Survey of a Protocol to Increase Appropriate Implementation of Dispatcher-Assisted Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest

Circulation (Impact Factor: 14.43). 02/2014; 129(17). DOI: 10.1161/CIRCULATIONAHA.113.004409
Source: PubMed


Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) attempts to improve the management of out-of-hospital cardiac arrest (OHCA) by laypersons who are unable to recognize cardiac arrest and are unfamiliar with CPR. Therefore, we investigated the sensitivity and specificity of our new DA-CPR protocol for achieving implementation of bystander CPR in OHCA victims not already receiving bystander CPR.
Since 2007, we have applied a new DA-CPR protocol that uses supplementary keywords. Fire departments prospectively collected baseline data regarding DA-CPR from January 2009 to December 2011. DA-CPR was attempted in 2747 patients; of these, 417 (15.2%) did not experience cardiac arrest. The sensitivity and specificity of the 2007 protocol vs. estimated values of the previous standard protocol were 72.9% vs. 50.3% and 99.6% vs. 99.8%, respectively. We identified keywords that may be useful for detecting OHCA. Multiple logistic regression analysis revealed that the occurrence of cardiac arrest after an emergency call (odds ratio = 16.85) and placing an emergency call away from the scene of the arrest (11.04) were potentially associated with failure to provide DA-CPR. Furthermore, at-home cardiac arrest (1.61) and family members as bystanders (1.55) were associated with bystander non-compliance with DA-CPR. No complications were reported in the 417 patients who received DA-CPR but did not have cardiac arrest.
Our 2007 protocol is safe, highly specific, and may be more sensitive than the standard protocol. Understanding the factors associated with failure of bystanders to provide DA-CPR and implementing public education will be necessary to increase the benefit of DA-CPR.

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Available from: Hideo Inaba, Nov 20, 2015
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    ABSTRACT: To investigate whether the bystander–patient relationship affects bystander response to out-of-hospital cardiac arrest (OHCA) and patient outcomes depending on the time of day.Methods This population-based observational study in Japan involving 139,265 bystander-witnessed OHCAs (90,426 family members, 10,479 friends/colleagues, and 38,360 others) without prehospital physician involvement was conducted from 2005 to 2009. Factors associated with better bystander response [early emergency call and bystander cardiopulmonary resuscitation (BCPR)] and 1-month neurologically favorable survival were assessed.ResultsThe rates of dispatcher-assisted CPR during daytime (7:00–18:59) and nighttime (19:00–6:59) were highest in family members (45.6% and 46.1%, respectively, for family members; 28.7% and 29.2%, respectively, for friends/colleagues; and 28.1% and 25.3%, respectively, for others). However, the BCPR rates were lowest in family members (35.5% and 37.8%, respectively, for family members; 43.7% and 37.8%, respectively, for friends/colleagues; and 59.3% and 50.0%, respectively, for others). Large delays (≥5 min) in placing emergency calls and initiating BCPR were most frequent in family members. The overall survival rate was lowest (2.7%) for family members and highest (9.1%) for friends/colleagues during daytime. Logistic regression analysis revealed that the effect of bystander relationship on survival was significant only during daytime [adjusted odds ratios (95% CI) for survival from daytime OHCAs with family as reference were 1.51 (1.36–1.68) for friends/colleagues and 1.23 (1.13–1.34) for others].Conclusions Family members are least likely to perform BCPR and OHCAs witnessed by family members are least likely to survive during daytime. Different strategies are required for family-witnessed OHCAs.
    Full-text · Article · Nov 2014 · Resuscitation
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    ABSTRACT: Aim: Some out-of-hospital cardiac arrests (OHCAs) are witnessed after emergency calls. This study aimed to confirm the benefit of early emergency calls before patient collapse on survival after OHCAs witnessed by bystanders and/or emergency medical technicians (EMTs). Methods: We analysed 278,310 witnessed OHCAs [EMT-witnessed cases (n = 54,172), bystander-witnessed cases (n = 224,138)] without pre-hospital physician involvement from all Japanese OHCA data prospectively collected between 2006 and 2012. The data were analysed for the correlation between neurologically favourable 1-month survival and the time interval between the emergency call and patient collapse. Results: When emergency calls were placed earlier before patient collapse, the proportion of EMT-witnessed cases and survival rate after OHCAs witnessed by bystanders and EMTs were higher. When analysed only for bystander-witnessed cases, for earlier emergency calls placed before patient collapse, survival rate and incidences of bystander cardiopulmonary resuscitation (CPR) and dispatcher-assisted CPR decreased: 2.9%, 33.6% and 24.4%, respectively, for emergency calls placed >6 min before collapse and 5.5%, 48.8% and 48.5%, respectively, for those placed 1–2 min after collapse. Multivariable logistic regression showed that call-to-collapse interval (adjusted odds ratio; 95% confidence interval) (0.92; 0.90–0.94) and EMT response time after collapse (0.84; 0.82–0.86) were associated with survival after bystander-witnessed OHCAs with emergency calls before collapse. Conclusion: Early emergency calls before patient collapse efficiently increase the proportion of EMT-witnessed cases and promotes survival after witnessed OHCAs. However, early emergency call before collapse may worsen the outcome when the patient's condition deteriorates to cardiac arrest before EMT arrival.
    Full-text · Article · Nov 2014 · Resuscitation

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