Abstract 167: EMS Provider Documentation Changes the Predictive Value of Bystander CPR
Background: It is accepted that bystander CPR improves survival from out-of-hospital cardiac arrest (OHCA). The Utstein template advocates for collection of bystander CPR data. The Circulation Improving Resuscitation Care (CIRC) Trial failed to identify a survival benefit from bystander CPR. We hypothesis that this may be because the definition of bystander CPR is not standardized and likely varies between providers. The objective of this subgroup analysis was to determine if analysis of explicit documentation of bystander CPR components is a better predictor of patient survival.
Methods: We conducted a secondary analysis of the CIRC trial; a randomized controlled trial of Emergency Medical Services (EMS) treated OHCA comparing integrated AutoPulse-CPR to Manual-CPR. EMS data was abstracted from EMS agency medical records by trained research coordinators. There were 4 variables for bystander CPR: 1) a general bystander CPR variable, 2) bystander compressions, 3) bystander ventilations, and 4) bystander AED use. A general bystander CPR variable was present on all patient care reports. Some agencies had check boxes for the remaining variables, while the others obtained them from the medical record narrative. Logistic regression was used to determine the association of each of these variables with hospital discharge.
Results: CIRC enrolled 4,231 patients. Bystander CPR was performed for 2,059 patients (49%), but was not found to be predictive of survival (OR 0.96, 95% CI: 0.90-1.02). The bystander CPR components were all found to be associated with survival: bystander compressions (documented for 936, OR 1.410, 95% CI: 1.13-1.77), bystander ventilations (documented for 315, OR 1.58, 95% CI: 1.14-2.20), bystander AED use (documented for 215, OR 1.93, 95% CI: 1.33-2.79).
Conclusion: Each component of bystander CPR was found to be associated with survival to hospital discharge, even though general documentation of bystander CPR was not. An explicit definition of bystander CPR should be developed and EMS providers should be trained to identify and document the type of bystander CPR that is provided.
- © 2013 by American Heart Association, Inc.