Abstract 113: Barriers to Effective Bystander-Initiated CPR in Out-of-Hospital Cardiac Arrest
Background: Telephone-CPR can increase bystander CPR (BCPR) and survival in out-of-hospital cardiac arrest (OHCA). Studies show that CPR is more effective when delivered on the ground than on other surfaces, but patients often collapse in locations suboptimal for CPR.
Objectives: To assess patient found locations (PFL) and barriers to initiating effective BCPR.
Methods: Standardized review of audio recordings from confirmed OHCAs in a large, regional 9-1-1 dispatch center. OHCA was identified in 2,812 recordings (2/2011-6/2013). Caller-described barriers were categorized and recorded in a structured data format.
Results: Cases were excluded if at least one of the following was observed: CPR was not indicated (n=770, 27.4%), CPR was already in progress (n=607, 21.6%), the caller was not with the patient (n=132, 4.7%), a language barrier was present between caller and dispatcher (n=63, 2.2%), the patient had a do-not-resuscitate order (n=33, 1.2%), or the patient displayed obvious signs of rigor mortis (n=119, 4.2%). Among the remaining incidents (n=1302, 46.3%; study group), a barrier to moving the patient to a supine position on the ground was present in 24.6% of cases (320/1302). Among these 320 cases, PFLs were: the patient was found on a bed (n=149, 46.6%), in a couch/chair (n=68, 21.2%), on the floor but not supine (n=48, 15.0%), and all others (n=48, 15.0%). The PFL was unknown in seven cases (2.2%). The barriers described by callers for why the patient could not be moved into optimal position were: patient too heavy to be moved (n=161, 50.3%), bystander physically unable (n=40, 12.5%), and other reasons (n=39, 12.2%). Callers did not describe the barrier encountered in 80 cases (25.0%).
Conclusion: In cases where callers described a barrier to BCPR, 82.8 % of patients were found in positions other than on the ground. In addition, callers said patients were too heavy to move in half of all cases where they encountered a barrier to getting the patient into optimal position for CPR. These findings have important implications for training dispatchers on OHCA calls.
Author Disclosures: B. Langlais: None. M. Panczyk: None. M. Sotelo: None. T. Irisawa: None. H. Ryoo: None. J. Jaber: None. D. Spaite: Research Grant; Significant; Medtronic Foundation. B. Bobrow: Research Grant; Significant; Medtronic Foundation.
- © 2014 by American Heart Association, Inc.