Elsevier

Resuscitation

Volume 57, Issue 2, May 2003, Pages 123-129
Resuscitation

Dispatcher assisted CPR: implementation and potential benefit. A 12-year study

https://doi.org/10.1016/S0300-9572(03)00005-4Get rights and content

Abstract

Objectives: Our objectives are to describe details of the dispatcher assisted cardiopulmonary resuscitation (CPR) instruction program we implemented during a 12 years study and to provide estimates of the potential number of out-of-hospital cardiac arrests that might benefit from such instruction based on data from the last 77 months. Methods: Basic data were obtained for all episodes of out-of-hospital cardiac arrest in the city of Seattle, as well as all emergency medical services (EMS) dispatches for suspected cardiac arrest. In addition to EMS run reports, data sources included audio tapes of dispatches, and interviews of callers. These data were used in a potential benefit analysis. Results: Over a period of 77 months, 54% (3320/6130) of cardiac arrests received advanced cardiac life support (ACLS) by Seattle Fire Department emergency medical technicians (EMTs) and paramedics. We estimated that 29.9% (994/3320) of cardiac arrests in Seattle treated by EMS could have theoretically benefited from dispatcher assisted CPR. No serious adverse consequences of a dispatcher assisted CPR program were observed. Failure to identify a cardiac arrest by dispatchers was largely attributed to deviation from a well-defined protocol. However, non-arrests identified, initially as arrests appeared to be unavoidable. Conclusions: In the city of Seattle, some 29.9% of all out-of-hospital cardiac arrest victims who received ACLS had the potential to benefit from dispatcher assisted CPR.

Sumàrio

Objectivos: os nossos objectivos são descrever detalhes do programa de reanimação cardio-pulmonar (RCP) com instruções por operador telefónico que implementamos durante ao longo de 12 anos e estimar do número potencial de paragens cardı́acas extra-hospitalares que podem ter beneficiado dessas instruções, com base nos dados dos últimos 77 meses. Métodos: foram obtidos dados básicos de todos os episódios de paragem cardı́aca extra-hospitalar na cidade de Seattle, bem como todas as chamadas operadas pelos serviços médicos de emergência (SEM) por suspeita de paragem cardı́aca. Além dos relatórios feitos pelos SEM, as fontes de dados incluı́ram gravações audio das chamadas e entrevistas às pessoas que fizeram o telefonema. Estes dados foram utilizados para analisar o benefı́cio potencial. Resultados: Durante um perı́odo de 77 meses, 54% (3320/6139) das paragens cardı́acas receberam Suporte Avançado de Vida (SAV) por técnicos de emergência médica (TEM) e paramédicos do Departamento de Bombeiros de Seattle. Estimamos que 29.9% (994/3320) das paragens cardı́acas em Seattle tratadas pelo SEM teriam em teoria beneficiado de tratamento de paragem cardı́aca assistido por operador telefónico. Não se observaram consequências adversas graves nos programas de tratamento de PCR assistido por operadores telefónicos. A incapacidade dos operadores em identificar uma paragem cardı́aca foi atribuı́da na grande maioria a desvios de um protocolo bem definido. No entanto, situações de não paragem, identificadas inicialmente como paragem, parecem ser inevitáveis. Conclusões: Na cidade de Seattle, cerca de 29.9% de todas as paragens cardı́acas extra-hospitalares que receberam ACLS tinham potencial para beneficiar de tratamento da PCR assistido por operador telefónico.

Resumen

Objetivos: Nuestros objetivos son describir detalles del programa de instrucciones de reanimación cardiopulmonar(RCP) asistida por despachador telefónico que implementamos en un estudio de 12 años, y proveer estimación del número potencial de paros cardı́acos extrahospitalarios que podrı́an beneficiarse con tales instrucciones, basados en datos de los últimos 77 meses. Métodos: Se obtuvieron los datos básicos de todos los episodios de paro cardı́aco extrahospitalario en la ciudad de Seattle, al igual que todos los despachos de servicios de emergencias médicas (EMS) para sospechas de paros cardı́acos. Además de los reportes de salidas de EMS, la fuente de datos incluyó las cintas de audio de los despachos y entrevistas con los solicitantes. Estos datos fueron usados en un análisis de beneficio potencial. Resultados : En un perı́odo de 77 meses, 54% de los llamados (3320/6130) de los llamados por paro cardı́aco recibieron soporte cardı́aco vital avanzado por los técnicos en emergencias médicas (EMTs) y paramédicos del Departamento de Bomberos de Seattle. Estimamos que el 29.9% (994/3320) de los paros cardı́acos en Seattle tratados por los EMS podrı́an beneficiarse teóricamente con RCP asistida por despachador. No se observaron consecuencias adversas de los programas de RCP asistida por despachador. La falla en la identificación de paro cardı́aco fue atribuida grandemente a desviación del protocolo bien definido. Sin embargo, no parecen evitables cuadros que no resultaron ser paros y que inicialmente como paros. Conclusiones: En la ciudad de Seattle, el 29.9% de todos los paros cardı́acos extrahospitalarios que recibieron ACLS tuvieron el potencial de beneficiarse con RCP asistida por despachador.

Introduction

Despite an extensive program for training citizens in cardiopulmonary resuscitation (CPR) technique [1], [2] only some 50% of the witnessed out-of-hospital cardiac arrests in Seattle and in the adjacent suburban King County area had been attended with bystander-initiated CPR. To address this problem, Eisenberg et al. initiated a program in suburban King County in the early 1980s in which dispatchers were taught to instruct willing callers on how to initiate CPR in cases of suspected cardiac arrest [3], [4]. Building on the work of Eisenberg, we initiated dispatcher assisted CPR in Seattle and studied this in a non-randomized prospective design (instructions were rotated quarterly) from 22 May of 1986 until 20 August of 1988 (Phase I), in a randomized pilot from 1 May 1989 to 15 January 1992 (Phase II), and in a randomized trial from 16 January 1992 to 20 August 1998 (Phase III). The study intervention in all three phases was the type of dispatcher instructions administered: standard airway, breathing, and compression (ABC) instructions versus chest compression only. The major finding of the randomized trial was that the survival rate was 27% higher with the chest compression only instruction set, but the result was only marginally significant (a priori one-sided P=0.09) [5], [6]. During these 12 years of study, extensive data were collected from cases of presumed out-of-hospital cardiac arrest [7], [8]. Much of the data collected was used to address issues of quality control and safety.

Not all episodes of out-of-hospital cardiac arrest can be expected to benefit from dispatcher assisted CPR. For example, episodes occurring in a nursing home or medical facility should have persons available who know CPR and hence not need dispatcher instructions. Arrests which occur in an inaccessible location or in which the caller is relaying information secondhand from another person are also not likely to benefit. Overall, almost half (46%) of all episodes of circulatory arrest were assessed as futile, defined as no emergency medical services (EMS) treatment administered.

The purpose of this paper is to provide an estimate of the proportion of patients that could potentially benefit from dispatcher assisted CPR instruction. Additionally, the limitations and attributes of the dispatcher assisted CPR protocols are described.

Section snippets

Methods

This study was approved by the University of Washington IRB. Consent at the time of the episode was not possible and was not required. Telephone interviews required verbal concurrence with a formal consent statement read at the start of the interview.

The same interrogation protocol (Fig. 1) and CPR instructions (adopted from the work of Eisenberg et al. [4]) were used, except for some wording changes made during the first 3 years. A major and early modification of the interrogation protocol

The potential benefit from dispatcher assisted CPR

During the 12 years a total of 10 533 cardiac arrests were attended by the fire department paramedics and/or emergency medical technicians (EMTs), 6103 of which occurred during the study period (Phase III) and of the latter, 3320 received advanced cardiac life support (ACLS). (ACLS: Precordial shock, medications, I.V. line placement, and/or tracheal intubation.) The remaining 2783 episodes were assessed as futile by the EMT personnel and we excluded them from consideration of potential benefit

Acknowledgements

This study was supported by the Washington State Affiliate of the American Heart Association and Medic I Foundation and by a grant (5 R01 HS08197-04) from the Agency for Healthcare Research and Quality. None of the authors have any financial arrangement that might represent a conflict of interest in this study or the publication of this manuscript.

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