Bystander Cardiopulmonary Resuscitation Quality: Potential for Improvements in Cardiac Arrest Resuscitation

Abstract

Background Bystander cardiopulmonary resuscitation (CPR) is a critical intervention to improve survival following out‐of‐hospital cardiac arrest. We evaluated the quality of bystander CPR and whether performance varied according to the number of bystanders or provision of telecommunicator CPR (TCPR). Methods and Results We investigated non‐traumatic out‐of‐hospital cardiac arrest occurring in a large metropolitan emergency medical system during a 6‐month period. Information about bystander care was ascertained through review of the 9‐1‐1 recordings in addition to emergency medical system and hospital records to determine bystander CPR status (none versus TCPR versus unassisted), the number of bystanders on‐scene, and CPR performance metrics of compression fraction and compression rate. Of the 428 eligible out‐of‐hospital cardiac arrest, 76.4% received bystander CPR including 43.7% unassisted CPR and 56.3% TCPR; 35.2% had one bystander, 33.3% had 2 bystanders, and 31.5% had ≥3 bystanders. Overall compression fraction was 59% with a compression rate of 88 per minute. CPR differed according to TCPR status (fraction=52%, rate=87 per minute for TCPR versus fraction=69%, rate=102 for unassisted CPR, P <0.05 for each comparison) and the number of bystanders (fraction=55%, rate=87 per minute for 1 bystander, fraction=59%, rate=89 for 2 bystanders, fraction=65%, rate=97 for ≥3 bystanders, test for trend P <0.05 for each metric). Additional bystander actions were uncommon to include rotation of compressors (3.1%) or application of an automated external defibrillator (8.0%). Conclusions Bystander CPR quality as gauged by compression fraction and rate approached guideline goals though performance depended upon the type of CPR and number of bystanders.

A scoping review to determine the barriers and facilitators to initiation and performance of bystander cardiopulmonary resuscitation during emergency calls

“…, 38. Dispatcher hung up 35 Fear of contact Call-taker lack of responsibility over resuscitation 35 Fear of dead patient Fear of hurting patient Medicolegal concerns Apprehension Continuing CPR - - - CPR quality - Single bystander 42 - Phone call (audio) 50 …”

Improve Cardiac Emergency Preparedness by Building a Team-Based Cardiopulmonary Resuscitation Educational Plan

“…TeamSTEPPS is a teamwork and communication systems model that has the potential to increase the effectiveness of team members with regard to leadership, communication, situation monitoring, and mutual support ( 15 ). As shown in Figure 1 , the team-based CPR protocol divided the team-based CPR process into five parts, namely, ( 1 ) identification of cardiac arrest, ( 2 ) organization of a team (role distribution), ( 3 ) resuscitation before the AED arrives (Role A and Role B), ( 4 ) resuscitation after the AED arrives (Role A, Role B, and Role C), and ( 5 ) arrival of the ambulance. It concisely defined the roles and responsibilities of each member and emphasized the methods and importance of reasonable task allocation, leadership, and closed-loop communication within the resuscitation team.…”

“…It is noted that out-of-hospital cardiac arrest (OHCA) is one of the most critical medical emergencies. Prompt and effective cardiopulmonary resuscitation (CPR) by community first responders is essential for a better prognosis for patients with OHCA ( 5 ). To achieve high-quality CPR, China has proposed to have 3% and upper of its personnel certified in CPR training by 2030.…”

Out of hospital cardiac arrest: Past, present, and future

“…72À74 The telecommunicator also has the potential to affect the quality of bystander CPR and access to an AED. 75 Widespread adoption of established performance metrics that prioritizes measurement and telecommunicator feedback could increase timely recognition and bystander CPR performance. 42 Technology affords the potential to supplement the human interface between the caller and telecommunicator.…”

“…90 In many communities, bystanders provide early CPR in well over half of OHCA; however less than 5% receive early AED, even when multiple rescuers are on site. 3,4,67,75 Hence there are often willing early rescuers providing CPR who lack access to lifesaving defibrillation.…”