Abstract 239: Does the Performance of Emergency Medical Dispatch (EMD) Affect Survival from Out-of-Hospital Cardiac Arrests (OHCAs)? An Analysis of the Taipei Utstein Arrest Registry
Introduction Dispatch-instructed bystander cardiopulmonary resuscitation (DI-CPR) was recommended by current resuscitation guidelines. The pivotal step of DI-CPR was the accurate recognition of OHCAs by interview of caller. However, previous studies showed the compliance of dispatchers in posing priority questions to identification of OHCAs is unsatisfactory. This study aimed to estimate the incremental effect on recovery of spontaneous circulation (ROSC) of OHCAs if the dispatcher could have more OHCAs recognized through a better adhesion to dispatch protocol.
Methods Emergency medical service system of Taipei City is the first one in Taiwan to implement service of prehospital advanced life support (ALS) and to develop the database of Utstein registry to track the OHCAs. We analyzed the Taipei Utstein database to evaluate the association between bystander CPR and ROSC of OHCAs stratified by EMD performance including recognition of OHCA and instruction of CPR. Because the recognition of OHCAs was not requested in registry, we used the results of dispatched tier as surrogates. The dispatcher would send an ALS team to the scene if they succeed to alert the OHCAs by call, while only a BLS team would be dispatched if they failed to.
Results From 2008 to 2009, there were total 3573 adult non-traumatic OHCAs registered with attempted resuscitation. Among them, bystander CPR rate and overall ROSC rate were 15.4% and 22.2% respectively. Bystander CPR was significantly associated with better ROSC even after adjustment for other variables. The bystander CPR rate was up to 25.5% in OHCAs recognized by EMD but was only 10.0% in those who did not. The association between ROSC and the performance of dispatchers were tabulated beneath.
Conclusion Bystander CPR was one of the most important factors to survival of OHCAs in Taipei. Performance of EMD had the potential to benefit the ROSC rate of OHCA patients as long as the dispatcher could recognize more OHCAs cases.
- © 2011 by American Heart Association, Inc.