Survey of a Protocol to Increase Appropriate Implementation of Dispatcher-Assisted Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest
Background—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.
Methods and Results—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.
Conclusions—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.
- Received June 12, 2013.
- Revision received January 22, 2014.
- Accepted January 28, 2014.