Dispatcher-assisted Cardiopulmonary Resuscitation Research Articles

The effect of dispatcher-assisted cardiopulmonary resuscitation on early defibrillation and return of spontaneous circulation with survival

BackgroundDispatcher-assisted cardiopulmonary resuscitation (DA-CPR) programs are implemented to augment bystander CPR and improve outcomes of patients with out-of-hospital cardiac arrest (OHCA). To understand the pathway of how DA-CPR improves outcomes of OHCA, we aimed to evaluate the effect of DA-CPR on defibrillation and return of spontaneous circulation (ROSC) with survival to hospital discharge within 90 min. MethodsWe conducted a population-based observational study of all adults with OHCA with presumed cardiac aetiology treated by emergency medical services (EMS) between 2013 and 2016, using a national OHCA registry. We excluded cases without a witness, those that occurred in hospital, were witnessed by an EMS provider, or defibrillated by a layperson. The exposure was bystander CPR status: no bystander CPR (No BCPR), bystander CPR without dispatcher assistance (NDA-BCPR), and bystander CPR with dispatcher assistance (DA-BCPR). The observation time was set to a maximum of 90 min for survival analysis. The primary outcome was ROSC within 90 min leading to being discharged alive (ROSC with survival). The secondary outcomes were ROSC within 90 min leading to being discharged with cerebral performance category I or II (ROSC with good CPC) and first defibrillation within 90 min (defibrillation). Multivariable Cox proportional hazards analysis was performed to calculate adjusted hazard ratios (AHRs), according to bystander CPR status adjusted for potential confounders. ResultsOf 25,450 eligible OHCAs, NDA-BCPR was provided for 3193 cases (12.5%) and DA-BCPR was provided for 12,154 cases (47.8%). ROSC with survival was observed in 13.2% of cases with NDA-BCPR and 12.0% with DA-BCPR. Compared with No BCPR, both type of bystander CPR were associated with 44% and 55% increases in ROSC with survival to discharge (AHR, 95% confidence interval (CI): 1.44, 1.27–1.63 for NDA-BCPR and 1.55, 1.41–1.69 for DA-BCPR). DA-BCPR was also associated with defibrillation compared with No-BCPR, accounting for ROSC as a competing risk (AHR 1.16, 95% CI 1.12–1.21). ConclusionsCompared with no bystander CPR provided, both bystander CPR with or without dispatcher assistance were associated with defibrillation and ROSC leading to survival to discharge in patients with witnessed OHCA.

Does dispatcher-assisted bystander CPR improve outcomes from adult out-of-hospital cardiac arrest?

This short review addresses the evidence behind dispatcher-assisted CPR (DA-CPR) and whether it contributes to overall survival of out-of-hospital cardiac arrest (OHCA). Six papers directly addressed the review question and were selected for appraisal, including one systematic review. The outcomes of these studies demonstrate variable results from the implementation of DA-CPR strategies. While DA-CPR has some utility as a substitute for spontaneously delivered bystander CPR, available evidence suggests there is scope to improve. Further work should focus on the identification and adoption of more effective protocols.

‘We’re going to do CPR’: A linguistic study of the words used to initiate dispatcher-assisted CPR and their association with caller agreement

Background: In emergency ambulance calls for out-of-hospital cardiac arrest (OHCA), dispatcher-assisted cardiopulmonary resuscitation (CPR) plays a crucial role in patient survival. We examined whether the language used by dispatchers to initiate CPR had an impact on callers’ agreement to perform CPR.Methods: We analysed 424 emergency calls relating to cases of paramedic-confirmed OHCA where OHCA was recognised by the dispatcher, the caller was with the patient, and resuscitation was attempted by paramedics. We investigated the linguistic choices used by dispatchers to initiate CPR, and the impact of those choices on caller agreement to perform CPR.Results: Overall, CPR occurred in 85% of calls. Caller agreement was low (43%) when dispatchers used terms of willingness (“do you want to do CPR?”). Caller agreement was high (97% and 84% respectively) when dispatchers talked about CPR in terms of futurity (“we are going to do CPR”) or obligation (“we need to do CPR”). In 38% (25/66) of calls where the caller initially declined CPR, the dispatcher eventually secured their agreement by making several attempts at initiating CPR.Conclusion: There is potential for increased agreement to perform CPR if dispatchers are trained to initiate CPR with words of futurity and/or obligation.

Association of dispatcher-assisted bystander cardiopulmonary resuscitation with survival outcomes after pediatric out-of-hospital cardiac arrest by community property value

ObjectiveWe aimed to demonstrate the association of bystander cardiopulmonary resuscitation (BCPR) with survival outcomes after pediatric out-of-hospital cardiac arrest (OHCA) by community property value groups. MethodsThis observational study enrolled all emergency medical services (EMS)-treated pediatric OHCAs in Korea between 2012 and 2015. Enrolled patients were divided into three groups: BCPR with dispatcher-assistance (DA), BCRP-without-DA, and no-BCPR. Patients were categorized based on tertiles for property tax per capita of community in which the cardiac arrest occurred. The endpoint was survival to discharge. To test the interactive effects between BCPR and community property value on study endpoints, a multilevel logistic regression model with an interaction term was used. ResultsA total of 2020 patients were enrolled (37.0% BCPR-with-DA, 14.5% BCPR-without-DA, and 48.5% no-BCPR). BCPR-with-DA and BCPR-without-DA were more likely to have higher rates of survival to discharge compared to no-BCPR (8.6% and 13.0% vs. 3.5%; AORs (95% CIs): 2.23 (1.33–3.74) and 2.87 (1.57–5.25)). By interaction analysis with community property tax per capita, the AORs for survival in BCPR-with-DA and BCPR-without-DA groups were 2.56 (1.03–6.38) and 3.48 (1.10–10.9) for high value communities, 2.25 (0.95–5.31) and 3.76 (1.53–9.23) in middle communities, and 1.88 (0.88–3.99) and 1.54 (0.57–4.17) in low value communities (interaction, p = 0.68). ConclusionIn pediatric OHCAs, BCRP was associated with improved survival outcomes. The survival benefits of BCPR did not differ significantly by community property value.

The association between dispatcher-assisted cardiopulmonary resuscitation and early return-of-spontaneous circulation with survival

The association between dispatcher-assisted cardiopulmonary resuscitation and early return-of-spontaneous circulation with survival

The ten-year transition of the favorable neurological outcomes by dispatcher-assisted cardiopulmonary resuscitation in Japan

The ten-year transition of the favorable neurological outcomes by dispatcher-assisted cardiopulmonary resuscitation in Japan

Dispatcher-assisted cardiopulmonary resuscitation in patients with traumatic out-hospital cardiac arrest

Dispatcher-assisted cardiopulmonary resuscitation in patients with traumatic out-hospital cardiac arrest

Different dialing method affect the effect of dispatch-assisted cardiopulmonary resuscitation

Background: Dispatch-assisted cardiopulmonary resuscitation could improve survival of out of hospital cardiac arrest (OHCA) patient. However, there were many barriers between dispatch and bystander. Our study aimed to determine the effectiveness of dispatch-assisted cardiopulmonary resuscitation from different dialing methods.

Improvements in bystander CPR rates and survival for Out-of-Hospital Cardiac Arrest with a comprehensive dispatcher-assisted CPR program in Singapore

Background: Out-of-Hospital Cardiac Arrest (OHCA) in Singapore is historically associated with poor survival (3% survival-to-discharge) and low Bystander CPR (BCPR) rates (20.3%). This study evaluates the impact of a comprehensive Dispatcher-assisted CPR (DACPR) program on BCPR rates and OHCA outcomes in Singapore.

Quality assessment of instructions for dispatcher-assisted telephone cardiopulmonary resuscitation (DATCPR) performed between emergency medical technicians (EMTs) and registered nurses (RNs)

Purpose: Quality of DATCPR instructions between EMT and RN are not well known. In vertical dispatch call-taker and CPR instructor would be the same EMT; in horizontal dispatch call-taker would be EMT while CPR instructor could be RN to takeover the calls of recognized OHCA. This study was to compare the quality of DATCPR instructions between EMTs and RNs.

The Critical Role of Dispatch.

There are 240 million 9-1-1 calls in the United States every year. The burden of managing these emergencies until first responders can arrive is on the dispatchers working in the 5806 public safety answering points, more commonly known as dispatch centers. They are the first link in the chain of survival between the public and the remainder of the health care system. Dispatchers play a critical role in the early identification of emergencies, assignment of appropriate emergency resources, and provision of life-sustaining interventions like dispatcher-assisted cardiopulmonary resuscitation and disaster management.

Association between the centralization of dispatch centers and dispatcher-assisted cardiopulmonary resuscitation programs: A natural experimental study

ObjectivesWe aimed to evaluate the associations between the centralization of dispatch centers and dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) for out-of-hospital cardiac arrest (OHCA) patients. MethodsAll emergency medical services (EMS)-treated adults in Gyeonggi province (34 fire departments covering 43 counties, with a population of 12.6 million) with OHCAs of cardiac etiology were enrolled between 2013 and 2016, excluding cases witnessed by EMS providers. In Gyeonggi province, 34 agency-based dispatch centers were sequentially integrated into two province-based central dispatch centers (north and south) between November 2013 and May 2016. Exposure was the centralization of the dispatch centers. Endpoint variables were BCPR and dispatcher-provided CPR instructions. Generalized linear mixed models for multilevel regression analyses were performed. ResultsOverall, 11,616 patients (5060 before centralization and 6556 after centralization) were included in the final analysis. The OHCAs that occurred during the after-centralization period were more likely to receive BCPR (62.6%, 50.6% BCPR-with-DA and 12.0% BCPR-without-DA) than were those that occurred before-centralization period (44.6%, 16.6% BCPR-with-DA and 28.1% BCPR-without-DA) (p < 0.01, adjusted OR: 1.59 (1.38–1.83), adjusted rate difference: 9.1% (5.0–13.2)). For dispatcher-provided CPR instructions, OHCAs diagnosed at a higher rate during the after-centralization period than during the before-centralization period (67.4% vs. 23.1%, p < 0.01, adjusted OR: 4.57 (3.26–6.42), adjusted rate difference: 30.3% (26.4–34.2)). The EMS response time was not different between the groups (p=0.26). ConclusionsThe centralization of dispatch centers was associated with an improved bystander CPR rate and dispatcher-provided CPR instructions for OHCA patients.

Can a Software-Based Metronome Tool Enhance Compression Rate in a Realistic 911 Call Scenario Without Adversely Impacting Compression Depth for Dispatcher-Assisted CPR?

The prospective, randomized, controlled study involved simulated 911 cardiac arrest calls made by layperson-callers and handled by certified emergency medical dispatchers (EMDs) at four locations in Salt Lake City, Utah USA. Participants were randomized into two groups. In the experimental group, layperson-callers received CPR pre-arrival instructions with metronome assistance. In the control group, layperson-callers received only pre-arrival instructions. The primary outcome measures were correct compression rate (counts per minute [cpm]) and depth (mm). A total of 148 layperson-callers (57.4% assigned to experimental group) participated in the study. There was a statistically significant association between the number of participants who achieved the target compression rate and experimental study group (P=.003), and the experimental group had a significantly higher median compression rate than the control group (100 cpm and 89 cpm, respectively; P=.013). Overall, there was no significant correlation between compression rate and depth. An automated software metronome tool is effective in getting layperson-callers to achieve the target compression rate and compression depth in a realistic DA-CPR scenario.Scott G, Barron T, Gardett I, Broadbent M, Downs H, Devey L, Hinterman EJ, Clawson J, Olola C. Can a software-based metronome tool enhance compression rate in a realistic 911 call scenario without adversely impacting compression depth for dispatcher-assisted CPR? Prehosp Disaster Med. 2018;33(4):399-405.

Implementation of a bundle of Utstein cardiopulmonary resuscitation programs to improve survival outcomes after out-of-hospital cardiac arrest in a metropolis: A before and after study

IntroductionThe study aimed to determine the effect of community implementation of a bundles of cardiopulmonary resuscitation (CPR) programs on outcomes in out-of-hospital cardiac arrest (OHCA). MethodsA before- and after-intervention study was performed in a metropolis. Emergency medical services (EMS)-treated adults and cardiac OHCAs were included. Three new CPR programs was implemented in January 2015: 1) a high-quality dispatcher-assisted CPR program (DACPR), 2) a multi-tier response (MTR) program using fire engines or basic life support vehicles, and 3) a feedback CPR (FCPR) program with professional recording and feedback of CPR process. The outcomes (cerebral performance category 1 or 2, good CPC) and survival to discharge) were compared between study period (2015–2016) and control period (2013–2014). ResultsOverall, 6201 and 6469 patients were included in the control period and the study period, respectively. During the post-intervention period, the proportion of OHCA patients who underwent three types of cardiopulmonary resuscitation programs increased significantly compared to those in the pre-intervention period. DACPR increased from 38.3% to 44.3%, MTR increased from 0.0% to 37.5%, and FCPR increased from 25.3% to 61.5%. (All p values <0.001). Good neurological recovery and survival to discharge were significantly increased from 5.4% to 6.8%, and from 9.6% to 10.9%. The adjusted odds ratio (95% confidence intervals) of the study period was 1.45 (1.12–1.87) for good CPC, and 1.31 (1.09–1.58) for survival to discharge. ConclusionsThe citywide implementation of a bundle of UTIS CPR programs was associated with significantly better OHCA outcomes.

Effects of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological recovery in paediatric patients with out-of-hospital cardiac arrest based on the pre-hospital emergency medical service response time interval

ObjectivesWe investigated the effect of bystander cardiopulmonary resuscitation (BCPR) with dispatcher assistance (DA) on neurological outcomes based on the response time interval (RTI) of the pre-hospital emergency medical service (EMS) among paediatric patients with out-of-hospital cardiac arrest (OHCA). MethodsThis retrospective registry study was conducted on paediatric patients (<19 years old) with OHCA who were assessed by EMS providers between 2012 and 2016. The primary outcome was good neurological recovery based on BCPR with or without DA and the EMS RTI. Differential effects of BCPR with DA based on the EMS RTI were analysed by multivariable logistic regression analysis with interaction terms. ResultsAdjusted odds ratios (AORs) and corresponding 95% confidence intervals (95% CIs) for good neurological recovery were 2.22 (1.27–3.88) for BCPR with DA and 1.51 (0.77–2.97) for BCPR without DA compared to no BCPR. The faster EMS RTI group (<5 min) had better neurological recovery than the later EMS RTI group (≥5 min) (AOR: 1.87 [1.04–3.29]). The AORs for good neurological recovery following BCPR with DA based on the EMS RTI were 2.52 (0.91–6.97) in the faster EMS RTI group and 2.17 (1.13–4.19) in the later EMS RTI group compared to the no BCPR group. ConclusionBCPR with DA and a faster EMS RTI were significantly associated with good neurological recovery in paediatric patients with OHCA. When the EMS RTI was delayed, the association of BCPR with DA with good neurological recovery was preserved in paediatric patients with OHCA.

Effect of detection time interval for out-of-hospital cardiac arrest on outcomes in dispatcher-assisted cardiopulmonary resuscitation: A nationwide observational study

IntroductionThe association between the detection time interval (DTI) from the call for ambulance to the detection of out-of-hospital cardiac arrest (OHCA) by the dispatcher and the neurological outcome in dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is unclear. MethodsAdults who sustained OHCA with cardiac etiology received DA-CPR between 2013 and 2016 were analyzed. The main predictor was DTI defined as the time interval from the beginning of the emergency call to identification of OHCA by the dispatcher. The primary outcomes were the good cerebral performance category (CPC) 1 or 2. Multivariable logistic regression analysis was performed to calculate the adjusted odds ratio (AOR) and 95% confidence interval (CI) for outcomes, adjusting for potential confounders, by the 10- and 30-s DTI delay and three DTI groups; Short (0–90 s), Middle (91–180 s), and Long (181–1,200 s) groups. Interaction analysis for DTI and urbanization level (megacity with 10 million or more population in urban region, metropolis with 1 to 5 million population in urban region, and Rural province with less than 2 million population in urban, suburban, and rural region) was performed to compare the effect size of DTI group according to urbanization level. ResultsOf 116,374 adults with an OHCA, 11,833 were finally analyzed. Overall, the number (%) of survival to discharge was 1380 (11.4%), and the good CPC was 945 (8.0%). For good cerebral performance category, the AOR (95% CIs) for good CPC was 0.99 (0.98–1.00) by 10-s DTI delay and 0.97 (0.95–0.99) by 30-s DTI delay. The AORs (95% CIs) for good CPC were 0.84 (0.71–1.00) for the Middle and 0.79 (0.66–0.96) for the Long DTI groups compared with Short DTI. The AORs (95% Cl) for good CPC compared with Short DTI group were 0.93 (0.68–1.27) by Middle DTI and 0.84 (0.59–1.20) by Long DTI in megacity, 0.60 (0.44–0.81) by Middle DTI and 0.60 (0.44–0.82) by Long DTI in metropolis, and 0.43 (0.31–0.60) by Middle DTI and 0.38 (0.26–0.56) by Long DTI in Rural province, respectively. ConclusionA longer DTI in DA-CPR showed significantly lower good neurological recovery in adult patients with witnessed OHCA. A 30 s delay in DTI was associated with a 3% decrease of a good CPC score. The DTI effect on good CPC was significant in metropolis and Rural province while not in megacity region.

Recognition of out-of-hospital cardiac arrest during emergency calls and public awareness of cardiopulmonary resuscitation in communities: A multilevel analysis

BackgroundFor an effective dispatcher-assisted cardiopulmonary resuscitation (CPR) program, recognition of out-of-hospital cardiac arrest (OHCA) by a dispatcher is the first step in initiating bystander CPR. This study evaluated whether CPR awareness in the community is associated with recognition of arrest, dispatcher-provided CPR instructions, and bystander CPR. MethodsAll emergency medical services (EMS)-treated adult OHCAs with cardiac etiology were enrolled between 2013 and 2015, excluding cases witnessed by EMS providers. Exposure was CPR awareness in the community where the OHCA occurred. Endpoints were recognition of arrest, dispatcher-provided CPR instructions, and bystander CPR. Multilevel logistic regression analysis was performed to calculate adjusted odds ratios (AORs) per 10% increment in community CPR awareness adjusting for potential confounders. ResultsOf 44,185 eligible OHCAs, 20,255 (45.8%) cases were recognized by a dispatcher, 17,858 (40.4%) received dispatcher-provided CPR instructions, and 22,255 (50.4%) received bystander CPR (39.8% with dispatcher assistance and 10.6% without dispatcher assistance). Compared with OHCAs that occurred in the communities with low awareness, dispatchers were more likely to provide CPR instructions to the caller, and bystanders were more likely to perform CPR for OHCAs that occurred in the communities with high CPR awareness. AORs (95% CIs) per 10% increment in public awareness of CPR in the community were 1.05 (1.01–1.10) for recognition of arrest, 1.11 (1.06–1.16) for dispatcher-provided CPR instructions, and 1.07 (1.03–1.11) for bystander CPR. ConclusionsPublic CPR awareness of the communities where OHCAs occurred was associated with recognition of arrest during an emergency call, dispatcher-provided CPR instructions, and bystander CPR.

Dispatcher CPR Instructions Across the Age Continuum.

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.

Dispatcher-assisted bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest

IntroductionBystander cardiopulmonary resuscitation (CPR) is critical to the survival of patients with out-of-hospital cardiac arrest (OHCA). However, it is unknown whether bystander CPR with or without dispatcher assistance is more effective or why. Thus, we evaluated the association between dispatcher-assisted bystander CPR (vs. bystander CPR without dispatcher assistance) and survival of patients with OHCA. MethodsThis is a retrospective, nonrandomized, observational study using national registry data for all OHCAs. We performed a propensity analysis. Patients with OHCA of cardiac origin were 18–100 years of age and received bystander chest compression in Japan between 2005 and 2014. Outcome measures were bystander rescue breathing, return of spontaneous circulation (ROSC) before hospital arrival, and survival and Cerebral Performance Category (CPC) 1 or 2 at 1 month after the event. ResultsDuring the study period, 1,176,351 OHCAs occurred, and 87,400 cases met the inclusion criteria. Among propensity-matched patients, a negative association was observed between dispatcher-assisted bystander CPR and outcome measures in a fully-adjusted model [odds ratio (OR) (95% CI) for ROSC = 0.87 (0.78–0.97), P < 0.05; OR (95% CI) for 1-month survival = 0.81 (0.65–1.00), P < 0.05; OR (95% CI) for CPC 1 or 2 = 0.64 (0.43–0.93), P < 0.05]. OR of survival for dispatcher-assisted bystander CPR tended to decrease as the emergency medical services response time increased. ConclusionsSurvival benefit was less for dispatcher-assisted bystander CPR with dispatcher assistance than without dispatcher assistance. Low quality is hypothesized to be the cause of the reduced benefit.

Temporal variations in dispatcher-assisted and bystander-initiated resuscitation efforts

PurposeTo investigate temporal variations in dispatcher-assisted and bystander-initiated resuscitation efforts and their association with survival after bystander-witnessed out-of-hospital cardiac arrests (OHCAs). MethodsWe retrospectively analyzed the neurologically favorable 1-month survival and the parameters related to dispatcher assisted cardiopulmonary resuscitation (DA-CPR) and bystander CPR (BCPR) for 227,524 OHCA patients between 2007 and 2013 in Japan. DA-CPR sensitivity for OHCAs, bystander's compliance to DA-CPR assessed by the proportion of bystanders who follow DA-CPR, and performance of BCPR measured by the rate of bystander-initiated CPR in patients without DA-CPR were calculated as indices of resuscitation efforts. ResultsPerformance of BCPR was only similar to temporal variations in the survival (correlation between hourly paired values, R2=0.263, P=0.01): a lower survival rate (3.4% vs 4.2%) and performance of BCPR (23.1% vs 30.8%) during night-time (22:00–5:59) than during non-night-time. In subgroup analyses based on interaction tests, all three indices deteriorated during night-time when OHCAs were witnessed by non-family (adjusted odds ratio, 0.73–0.82), particularly in non-elderly patients. The rate of public access defibrillation for these OHCAs markedly decreased during night-time (adjusted odds ratio, 0.49) with delayed emergency calls and BCPR initiation. Multivariable logistic regression analyses revealed that the survival rate of non-family-witnessed OHCAs was 1.83-fold lower during night-time than during non-night-time. ConclusionsDispatcher-assisted and bystander-initiated resuscitation efforts are low during night-time in OHCAs witnessed by non-family. A divisional alert system to recruit well-trained individuals is needed in order to improve the outcomes of night-time OHCAs witnessed by non-family bystanders.