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Association between OHCA Recognition and Bystander CPR, ROSC, and 30-day Survival OR for the association between recognition of OHCA during emergency calls and bystander CPR, ROSC, and 30-day survival among all OHCA-patients and witnessed OHCA-patients only. Fully adjusted: Adjusted for sex, age group, and number of bystanders in both sets of analyses (all cases and witnessed cases only) as well as witnessed status in the analyses of all cases. CI indicates confidence interval; CPR, cardiopulmonary resuscitation; OHCA, out-of-hospital cardiac arrest; OR, odds ratio; ROSC, return of spontaneous circulation.
Source publication
Background:
Initiation of early bystander cardiopulmonary resuscitation (CPR) depends on bystanders' or medical dispatchers' recognition of out-of-hospital cardiac arrest (OHCA). The primary aim of our study was to investigate if OHCA recognition during the emergency call was associated with bystander CPR, return of spontaneous circulation (ROSC),...
Context in source publication
Context 1
... all OHCA patients, the fully-adjusted logistic regression analysis showed that recognition of OHCA during emergency calls was significantly associated with bystander CPR (OR = 7.84, 95% CI: 5.10-12.05). However, recognition of OHCA was not associ- ated with ROSC (OR = 1.23, 95% CI: 0.81-1.88) or 30-day survival (OR = 1.72, 95% CI: 0.95-3.12) among all OHCA patients. Among witnessed OHCAs only, the multivariable analysis demonstrated that recognition of OHCA during emergency calls was signifi- cantly associated with bystander CPR (OR = 5.36, 95% CI: 3.19-9.01), ROSC (OR = 1.86, 95% CI: 1.13-3.06), and 30-day survival (OR = 2.80, 95% CI: 1.58-4.96) (Fig. 2). No effect modification was identified as significant in the analysis evaluating the association between OHCA recognition and bystander CPR (p-value ≥ 0.07). The full multivariable models are provided as supplementary material (Supplemental Table ...
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Method
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Introduction
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Objective
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Setting
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Participants
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Citations
... The efficiency and effectiveness of medical dispatching are crucial factors that directly impact on patient outcomes. Rapid recognition of out-of-hospital cardiac arrest (OHCA) during emergency calls has been associated with improved survival [3,4], and recognition of stroke and acute coronary syndrome is associated with improved treatment course [5,6]. Importantly, dispatchers play a crucial role that extends beyond responding to life-threatening emergencies. ...
Background
Improving prehospital emergency care requires a comprehensive understanding of the efficiency of emergency medical services and demand fluctuations. The medical emergency call is the primary contact between citizens and the emergency medical dispatch center, serving as the gateway to accessing emergency assistance. This study aimed to characterize the emergency call population and analyze the development of emergency call utilization in Region Zealand in Denmark during a 10-years period.
Methods
This was an observational register-based study of administrative data from the emergency medical dispatch center in Region Zealand. Data was collected from 1 January 2013 to 31 December 2022. All unique emergency calls from residents to the emergency number “1-1-2” were included. Descriptive analyses were used to characterize the study population. Poisson regression models were used to calculate ratio estimates for the association between years and hospital catchment areas, using the incidence rate of emergency calls as outcome measure.
Results
A total of 641,457 emergency calls were included. A significant increase in the total number of emergency calls was found, with an increase from 58,454 annual calls to 80,819 calls over the study period. The incidence rate per 1000 residents per year increased from 71.1 to 95.2, a 35% increase. The southern part of the region had significantly more emergency calls per 1000 residents per year during the study period compared to the eastern part of the region (IRR 1.70). Demographically, males comprised 52.3% of cases, and patients aged 65 and older represented 48.2% of calls. Emergency calls were “Emergency level A” in 45.5% and “Emergency level B” in 39.1%. In 22.3% of cases, the emergency call was categorized as “Unclear problem.” The most frequent categories were “chest pain” (12.7%), “impaired consciousness” (9.6%), “breathing difficulties” (8.8%), “accidents” (7.9%), and “minor injuries” (7.6%).
Conclusions
The study revealed a significant increase in emergency calls, both in absolute numbers and per 1000 residents per year, indicating growing demand for emergency care, along with a surge in activity at the region's dispatch center. Regional disparities underscores the potential necessity for tailored developmental approaches over time.
... Rapid recognition of OHCA is crucial for improving patient outcomes (24). EMTs must swiftly confirm OHCA upon arrival at the scene to initiate immediate chest compressions and minimize the lack of blood flow. ...
Objectives:
The quality of prehospital resuscitation provided by emergency medical technicians (EMTs) is essential to ensure better outcomes following out-of-hospital cardiac arrests (OHCA). We assessed the quality of prehospital resuscitation by recording time to key prehospital interventions using EMT-worn video devices and investigated its association with outcomes of patients with OHCA.
Methods:
This retrospective, cross-sectional study included cases of non-traumatic OHCA in adults treated by EMS in Hsinchu City, Taiwan, during 2022 and 2023. We used data from high-resolution, chest-mounted wearable cameras to define and measure six Quality Indices (QIs) for prehospital resuscitation interventions (i.e., time spent recognizing OHCA). To evaluate the association between QI performance and sustained return of spontaneous circulation (ROSC), we used multivariable logistic regression.
Results:
Of 745 patients eligible for this study, 187 (25.1%) achieved sustained ROSC. Six core QIs were analyzed: recognition of OHCA (median time: 9.0 seconds), time from recognizing OHCA to initiating cardiopulmonary resuscitation (CPR; 9.0 seconds), automated external defibrillator setup (34.0 seconds), time from recognizing OHCA to beginning ventilation (160.0 seconds), advanced airway management (300 seconds), and deploying a mechanical CPR device (50 seconds). The performance of the six QIs were not associated with sustained ROSC (Adjusted odds ratio [95% confidence interval]: 1.00 [0.99-1.00], 0.99 [0.98-1.00], 1.00 [1.00-1.01], 1.00 [1.00-1.00], 1.00 [1.00-1.00] and 0.99 [0.99-1.00], respectively).
Conclusions:
This study describes the rate of sustained ROSC and time to key interventions captured by EMT-worn video devices in non-traumatic OHCA patients. Although we found no direct link between QI performance and improved OHCA outcomes, this study highlights the potential of video-assisted QIs to enhance the documentation and understanding of prehospital resuscitation processes. These findings suggest that further refinement and application of these QIs could support more effective resuscitation strategies and training programs.
... Twenty-six studies evaluated the accuracy of OHCA recognition in relation to the use of dispatch protocols and quality improvement initiatives (See Table 4 and Supplemental Table 4). 12,13,[16][17][18]26,30,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] All studies were observational, and no randomized trials tested different protocol types. The majority of these studies (n = 20) reported only the accuracy of OHCA detection in terms of the proportion of OHCAs recognized of those confirmed to be OHCA on-scene by EMS and did not report both sensitivity and specificity. ...
... The likelihood of recognition using CBD ranged from 70% to 83%. 26,44,47,52,58 In an observational study, Hardeland et al. investigated MPDS (Richmond, USA) versus CBD (Oslo, Norway) performance on recognition. 44 This study showed both systems had similar performance on recognition, with the most frequent reason for unrecognized OHCAs being misinterpretations of agonal breathing. ...
Aim
To summarize existing literature and identify knowledge gaps regarding barriers and enablers of telecommunicators’ recognition of out-of-hospital cardiac arrest (OHCA).
Methods
This scoping review was undertaken by an International Liaison Committee on Resuscitation (ILCOR) Basic Life Support scoping review team and guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were peer-reviewed and explored barriers and enablers of telecommunicator recognition of OHCA. We searched Ovid MEDLINE® and Embase and included articles from database inception till June 18th, 2024.
Results
We screened 9,244 studies and included 62 eligible studies on telecommunicator recognition of OHCA. The studies ranged in methodology. The majority were observational studies of emergency calls. The barriers most frequently described to OHCA recognition were breathing status and agonal breathing. The most frequently tested enabler for recognition was a variety of dispatch protocols focusing on breathing assessment. Only one randomized controlled trial (RCT) was identified, which found no difference in OHCA recognition with the addition of machine learning alerting telecommunicators in suspected OHCA cases.
Conclusion
Most studies were observational, assessed barriers to recognition of OHCA and compared different dispatch protocols. Only one RCT was identified. Randomized trials should be conducted to inform how to improve telecommunicator recognition of OHCA, including recognition of pediatric OHCAs and assessment of dispatch protocols.
... The actual number of cardiac arrests occurring in Europe is not known due to the fact that in some countries the documentation does not reflect reality, and unfortunately there are situations where rescue teams are not called. In people between the ages of 18-40, sudden cardiac arrest is very often fatal [4]. ...
... zdarzają się niestety sytuacje, do których zespoły ratownictwa nie są wzywane. U osób w przedziale wiekowym 18-40 lat nagłe zatrzymanie krążenia następuje bardzo często ze skutkiem śmiertelnym [4]. A zatem wiedza na temat ratowania ludzkiego życia jest na wagę złota. ...
Aim: The survey focused on the assessment of students' knowledge after first aid training carried out using two methods. In order to check the effectiveness and compare both methods, standard training with the use of training phantoms and a BLS and AED course supported by Virtual Reality technology were organized among students. The aim was to test whether virtual reality training would be as effective as standard training with training phantoms. In addition, the study also included collecting students' subjective opinions on the use of VR technology in first aid. During the research, a research hypothesis was put forward, according to which students after standard training with the use of phantoms have more knowledge about cardiopulmonary resuscitation than students after training with the use of virtual reality. Methodology: The method of a survey was used to assess the effectiveness of training. It was attended by 57 students of Civil Engineering, aged 20 to 22. Thanks to the study, the theoretical and practical knowledge of students on first aid was verified and their subjective feelings after training with the use of VR technology were analyzed. Results: The results of the research indicate that the level of knowledge in the field of first aid is higher in students after standard training with the use of training phantoms. In this group, the respondents answered 100% correctly in 7 questions, while the respondents in the group using virtual reality answered only 4 questions correctly in 100%. Students from the first group also showed a greater knowledge of the first aid procedure – they answered correctly in 82%, and the respondents in the second group in 56%. Students from the first group also gave better answers to the questions verifying the knowledge of the principles of proper cardiopulmonary resuscitation – 85% of them answered these questions correctly, while in the second group there were less than half of the correct answers – only 40%. Conclusions: Based on the results of the research and the feelings of the students, it was concluded that training using the VR application without tactile interaction with the dummy is not sufficient. The use of physical phantoms in such training will increase the realism of the simulation and make the virtual environment better perceived by users interacting tactilely with virtual models and experiencing their (physical) properties in a tangible way. Keywords: safety, first aid training, VR, BLS, AED
... The median correct recognition of OHCA based on an emergency call is 74% (range 14 to 97%) (ref. [13][14][15][16] ). Dispatch centres with correctly set methodology of conducting emergency calls have a higher level of correct recognition, however there is still some room for improvement [13][14][15][16] . ...
... [13][14][15][16] ). Dispatch centres with correctly set methodology of conducting emergency calls have a higher level of correct recognition, however there is still some room for improvement [13][14][15][16] . The first reports on the topic of AI or MLM as a tool for emergency calls are no older than 2 years. ...
Sudden cardiac arrest remains a relevant problem with a significant number of deaths worldwide. Although survival rates have more than tripled over the last 20 years (4% in 2001 vs. 14% in 2020), survival rates with good neurological outcomes remain persistently low, representing a major socioeconomic problem. Every minute of delay from patient collapse to start cardiopulmonary resuscitation (CPR) and early defibrillation reduces the chance of survival by approximately 10-12%. Therefore, the time to treatment is a crucial factor in the prognosis of patients with out-of-hospital cardiac arrest (OHCA). Research teams working in the pre-hospital setting are therefore looking for ways to improve the transmission of information from the site of an emergency event and to make it easier for emergency medical dispatch centres (EMDC) to recognise life-threatening conditions with minimal deviation. For emergency unit procedures already at the scene of the event, methods are being sought to efficiently and temporarily replace a non-functioning cardiopulmonary system. In the case of traumatic cardiac arrest (TCA), the focus is mainly on effective affecting non-compressible haemorrhage.
... Chang showed that EMS response time interval faster than 4-5 minutes was associated with a higher hospital discharge rate and good neurological recovery [25]. Timely use of AED in shockable rhythms can increase survival at discharge and neurological outcomes [7,26,27]. Thus, in this study, delay in using AED may be a reason for the limited effectiveness of DA-BCPR. Although the use of AED, in general, brings challenges, along with the implementation of DA-BCPR instruction, it should be used so the chance of survival of OHCA patients can be increased with the timely use of AED. ...
Background: Bystander cardiopulmonary resuscitation (BCPR) is critical for the survival of patients with out-of-hospital cardiac arrest (OHCA). This study aims to identify barriers to performing dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) in patients with OHCA. Materials and Methods: This cross-sectional study was conducted on bystanders of 151 patients with OHCA who received emergency medical services (EMS) from June 2022 to June 2023 in Neyshabur City, Iran. The study data were collected using a questionnaire and telephone interviews. Data were analyzed using the chi-square test and Fisher exact test. P<0.05 was considered statistically significant for all tests. Analyses were done using R software, version 4.0.1. Results: Of 151 patients, 18.92% were less than 50 years old and 68.92% were male. In 69% of cases, the arrival time of EMS was less than 10 min, and 84.46% of patients received BCPR at the scene. The most common barrier to performing DA-BCPR was “not recognizing a cardiac arrest and how to perform cardiopulmonary resuscitation (CPR)” (41.48%). It was reported that 38.35% of the bystanders were familiar with CPR. There was a significant relationship between the bystanders’ familiarity with CPR and performing DA-BCPR (P<0.01). Conclusion: The most common barrier to performing DA-BCPR on patients with OHCA is the lack of knowledge and skills in bystanders. Improving bystanders’ knowledge and educating them about cardiac arrest, CPR, and DA-BCPR is critical to help them improve outcomes for OHCA patients.
... 12 Dispatcher guidance T-CPR or dispatcher-assisted CPR can reduce first responder inhibitions and significantly shorten the interval during which resuscitative efforts are not attempted. 47 Studies recommend that dispatchers instruct laypersons to perform chest compressions alone and to minimize the role of rescue breaths. 48 The ERC guidelines 2021, in agreement with ILCOR, also recommend focusing only on compression-only CPR in adults with suspected OHCA, less on respiratory support. ...
... 9 Telephone-assisted resuscitation by dispatchers is predicted to double survival. 11,47 Neurologically intact survival at discharge and after one month also shows an increase with dispatcher-assisted CPR. 49 ...
Sudden cardiac arrest is a global problem and is considered the third leading cause of death in industrialized countries. Patient survival rates after out-of-hospital cardiac arrest (OHCA) vary significantly between countries and continents. In particular, the 2021 European Resuscitation Council (ERC) Resuscitation Guidelines place a special focus on the chain of survival of patients after OHCA. As a complex, interconnected approach, the focus is on: Raising awareness for cardiac arrest and lay resuscitation, school children’s education in resuscitation “KIDS SAVE LIVES”, first responder systems – technologies to engage the community, telephone-assisted resuscitation (telephone-CPR; T-CPR) by dispatchers, and cardiac arrest centers (CAC) for further treatment in specialized hospitals. The Systems Saving Lives approach is a comprehensive strategy that emphasizes the interconnectedness of all links in the chain of survival following an OHCA, with a particular focus on the relationship between the community and emergency medical services (EMS). This system-level approach emphasizes the importance of the connection between all those involved in the chain of survival. It has a high potential to improve overall survival after OHCA. Therefore, it is recommended that these strategies be promoted and expanded in all countries.
... Early and correct recognition of OHCA by the emergency medical dispatcher is pivotal for initiation of bystander cardiopulmonary resuscitation (CPR). Dispatcher-assisted CPR (DA-CPR) has been shown to increase bystander CPR and have a positive effect on OHCA outcomes [3][4][5][6][7][8][9]. Recognizing OHCA can be difficult and even experienced medical dispatchers only recognize OHCA in approximately 75% of calls [8]. ...
... Dispatcher-assisted CPR (DA-CPR) has been shown to increase bystander CPR and have a positive effect on OHCA outcomes [3][4][5][6][7][8][9]. Recognizing OHCA can be difficult and even experienced medical dispatchers only recognize OHCA in approximately 75% of calls [8]. ...
Aim
The study aimed to investigate whether a bystander’s emotional stress state affects dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) in out-of-hospital cardiac arrest (OHCA). The primary outcome was initiation of chest compressions (Yes/No). Secondarily we analysed time until chest compressions were initiated and assessed how dispatchers instructed CPR.
Method
The study was a retrospective, observational study of OHCA emergency calls from the Capital Region of Denmark. Recorded calls were evaluated by five observers using a pre-defined code catalogue regarding the variables wished investigated.
Results
Included were 655 OHCA emergency calls, of which 211 callers were defined as emotionally stressed. When cardiac arrest was recognized, chest compressions were initiated in, respectively, 76.8% of cases with an emotionally stressed caller and 73.9% in cases with a not emotionally stressed caller (2.18 (0.80–7.64)). Cases with an emotionally stressed caller had a longer time until chest compressions were initiated compared to cases with a not emotionally stressed caller, however non-significant (164 s. vs. 146 s.; P = 0.145). The dispatchers were significantly more likely to be encouraging and motivating, and to instruct on speed and depth of chest compressions in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller (1.64 (1.07–2.56); 1.78 (1.13–2.88)). Barriers to CPR were significantly more often reported in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller (1.83 (1.32–2.56)).
Conclusion
There was no significant difference in initiation of chest compressions or in time until initiation of chest compressions in the two groups. However, the dispatchers were overall more encouraging and motivating, and likely to instruct on speed and depth of chest compressions when the caller was emotionally stressed. Furthermore, barriers to CPR were more often reported in cases with an emotionally stressed caller compared to cases with a not emotionally stressed caller.
Trial registration
We applied for ethical approval from The Danish National Committee on Health Research Ethics, but formal approval was waived. We received permission for storage of data and to use these for research of OHCAs in the Capital Region of Denmark by Danish Data Protection Agency (P-2021-670) and Danish Health Authorities (R-2,005,114). The study is registered at ClinicalTrials (NTC05113706).
... However, EMDs were found to be able to correctly OHCA detection in only 70.1% related to 7.84 times, indicating a considerable proportion of cases where OHCA conditions were not recognized. 8 Delays in recognizing OHCA were observed in various countries, including France, where the time from receiving a phone call to recognizing an emergency patient as OHCA exceeded the recommended threshold of 60 seconds set by the American heart association (AHA) by 8 seconds. 9 Additionally, a substantial amount of time was wasted during calls to the command control center and communication with the dispatchers. ...
Background: Globally, survival rates for out-of-hospital cardiac arrest remain low. Implementing a dispatch-assisted cardiopulmonary resuscitation protocol in evolving emergency medical services systems has shown potential for improving OHCA detection and reducing the time to initiate chest compressions. Methods: In this study, audio recordings of OHCA emergency calls from different regions of Thailand were analyzed from January 2021 to December 2021. The study aimed to assess OHCA detection efficiency and provide CPR recommendations, including OHCA discrimination rates, time from call initiation to OHCA identification, and time to start CPR following dispatcher guidance. Results: There were 280 OHCA cases, with 170 (60.7%) successfully identified and excluded by dispatchers. OHCA detection took an average of 39 seconds (compared to a benchmark of 60 seconds), while the mean time from notification to chest compression initiation was 298 seconds (compared to a benchmark of 220 seconds). However, OHCA discrimination and phone-based resuscitation advice were highly sensitive (81.18%), accurate (85.72%), and specific (92.73%). Conclusions: OHCA presents challenges, with the need for faster CPR initiation. Improving reporting processes, enhancing caller understanding, and refining dispatcher skills are crucial to enhance OHCA detection and DA-CPR, ultimately improving survival rates.
... 36 The importance of earlier recognition as a result of BLS education and training has been stressed by many in the resuscitation society [37][38][39][40] and several key publications suggest this to impact survival. 41,42 This might explain some of the remaining residual variance in the models. ...
Introduction
Annually, approximately 4% of the entire adult population of Denmark participate in certified basic life support (BLS) courses. It is still unknown whether increases in BLS course participation in a geographical area increase bystander cardiopulmonary resuscitation (CPR) or survival from out-of-hospital cardiac arrest (OHCA). The aim of the study was to examine the geographical association between BLS course participation, bystander CPR, and 30-day survival from OHCA.
Methods
This nationwide register-based cohort study includes all OHCAs from the Danish Cardiac Arrest Register. Data concerning BLS course participation were supplied by the major Danish BLS course providers. A total of 704,234 individuals with BLS course certificates and 15,097 OHCA were included from the period 2016–2019. Associations were examined using logistic regression and Bayesian conditional autoregressive analyses conducted at municipality level.
Results
A 5% increase in BLS course certificates at municipality level was significantly associated with an increased likelihood of bystander CPR prior to ambulance arrival with an adjusted odds ratio (OR) of 1.34 (credible intervals: 1.02;1.76). The same trends were observed for OHCAs in out-of-office hours (4pm-08am) with a significant OR of 1.43 (credible intervals: 1.09;1.89). Local clusters with low rate of BLS course participation and bystander CPR were identified.
Conclusion
This study found a positive effect of mass education in BLS on bystander CPR rates. Even a 5% increase in BLS course participation at municipal level significantly increased the likelihood of bystander CPR. The effect was even more profound in out-of-office hours with an increase in bystander CPR rate at OHCA.
