system, which contains modifications of the Class III recommendation and introduces LOE B-R (randomized studies) and B-NR (nonrandomized studies) as well as LOE C-LD (based on limited data) and LOE C-EO (consensus of expert opinion). The AHA process for identification and management of potential conflicts of interest was used, and potential conflicts for writing group members are listed at the end of each Part of the 2015 Guidelines Update. For additional information about the systematic review process or management of potential conflicts of interest, see “Part 2: Evidence Evaluation and Management of Conflicts of Interest” in this …

Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases

Cardiac arrest, acute myocardial infarction (AMI), and stroke affect millions of people in the United States annually.1 Despite significant advances in medical treatments for these conditions, they remain a major public health problem and a leading cause of morbidity and mortality.1 A critical common element in optimizing care and outcomes for these conditions is the timely recognition of symptoms and initiation of treatment. For example, rapid initiation of cardiopulmonary resuscitation (CPR) is associated with improved survival from cardiac arrest.2 Similarly, early recognition and presentation after onset of symptoms of AMI and ischemic stroke enable implementation of critical therapies such as primary angioplasty and thrombolysis, which are known to improve outcomes.1 Indeed, the “Chain of Survival” for emergency cardiovascular and cerebrovascular care (ECCC) starts with prompt identification of the condition and early activation of the healthcare system to rapidly initiate care.3 Unfortunately, despite national efforts that include public education initiatives and clinical practice guideline recommendations from entities such as the American Heart Association (AHA), major gaps remain in the timely identification of symptoms and initiation of ECCC.4–6 As one example, studies of out-of-hospital cardiac arrest (OHCA) have consistently noted delays in the initiation of bystander CPR.7 For AMI, there have been advances in the provision of timely primary angioplasty for ST-segment elevation myocardial infarction (STEMI), as reflected by significant improvements in door-to-balloon times.8 However, the time from patient symptom onset to seeking care for possible myocardial infarction has not improved significantly.9,10 Similarly, for stroke, there continue to be advances in door-to-needle times, but stroke symptom recognition and seeking of treatment by patients and their families remain a major barrier to timely stroke care.11–16 Public and clinician education efforts alone are not sufficient to reduce gaps …

Cardiac arrest is a common and treatable cause of death and disability. Each year ≈424 000 people experience emergency medical services (EMS)-assessed out-of-hospital cardiac arrest (OHCA) in the United States.1 The actual burden of OHCA is likely significantly higher because a substantial number go unassessed. In a prospective analysis of deaths in a US county, 5.6% of annual mortality was attributable to cardiac arrest.2 Many patients who suffer OHCA do not receive prompt cardiopulmonary resuscitation (CPR). Among those who receive CPR, a large number do not survive because of an inability to restore spontaneous circulation, or anoxic cerebral injury even after restoration of circulation. Nevertheless, when timely interventions are provided, a small proportion of patients (10.4% of all EMS-treated OHCA) recover to resume normal lives. The key therapeutic interventions that make the difference between life and death, metaphorically characterized as the 5 links in a chain of survival by the American Heart Association, include: (1) immediate recognition of cardiac arrest and activation of the EMS, (2) early CPR with emphasis on chest compression, (3) rapid defibrillation, (4) effective advanced life support, and (5) integrated postcardiac arrest care.3 Resuscitation science has undergone major advances since the origins of modern CPR >50 years ago.4 The field continues to be dynamic with emergence of new therapies such as therapeutic hypothermia5 and improvements in systems of care. However, many questions remain on issues such as optimum compression rate, efficacy of chest compression only CPR (CCCPR), dispatcher-assisted CPR, and benefits of postresuscitation measures such as hypothermia. A critical challenge also lies in the translation of resuscitation science into practice. To improve outcomes, each of the links in the chain of survival needs to be executed promptly and effectively. There remain several lacunae, which need to be overcome to develop an …

Part 5: Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

Can bystanders' gender affect the clinical outcome of out-of-hospital cardiac arrest: A prospective, multicentre observational study.

Extracorporeal Cardiopulmonary Resuscitation: Prehospital or In-Hospital Cannulation?

Survival rates following out-of-hospital cardiac arrest (OHCA) increase two to three times when cardiopulmonary resuscitation (CPR) is started by bystanders, as compared to starting CPR when Emergency Medical Services (EMS) arrives. Municipalities that have implemented dispatcher-assisted bystander CPR programs have seen increased rates of bystander CPR. Cardiopulmonary resuscitation instructions are given for victims of all ages, but it is unknown if offering instructions results in similar rates of EMS-documented bystander CPR across the age continuum in these municipalities. The aim of this study was to determine if there is a difference in EMS-documented bystander CPR rates based on the age group of the OHCA victim when dispatcher CPR instructions are available in the community. This was a three-year, retrospective chart review of OHCA patients in two municipalities within a single county that provided dispatcher-assisted CPR instructions. Bystander CPR and patient age were determined based on EMS documentation. Age was stratified into three groups: child (0-12 years), adult (13-54 years), and geriatric (≥55 years). Chi square was used to compare the rate of bystander CPR in each age group. During the study period, 1,993 patients were identified as being in OHCA at the time of EMS arrival. The overall bystander CPR rate was 10%. The highest rate of bystander CPR was in the child age group (19%). The lowest rate of bystander CPR was in the geriatric age group (9%). There was a statistically significant difference between age groups (P≤.01). The rate of EMS-documented bystander CPR was low, even though these municipalities provided dispatcher-assisted CPR instructions. The highest rates of bystander CPR were observed in children (0-12 years). Future investigations should determine why this occurs and if there are opportunities to modify dispatcher coaching based on patient age so that bystander CPR rates improve. WeinmeisterKL, LernerEB, GuseCE, AteyyahKA, PirralloRG. Dispatcher CPR instructions across the age continuum. Prehosp Disaster Med. 2018;33(3):342-345.

Objectives. We sought to identify barriers and facilitators to ambulance communications officers’ (ACOs’) recognition of abnormal breathing and administration of cardiopulmonary resuscitation (CPR) instructions. Methods. We conducted semistructured qualitative interviews based on the constructs of the Theory of Planned Behavior to elicit salient attitudes, social influences, and behavioral controls potentially influencing ACOs’ intent to recognize abnormal breathing as a symptom of cardiac arrest and administer CPR instructions over the phone. We conducted interviews until achieving data saturation. We recorded interviews and transcribed them verbatim. Two independent reviewers performed inductive analyses to identify emerging themes. Results. We interviewed 24 ACOs from four Canadian provinces (67% female, median 9.5 years of experience, 33% with paramedic training). We identified eight behavioral, 14 subjective normative, and 22 control beliefs. Important attitudes were as follows: 1) CPR instructions may help the patient and are likely to be beneficial for the caller; 2) abnormal breathing is an early sign of cardiac arrest; and 3) dispatch-assisted CPR instructions can improve survival. The leading social influence was management/quality assurance staff. Behavioral control was the construct most associated with ACOs’ ability to recognize abnormal breathing, including 1) adherence to mandatory scripted protocol, 2) poor caller description of breathing pattern, and 3) ACO training on abnormal breathing. Conclusions. This qualitative study found that control beliefs are most influential on ACOs’ intention to recognize abnormal breathing and provide CPR instructions over the phone. Training and policy changes should target these beliefs to increase the frequency of ACO-administered CPR instructions to callers reporting a patient in cardiac arrest.

Barriers to dispatcher-assisted telephone cardiopulmonary resuscitation

Survival from an out-of-hospital cardiac arrest (OHCA) depends on the sequence of interventions in "the chain of survival". If OHCA is recognized in the emergency medical communication centre (EMCC), the proper emergency medical service (EMS) should be dispatched and cardiopulmonary resuscitation (CPR) instructions should be given to a bystander. The study aimed to examine the impact of OHCA recognition in the EMCC on survival rates and the main elements of the chain of survival. Data from the Helsinki University Hospital's registry of OHCA patients between 1997 and 2013 were studied. Altogether, 2054 EMCC-handled and bystander-witnessed OHCA proven events of cardiac origin were analysed. In 80.5% of the victims, two EMS units were correctly dispatched and the OHCA was classified as recognized. Achieved return of spontaneous circulation (ROSC) and survival to hospital discharge were 49% and 23%, respectively, if cardiac arrest was recognized by the EMCC and 40% and 16% when it was not (P = 0.003 and 0.002). Dispatchers gave CPR instructions in 60% of the recognized OHCA cases. Bystander-performed CPR increased over time and was given in 58% of the recognized OHCAs and also in 17% of the unrecognized events. EMS delays were shorter if OHCA was recognized as opposed to unrecognized (8 min with an IQR 6.5-10 min vs. 9 min with an IQR 6.5-11 min; P = 0.001). Recognition of OHCA by the EMCC was significantly associated with an increased rate of bystander-performed CPR, reduced EMS response time, and increased OHCA patient ROSC and survival rates.

BackgroundPublic Cardiopulmonary resuscitation (CPR) education is important to increase the survival rate of out-of-hospital cardiac arrest (OHCA). In this study, we survey local healthcare personnel in China who met the requirements of becoming public CPR instructors to assess their level of knowledge and attitudes toward teaching CPR.Materials and MethodsTo find qualified public CPR instructors among the local healthcare personnel, we ran three training sessions between March 2018 and December 2018. We held three courses on selecting public CPR instructors from the local healthcare personnel (n = 496). We also surveyed candidates for public CPR instructors before making our final choice. The selected instructors were retrained for a single day in December 2021. The necessary information was exchanged with the members of the passing group, and the maintained valuables were investigated.ResultsPublic CPR instructors certified 428 cases (86.49%) after the final exam. The results showed that the emergency group had a higher success rate than the non-emergency group (control group) (175, 90.7% vs. 253, 83.8%; P = 0.042). Here, we conducted a binary logistic regression analysis to determine the relationship between 15 survey variables and the passing rate. The variables, such as financial incentives, prior automatic external defibrillator (AED) training, and younger age were independently affected by being public CPR instructors. Despite this, 246 instructors (57.9%) still attended the retraining courses in 2021, with significantly more instructors in the emergency group than those in the non-emergency group (111, 64.5% vs. 135, 53.4%; P = 0.022). Furthermore, the instructors who were not incentivized financially were less likely to switch between the emergency and non-emergency groups (96, 79.33% vs. 116, 86.56%; P = 0.990).ConclusionThe Chinese emergency team can serve as a model for the local healthcare personnel by training and leading a group of volunteer CPR instructors. Our research has practical implications for China's national CPR education policy by informing the scheduling of regional public CPR education programs.

Publication of the 2015 American Heart Association (AHA) Guidelines Update for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) marks 49 years since the first CPR guidelines were published in 1966 by an Ad Hoc Committee on Cardiopulmonary Resuscitation established by the National Academy of Sciences of the National Research Council.1 Since that time, periodic revisions to the Guidelines have been published by the AHA in 1974,2 1980,3 1986,4 1992,5 2000,6 2005,7 2010,8 and now 2015. The 2010 AHA Guidelines for CPR and ECC provided a comprehensive review of evidence-based recommendations for resuscitation, ECC, and first aid. The 2015 AHA Guidelines Update for CPR and ECC focuses on topics with significant new science or ongoing controversy, and so serves as an update to the 2010 AHA Guidelines for CPR and ECC rather than a complete revision of the Guidelines. The purpose of this Executive Summary is to provide an overview of the new or revised recommendations contained in the 2015 Guidelines Update. This document does not contain extensive reference citations; the reader is referred to Parts 3 through 9 for more detailed review of the scientific evidence and the recommendations on which they are based. There have been several changes to the organization of the 2015 Guidelines Update compared with 2010. “Part 4: Systems of Care and Continuous Quality Improvement” is an important new Part that focuses on the integrated structures and processes that are necessary to create systems of care for both in-hospital and out-of-hospital resuscitation capable of measuring and improving quality and patient outcomes. This Part replaces the “CPR Overview” Part of the 2010 Guidelines. Another new Part of the 2015 Guidelines Update is “Part 14: Education,” which focuses on evidence-based recommendations to facilitate widespread, consistent, efficient and effective implementation …