Telephone Cardiopulmonary Resuscitation Research Articles

Survival in Seattle: the Cardiac Arrest Survival Summit

Survival in Seattle: the Cardiac Arrest Survival Summit

Telecommunicator Cardiopulmonary Resuscitation: A Policy Statement From the American Heart Association.

Every year in the United States, >350 000 people have sudden cardiac arrest outside of a hospital environment. Sudden cardiac arrest is the unexpected loss of heart function, breathing, and consciousness and is commonly the result of an electric disturbance in the heart. Unfortunately, only ≈1 in 10 victims survives this dramatic event. Early access to 9-1-1 and early cardiopulmonary resuscitation (CPR) are the first 2 links in the chain of survival for out-of-hospital cardiac arrest. Although 9-1-1 is frequently accessed, in the majority of cases, individuals with out-of-hospital cardiac arrest do not receive lay rescuer CPR and wait for the arrival of professional emergency rescuers. Telecommunicators are the true first responders and a critical link in the cardiac arrest chain of survival. In partnership with the 9-1-1 caller, telecommunicators have the first opportunity to identify a patient in cardiac arrest and provide initial care by delivering CPR instructions while quickly dispatching emergency medical services. The telecommunicator and the caller form a unique team in which the expertise of the telecommunicator is provided just in time to a willing caller, transforming the caller into a lay rescuer delivering CPR. The telecommunicator CPR (T-CPR) process, also previously described as dispatch CPR, dispatch-assisted CPR, or telephone CPR, represents an important opportunity to improve survival from sudden cardiac arrest. Conversely, failure to provide T-CPR in this manner results in preventable harm. This statement describes the public health impact of out-of-hospital cardiac arrest, provides guidance and resources to construct and maintain a T-CPR program, outlines the minimal acceptable standards for timely and high-quality delivery of T-CPR instructions, and identifies strategies to overcome common implementation barriers to T-CPR.

Improving telephone CPR time interval at Hamad Medical Corporation Ambulance Service

Background: Hamad Medical Corporation Ambulance Service (HMCAS) Emergency Medical Dispatch Center uses protocols and processes ensuring early recognition and early telephone CPR (T-CPR) for Sudden Cardiac Arrest (SCA) reported by the public through 999 emergency lines. An audit of random sampling cases indicated that the average time to start bystander hands-on CPR varies from 5 to 7 minutes. Consequently, a quality improvement plan was designed and launched in the Emergency Dispatch Center of HMCAS for the aim of improving the average time interval from when the call is answered by an Emergency Medical Dispatcher until the caller starts hands-on CPR. The project aimed to improve the average telephone-CPR time initiation from 5 minutes in January 2018 to 3 minutes by July 2019. Methods: We adopted the American Heart Association Telephone Cardiopulmonary Resuscitation Time standards and performance benchmarks1. A cardiac registry was implemented, audio recordings of confirmed Out of Hospital Cardiac Arrests (OHCA) received at 999 Emergency Dispatch Center were reviewed using a standardized time-stamp methodology linked with the Ambulance Service outcome data. All call takers went through training and continuous measurement of their performance levels with timely feedback. Results: Out of 214,220 received emergency calls in 2018 a total of 697 OHCA cases were audited, 332 cases received T-CPR, 231 cases met the criteria for inclusion. By July 2019, there was a reduction in Average telephone-CPR time interval from 5:38 minutes to 3:33 minutes (Figure 1). Conclusion: The implementation of T-CPR time standards and staff training was associated with improvements in the provision and timeliness of T-CPR.

Cognitive survey of telephone cardiopulmonary resuscitation among emergency personnel

Objectives To investigate the cognition of dispatcher-initiated telephone cardiopulmonary resuscitation (TCPR) among emergency medical system(EMS) personnel and compare the cognition of TCPR among EMS personnel in different economic status, and to understand the current situation of TCPR cognition of EMS personnel in China. Methods This study is a multicenter cross-sectional survey. The method of multi-level convenient sampling was adopted, and the test reliability and split half reliability of the questionnaire was tested. Questionnaire survey and data collection were conducted from December 2018 to June 2019. The ethical approval number is M2018264. SPSS 20.0 was used for analysis. χ2 test was used to analyze the differences between groups. Results A total of 1 191 electronic questionnaires were collected. Of them, 80.94% respondents knew TCPR, 97.82% respondents thought that TCPR should be implemented in cardiac arrest, 36.62% respondents thought that bystander cardiopulmonary resuscitation quality monitoring was needed in TCPR, and TCPR training courses were set up in the emergency department which recruited 25.83% respondents. Emergency personnel in developed areas had a better understanding of the criteria for judging patients' breathlessness (11.69% vs 7.89%, P=0.048), of TCPR need ncluding guidance of chest compression (92.45% vs 87.49%, P=0.012) and of bystander cardiopulmonary resuscitation (BCPR) quality monitoring including the frequency of artificial respiration (84.42% vs 74.87%, P=0.029) than those in underdeveloped areas, but there was no significant difference in other indicators (P>0.05). Conclusions TCPR knowledge of EMS personnel in China is unsatisfactory. Further training is needed to improve their understanding of the criteria for judging cardiac arrest in out-of-hospital cardiac arrest patients via telephone, TCPR content and bystander cardiopulmonary resuscitation quality monitoring. There is difference in TCPR knowledge between the EMS personnel in developed and undeveloped areas in China. Key words: Emergency medical services; Telephone guidance; Cardiopulmonary resuscitation; Bystander; Out-of-hospital cardiac arrest; Cognition; Economic status; Cross-sectional survey

Impact of telephone cardiopulmonary resuscitation on the return of spontaneous circulation in patients with out-of-hospital cardiac arrest

The aim: Research aim is the evaluation of return of spontaneous circulation (ROSC) ratio among the individuals with out-of-hospital sudden cardiac arrest (SCA), depending on the so-called Telephone Cardiopulmonary Resuscitation (TCPR). T-CPR is based on live instruction given by the dispatcher to incident witness, who is performing CPR efforts until the EMS team arrives on scene. Material and methods: Research was based on the analysis of 782 entries (from EMS documentation) which recorded SCA and CPR. Emergency call voice recording has been rehearsed for each case, in order to confirm the capability of recognizing SCA and providing T-CPR instructions. Data was divided into two groups and the results have been compared. The ROSC ratio for both groups (“T-CPR” and “No T-CPR”) were analyzed along with the type of incident location. Results: The research has shown that 26,4% of all SCA cases researched ended up with the ROSC. In 94% of cases the dispatcher had succeeded in encouraging the witness to perform CPR with telephone instruction (T-CPR) until the EMS team has arrived. In the “T-CPR” group, 28,7% of cases have ended with ROSC. In the “No T-CPR” group, 19,7% of cases have ended with ROSC (28,7% vs. 19,7%). Conclusions: The T-CPR should be utilized by dispatcher in the form of uniform protocol. In the process of training dispatchers there should be special emphasis on the skill of recognizing SCA upon receiving a call. The evaluation of SCA recognition, T-CPR undertaken and ROSC ratio may be an effective indicator of quality monitoring within the State Emergency Medical System.

Importance of "Telephone Cardiopulmonary Resuscitation" in out-of-Hospital Cardiac Arrest in India.

Background:Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality in developing countries such as India. Most cardiac arrests happen outside the hospital and are associated with poor survival rates due to delay in recognition and in performing early cardiopulmonary resuscitation (CPR). Community CPR training and telephone CPR (T-CPR) in the dispatch centers have been shown to increase bystander CPR rates and survival.Objectives:The aim of this study is to identify the significance of T-CPR in OHCA and to discuss its implementation in the health system to improve OHCA outcomes in India.Materials and Methods:A descriptive research study methodology was adopted following a literature search.Results:The search criterion “Cardiovascular diseases” resulted in 162, “Out-side hospital cardiac arrest” in 50; For a comprehensive overview, these publications were evaluated looking for data on T-CPR incidence, criteria for detecting OHCA by emergency medical dispatchers, sensitivity and specificity, and BCPR.Conclusion:This current research stresses the scale and seriousness of the implementation of T-CPR in OHCA in India.

Effects of dispatcher-initiated telephone cardiopulmonary resuscitation after out-of-hospital cardiac arrest: A nationwide, population-based, cohort study

AimThis study aimed to investigate the effects of dispatcher-initiated telephone cardiopulmonary resuscitation (TCPR) in Japan using a nationwide population-based registry. MethodsAdult Japanese patients with out-of-hospital cardiac arrest (OHCA; n = 582,483, age ≥18 years) were selected from a nationwide Utstein-style database (2010–2016) and divided into 3 groups: no bystander CPR (NCPR) before emergency medical service arrival (n = 448,606), bystander-initiated CPR (BCPR) performed without assistance (n = 46,964), and TCPR (n = 86,913). The primary outcome was a favourable neurological outcome 1 month after OHCA. ResultsAfter adjusting for potential confounders, and relative to the NCPR group, significantly better 1-month neurological outcomes were observed in the BCPR group (odds ratio: 2.25, 95% confidence interval: 2.15–2.36; P < 0.001) and in the TCPR group (odds ratio: 1.30, 95% confidence interval: 1.24–1.36; P < 0.001). The collapse-to-CPR time was independently associated with the 1-month outcomes, with a rate of <1% for 1-month favourable neurological outcomes if CPR was initiated >5 min after the collapse. ConclusionPatients who received TCPR had significantly better outcomes than those who did not receive CPR. However, the TCPR outcomes were less favourable than those in the BCPR group. Better protocol development and enhanced education are needed to improve dispatcher instructions in Japan, which may help lessen the gap between the BCPR and TCPR outcomes and further improve the outcomes after OHCA.

Telephone CPR improvement: the importance of sharing data

Telephone CPR improvement: the importance of sharing data

Dispatcher-Assisted Bystander Cardiopulmonary Resuscitation (Telephone-CPR) and Outcomes after Out of Hospital Cardiac Arrest.

To determine the effects of the implementation of the telephone cardiopulmonary resuscitation (T-CPR) program on the outcomes of out-of-hospital cardiac arrest (OHCA). In this prospective study, Emergency Medical Service (EMS) dispatchers and all bystanders attending to patients with OHCA were included. The consensus sampling was carried out based on inclusion and exclusion criteria. The data collection tool was consisted of a demographic questionnaire for patients and bystanders accompanied by a checklist for CPR outcomes. Data were collected 6 months before and after the implementation of the T-CPR program and analyzed using SPSS version 18. The results revealed that the percentages of successful and unsuccessful CPR cases before the implementation of the T-CPR program were 28.1% and 71.9%, respectively. However, in total, 32% and 67.8% of the CPR cases were successful and unsuccessful, respectively, after the implementation of the mentioned program. The survival rate increased from 56.5% in the pre-intervention phase to 72.4% in the post-intervention one. In terms of the outcomes, brain complications decreased from 40% in the pre-intervention phase to 32.1% in the post-intervention one; however, the Chi-square test showed no significant difference in terms of CPR outcomes in the two time periods (p=0.797). According to the results, it is recommended that T-CPR programs be developed and dispatchers be trained in the area of this research. The results could be regarded as a guide to EMS managers, healthcare professionals, and the basis for further studies on this subject.

Dispatcher Assistance in Out-of-hospital Cardiac Arrest: Approaches for Diagnosing Cardiac Arrest by Telephone

Rapid recognition of cardiac arrest based on the data reported by a bystander, and delivering telephone cardiopulmonary resuscitation instructions by emergency medical services (EMS) dispatcher promote timely provision of frst aid by people who witness the emergency, and this may signifcantly influence the outcome of out-of-hospital cardiac arrest (OHCA). This review is aimed to analyze the up-to-date scientifc literature on EMS dispatcher recognition of OHCA. In particular, general concept and experience of algorithm-based diagnosis of cardiac arrest, diffculties of telephone OHCA recognition, approaches for dispatcher diagnosis quality evaluation and assurance are discussed herein. Based on the analysis results, recommendations on organizing and improving the effectiveness of EMS dispatcher recognition of cardiac arrest are formulated. The review is designed primarily for EMS and public health specialists.

Using a smartphone application (PocketCPR) to determine CPR quality in a bystander CPR scenario — A manikin trial

Purpose of the studyFeedback devices and dispatcher assistance increase CPR quality in bystander resuscitation. Yet, there is no data comparing both approaches with uninstructed CPR. The present prospective, randomized, controlled, manikin trial aims to determine the effects of the use of a smartphone application (PocketCPR) on CPR quality in a bystander CPR scenario compared to dispatcher-assisted telephone CPR and uninstructed CPR. Methods100 laypersons were included to perform 8-min CPR on a manikin. Volunteers were randomly assigned to one of four groups: (1) uninstructed CPR (uninstructed group), (2) dispatcher-assisted telephone CPR (telephone-group), (3) guidance and feedback through a smartphone application (app-group) and (4) dispatcher-assisted telephone CPR combined with the smartphone-app (telephone + app-group). Results and discussionThere was no significant difference in the time to first compression between the uninstructed and the app-group (p = 0.052), likewise between the telephone- and the telephone + app-group (p = 0.193). The no-flow-time of the uninstructed group was significantly longer compared to all other groups (p < 0.001). Median compression rate was significantly higher and within the recommended range in the app- and the telephone + app-group. There was no significant difference regarding correct compression depth between the four groups. Correct hand position and complete thorax release was found significantly more frequently in groups with smartphone-app support. ConclusionsFeedback by a smartphone application can improve bystander CPR quality in terms of no-flow-time, compression rate, correct hand position, thorax release and does not delay CPR onset. However, the use of a smartphone application does not improve compression depth significantly.

Abstract 265: Impact of Changes in the Telephone Cardiopulmonary Resuscitation Instruction After Out-of-Hospital Cardiac Arrest

Background: The international consensus on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care science with treatment recommendations (CoSTR) 2010 changed the dispatcher-initiated telephone CPR instruction. Major changes of the telephone CPR instruction were simplified algorithm, elimination of “Look, listen, and feel for breathing” chest compressions first (C-A-B), chest compression only CPR if bystander was not trained in CPR, et al. However, few studies have investigated the efficacy of telephone CPR instruction based on the CoSTR 2010. Methods: From the All-Japan Utstein Registry for out-of-hospital cardiac arrest (OHCA) between 2006 and 2015, we enrolled adult (18 years or older) patients with bystander-witnessed OHCA and stratified by the two CoSTR eras (the CoSTR 2010 group from 2011 through 2015 versus the CoSTR 2005 group from 2006 through 2010). The primary endpoint was 30-day favorable neurological outcome after OHCA. Results: Of the 378,757 adult patients with bystander-witnessed OHCA, 199,117 (52.5%) received CPR based on the CoSTR 2010 and 179,640 (47.4%) received CPR based on the CoSTR 2005. In the whole cohort, the CoSTR 2010 group had higher proportion of cases receiving telephone CPR instruction than the CoSTR 2005 group (48.8% versus 40.9%, P&lt;0.001). In the subgroups of patients receiving telephone CPR instruction, the CoSTR 2010 group had higher proportion of bystander chest compression-only CPR (60.5% versus 47.3%, p&lt;0.001) and public access defibrillation (1.9% versus 0.9%, P&lt;0.001) than the CoSTR 2005 group. Although those subgroups had similar proportion of initial shockable cardiac arrest rhythm (15.2 % in the CoSTR 2010 group versus 15.3 % in the CoSTR 2005 group, P=0.63), the CoSTR 2010 group had higher frequency of the favorable neurological outcome than the CoSTR 2005 group (4.5 % versus 3.7%%, P&lt;0.001). In the subgroup of patients receiving telephone CPR instruction, an adjusted odds ratio for the favorable neurological outcome in the CoSTR 2010 group (reference, the CoSTR 2005 group) was 1.47 (95 % CI, 1.43-1.51, p&lt;0.001). Conclusions: Telephone CPR instruction based on the CoSTR 2010 was the preferable approach to resuscitation for adult patients with bystander-witnessed OHCA.

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 influence of ongoing bystander chest compressions (BCC) upon calling-in on dispatcher-assisted telephonecardiopulmonary resuscitation (DATCPR) performance and its effects on chest compressions continuances

Purpose: Whether bystander already performing chest compressions (CC) upon calling-in may influence DATCPR performance and its effects on BCC continuances are not well known.

Using a smartphone application (PocketCPR) to determine CPR quality in a bystander CPR scenario

Purpose of the study: Feedback devices and dispatcher assistance increase CPR quality in bystander resuscitation. Yet, there is no data comparing both approaches with uninstructed CPR. The present prospective, randomized, controlled manikin trial (RCT) aims to determine the effects of the use of a smartphone application (PocketCPR) on CPR quality in a bystander CPR scenario compared to dispatcher assisted telephone CPR and uninstructed CPR.

News in Cardiopulmonary Resuscitation

For the first time, the european guidelines for cardiopulmonary resuscitation (CPR) have been updated by the ILCOR indecember 2017. If new data and findings are available, these guidelines can also be updated outside the 5-year cycle. Thus, it is now recommended that, depending on the level of training of the layer, a chest-compression-only CPR or in combination with ventilation should be done. The important function of the dispatchers in the context of telephone or dispatcher-assisted CPR is emphasized by the demand of a structured training. The use of mechanical chest compression devices remains reserved only for special situations.

Unmeasured Interface in Emergency Cardiovascular Care: How Do Dispatch-Assisted Telephone Cardiopulmonary Resuscitation and Bystander Training Interact?

Cardiac arrest survival remains poor, in part as a result of low rates of bystander cardiopulmonary resuscitation (B-CPR) in many communities. It has generally been assumed that training laypersons in CPR would increase the frequency of B-CPR delivery. Another means of increasing B-CPR frequency is the provision of dispatch-assisted telephone CPR, also known as telecommunicator-CPR (T-CPR), in which a 911 dispatcher provides CPR instruction over the telephone to bystanders who may need prompting or encouragement. Although numerous studies over the past decade have assessed methods to improve layperson CPR training and T-CPR independently, it is surprising that few studies have examined the interactions between these 2 important strategies (Figure). For example, it is unclear whether laypersons respond to T-CPR instructions adequately if they have not received CPR training previously. Furthermore, current CPR training courses do not typically incorporate T-CPR information (or practice with T-CPR), and whether to include such training to improve actual care delivery remains an unanswered question. Enormous efforts have been focused on both T-CPR and layperson CPR education independently over the past decades. The time is ripe to bring these …

Effect of National Implementation of Telephone CPR Program to Improve Outcomes from Out-of-Hospital Cardiac Arrest: an Interrupted Time-Series Analysis.

BackgroundIn cardiac arrest, the survival rate increases with the provision of bystander cardiopulmonary resuscitation (CPR), of which the initial response and treatment are critical. Telephone CPR is among the effective methods that might increase the provision of bystander CPR. This study aimed to describe and examine the improvement of neurological outcomes in individuals with out-of-hospital acute cardiac arrest by implementing the nationwide, standardized telephone CPR program.MethodsData from the emergency medical service-based cardiac arrest registry that were collected between 2009 and 2014 were used. The effectiveness of the intervention in the interrupted time-series study was determined via a segmented regression analysis, which showed the risk ratio and risk difference in good neurological outcomes before and after the intervention.ResultsOf 164,221 patients, 148,403 were analyzed. However, patients with unknown sex and limited data on treatment outcomes were excluded. Approximately 64.3% patients were men, with an average age of 63.7 years. The number of bystander CPR increased by 3.3 times (95% confidence interval [CI], 3.1–3.5) after the intervention, whereas the rate of good neurological outcomes increased by 2.6 times (95% CI, 2.3–2.9 [1.6%]; 1.4–1.7). The excess number was identified based on the differences between the observed and predicted trends. In total, 2,127 cases of out-of-hospital cardiac arrest (OHCA) after the intervention period received additional bystander CPR, and 339 cases of OHCA had good neurological outcomes.ConclusionThe nationwide implementation of the standardized telephone CPR program increased the number of bystander CPR and improved good neurological outcomes.

Pre-recorded instructional audio vs. dispatchers' conversational assistance in telephone cardiopulmonary resuscitation: A randomized controlled simulation study.

To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation (CPR) guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation. It was a prospective, blind, randomised controlled study involving 109 medical students without previous CPR training. In a standardized mannequin scenario, after the step of dispatcher-assisted cardiac arrest recognition, the participants performed compression-only resuscitation guided over the telephone by either: (1) the pre-recorded instructional audio (n=57); or (2) verbal dispatcher assistance (n=52). The simulation video records were reviewed to assess the CPR performance using a 13-item checklist. The interval from call reception to the first compression, total number and rate of compressions, total number and duration of pauses after the first compression were also recorded. There were no significant differences between the recording-assisted and dispatcher-assisted groups based on the overall performance score (5.6±2.2 vs. 5.1±1.9, P>0.05) or individual criteria of the CPR performance checklist. The recording-assisted group demonstrated significantly shorter time interval from call receipt to the first compression (86.0±14.3 vs. 91.2±14.2 s, P<0.05), higher compression rate (94.9±26.4 vs. 89.1±32.8 min-1) and number of compressions provided (170.2±48.0 vs. 156.2±60.7). When provided by untrained persons in the simulated settings, the compression-only resuscitation guided by the pre-recorded instructional audio is no less efficient than dispatcher-assisted CPR. Future studies are warranted to further assess feasibility of using instructional audio aid as a potential alternative to dispatcher assistance.

Impact of Automated External Defibrillator as a Recent Innovation for the Resuscitation of Cardiac Arrest Patients in an Urban City of Japan.

Context/Aims:We retrospectively analyzed the characteristics of prehospital care for cardiopulmonary arrest (CPA) to identify the predictors of a good recovery (GR) among the recent changes in the management of Japanese prehospital care.Settings and Design:This study was a retrospective medical chart review.Subjects and Methods:We reviewed the transportation records written by emergency medical technicians and the characteristics of prehospital management of out-of-hospital (oh) CPA described by the Sunto-Izu Fire Department from April 2016 to March 2017. The cases were divided into two groups: a GR group (cerebral performance category of 1–3 at 1 month after CPA) and a poor recovery (PR) group.Results:During the analysis period, there were 545 cases of CPA. The average age in the GR group (n = 19) was significantly younger than that in the PR group. The proportions of patients with witnessed collapse, automated external defibrillator (AED) executed by a bystander, ventricular fibrillation during prehospital cardiopulmonary resuscitation (CPR), defibrillation-induced cardioversion, cardiogenic arrest, and oh-return of spontaneous circulation (ROSC) were significantly greater in the GR group than in the PR group. The proportions of telephone CPR conducted by operator, instrumentally secured airways, and administration of epinephrine were significantly smaller in the GR group than in the PR group. A multivariate analysis showed that the significant predictors of GR were bystander AED, ROSC, not instrumentally secured airway, and younger age.Conclusions:This study showed that patients with CPA who were younger, underwent AED executed by a bystander, and obtained oh-ROSC had a higher chance of a favorable outcome.