Dispatcher-assisted telephone CPR: Common delays and time standards for delivery

Background— During the past quarter century, advances in treatment of cardiovascular disease have occurred that might potentially benefit survivors of sudden cardiac arrest (SCA). Little is known, however, about the temporal patterns in long-term survival among persons resuscitated from SCA. We hypothesized that long-term survival would improve over time and that this temporal pattern would be most evident for cardiac causes of death. Methods and Results— The investigation was a retrospective cohort study of survival among persons who were discharged alive from the hospital after resuscitation from out-of-hospital SCA due to heart disease in King County, Wash, between May 1, 1976, and December 31, 2001 (n=2035). Calendar time was divided into four 5-year intervals: 1976 to 1980, 1981 to 1985, 1986 to 1990, and 1991 to 1995, and one 6-year interval, 1996 to 2001. Age-adjusted survival curves were constructed, and Cox proportional-hazards regression was used to compute hazard ratios (HRs) for the association between mortality and time period. During 11 201 person-years of follow-up, 1334 persons died. Compared with the initial time period, the HR for total mortality was 0.86 (95% confidence interval, 0.73 to 1.01) for 1981 to 1985, 0.82 (0.69 to 0.96) for 1986 to 1990, 0.66 (0.55 to 0.79) for 1991 to 1995, and 0.58 (0.47 to 0.71) for 1996 to 2001 (HR for trend=0.87 [0.84 to 0.91] for each successive time period). In analyses that assessed cardiac mortality, an even stronger temporal association was evident (HR for trend=0.79 [0.75 to 0.84]). Conclusions— Long-term survival after resuscitation from SCA improved steadily over time in this cohort. To continue this trend, future studies should identify circumstances in which proven treatments are underutilized as well as investigate new therapies that might benefit survivors of SCA.

show abstract

“…For cardiac arrest calls, emergency dispatchers offer and provide cardiopulmonary resuscitation instructions over the telephone. 13 …”

Section: Methods Study Design Subjects and Settingmentioning

confidence: 99%

Temporal Patterns in Long-Term Survival After Resuscitation From Out-of-Hospital Cardiac Arrest

et al. 2003

View full text Add to dashboard Cite

show abstract

“…There is significant variation in the time to recognition of cardiac arrest by dispatchers, with reports ranging from 50 seconds to 2 minutes 38 seconds. [6][7][8][9] A recent evaluation reports a mean time to first compression of 4 minutes after call initiation. 10 Understanding the factors that lead to nonrecognition of cardiac arrest and the reasons for delay in the delivery of chest compressions represents an important step toward improving DA-CPR rates.…”

Section: Editorial See P 1490 Clinical Perspective On P 1530mentioning

confidence: 99%

“…There is wide variation in the time to recognition of cardiac arrest by dispatchers reported in previous studies, from 50 seconds to 2 minutes 38 seconds. [6][7][8][9] These studies took place when ventilations were included in DA-CPR instructions. We found only 1 study that reported the time to first chest compression when ventilation instructions were not given (4 minutes in a Medical Priority Dispatch system).…”

mentioning

confidence: 99%

Dispatcher-Assisted Cardiopulmonary Resuscitation

2013

View full text Add to dashboard Cite

Background-Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), in which 9-1-1 dispatchers provide CPR instructions over the telephone, has been shown to nearly double the rate of bystander CPR. We sought to identify factors that hampered the identification of cardiac arrest by 9-1-1 dispatchers and prevented or delayed the provision of dispatcher-assisted CPR chest compressions. Methods and Results-We reviewed dispatch recordings for 476 out-of-hospital cardiac arrests occurring between January 1, 2011, and December 31, 2011. We found that the dispatcher correctly identified cardiac arrest in 80% of reviewed cases and 92% of cases in which they were able to assess patient consciousness and breathing. The median time to recognition of the arrest was 75 seconds. Chest compressions following dispatcher-assisted CPR instructions occurred in 62% of cases when the dispatcher had the opportunity to asses for consciousness and breathing and bystander CPR was not already started. The median time to first dispatcher-assisted CPR chest compression was 176 seconds. Conclusions-Dispatchers are able to accurately diagnose cardiac arrest over the telephone, but recognition is likely not possible in all circumstances. In some cases, recognition of cardiac arrest may be improved through training in the detection of agonal respirations. Delays in the delivery of dispatcher-assisted CPR chest compressions are common and are attributable to a mixture of dispatcher behavior and factors beyond the control of the dispatcher. Performance standards for the successful and quick recognition of cardiac arrest and delivery of first chest compressions should be adopted as metrics against which emergency medical services systems can measure their performance. Lewis et alTimeliness of Dispatcher-Assisted CPR 1523 CPR program in 1982. 11 Dispatchers undergo 32 hours of emergency medical training, with 6 hours dedicated to the recognition of cardiac arrest and delivery of CPR instructions over the telephone. Dispatchers receive 8 hours of continuing education each year and undergo regular performance evaluations to ensure that quality assurance standards are met. For the purposes of this study, we use the term dispatcher to refer to the person responsible for questioning and giving instructions to the 9-1-1 caller, although this term may not be used in all emergency response systems. In the 2 communications centers participating in this study, the dispatcher handles only 1 call at a time and stays on the line until the call is terminated.Dispatchers are trained to approach every call with a high index of suspicion for cardiac arrest and to assertively provide CPR instructions in cases of suspected arrest. After the incident address is confirmed, protocol dictates that dispatchers ask every caller 2 questions: "Is the patient conscious?" and "Is the patient breathing normally?" If the caller answers no to both questions, then the patient is presumed to be in cardiac arrest and CPR instructions are provided. The protocol allows dispatc...

show abstract

“…The instructions for CPR with both compressions and ventilations have been found to have been delivered in 25.7-75.9% of cases. [9,15,25,26] One of the earlier assessments of the potential causes for lack of BCPR was done by Culley et al [8] They found that the most frequent causes for not delivering DACPR were that instructions were refused in 12% of the cases, that EMS personnel arrived before BCPR could be initiated in 11% of the cases, that a trained bystander was present in 11% of the cases and that the dispatcher did not offer instructions in 9% of the cases. Vaillancourt et al [9] reported that 43.8% of cases of true cardiac arrests were successfully identified by dispatchers.…”

Section: Rate Of Dispatcher Instructionsmentioning

confidence: 99%

“…The provision of CPR instructions by the Emergency Medical Services (EMS) dispatcher was first conceived in 1970s [6]. Dispatcher assisted CPR (DACPR) was found to be effective in getting previously untrained persons to initiate CPR [7,8] and also in increasing rates of bystander CPR [8][9][10] in early stages of its implementation. Dispatchers were able to identify cardiac arrest as well as the necessity to initiate CPR in 50-83% of the cases [11][12][13] and this has been shown to be directly related to positive mortality outcomes [14,15].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Dispatcher Assistance in the Rates and Efficacy of Bystander CPR: A Meta-analysis

Akter¹,

Hasan²,

Sana³

et al. 2017

Emerg Med

View full text Add to dashboard Cite

Objective: To perform a meta-analysis of observational studies addressing whether Dispatcher Assisted Cardiopulmonary Resuscitation (DACPR), compared with independent Bystander Cardiopulmonary Resuscitation (BCPR), increases the rates of BCPR, and whether they alter survival outcomes in out-of-hospital cardiac arrests (OHCA). Methods:Relevant published articles from PubMed and Cochrane databases were studied. The baseline information and outcome data (BCPR rates, survival to hospital discharge, 1-month survival) were extracted from the out-of-hospital cardiac arrest subgroup. Meta-analyses were performed by using STATA 11.0 software. Results Conclusion:This study found that DACPR resulted in greater survival rate as compared to independent BCPR and no BCPR in OHCAs. Considering that DACPR also resulted in significantly higher rates of BCPR, DACPR should be a standard protocol for EMS systems worldwide.

show abstract

Dispatcher-assisted telephone CPR: Common delays and time standards for delivery

Cited by 168 publications

References 5 publications

Temporal Patterns in Long-Term Survival After Resuscitation From Out-of-Hospital Cardiac Arrest

Temporal Patterns in Long-Term Survival After Resuscitation From Out-of-Hospital Cardiac Arrest

Dispatcher-Assisted Cardiopulmonary Resuscitation

The Impact of Dispatcher Assistance in the Rates and Efficacy of Bystander CPR: A Meta-analysis

Contact Info

Product

Resources

About