Original ContributionDispatcher assisted CPR: Is it still important to continue teaching lay bystander CPR?
Introduction
Sudden cardiac arrest (SCA) is one of the main causes of death worldwide; in Europe, between 350,000 and 700,000 people die every year [1], [2], [3], [4]. Early recognition and a prompt initiation of bystander Cardiopulmonary Resuscitation CPR are critical for successful defibrillation [5], [6], [7], [8] and to improve the outcome, thus doubling or quadrupling a victim's chances of survival [9], [10], [11], [12].
The rate of bystander CPR varies greatly among communities from 10% to 65% [13]. To improve this situation in the early 1970s, the idea of Dispatcher-assisted CPR (DACPR) or telephone CPR was first conceived [14]. International Guidelines for Resuscitation 2015 [15] recommend DACPR because it improves bystander CPR rates [16], [17], [18], [19], [20], increases the number of chest compressions delivered [20] and improves patient outcomes following out-of hospital cardiac arrest (OHCA) [6], [7], [8], [9], [15], [21], [22], [23]. Recent studies [24], [25] relate a higher survival to hospital discharge rate and higher favorable functional outcome rate after the implementation of a telephone CPR program and DACPR outcomes are comparable to those of presumably trained bystander CPR without assistance [26], [27], even improving neurological recovery at discharge in adults and children aged older than 8, especially in OHCA in private settings.
Previous manikin studies [28], [29] delivering both ventilations and compressions relate that DACPR with previously untrained volunteers performed CPR of an overall quality comparable to that performed by previously trained bystanders, but this may have changed with the new adult guidelines with chest-compressions-only DACPR and the supposed better recall results of teaching a single skill in a chest compression only CPR course instead of standard CPR.
The aim of this study was to compare on manikin chest compressions only CPR performance carried out by untrained volunteers following DACPR instructions, their performance immediately after chest compressions only CPR course and then 4 months after CPR course.
Section snippets
Participants
The participants were students from Santiago de Compostela University (Spain) who had received no prior CPR training. They volunteered for the study, were provided with information on the study and written consent was obtained. The study was approved by the Santiago de Compostela University Ethics Committee.
Pre-assessment
An ad hoc questionnaire was initially administered to find out the socio-demographic details and previous knowledge of BLS, eliminating those who had received previous formation or training
Participant demographics and follow up
38 individuals, between the ages of 19 and 26 (M = 20.68; SD = 1.61), were included in the DACPR procedure. During the initial DACPR evaluation three participants were not able to deliver cardiac compressions: two participants delivered the compressions outside of the thorax (1 in the abdomen and 1 in the neck) and the other one did not compress but massaged.
The remaining 35 participants (92.1%) carried out compressions on the thorax, but 1 of these cases was not recorded due to technical problems
Discussion
Unlike previous on manikin simulations involving rescue breathing in addition to chest compressions, the present study of chest compressions only CPR shows that CPR performed by basic life support trained bystanders achieves better results than DACPR.
Cardiac compressions were not carried out in almost 8% of cases in the DACPR group because they were delivered outside the chest or as a soft massage and the DACPR efforts were useless. According to current guidelines [15] the recommendation “place
Conclusions
Unlike other previous ventilation and compression CPR on manikin studies, the results of the present study show that chest compressions only CPR trained bystanders perform cardiac compressions sooner and better than untrained bystander DACPR.
Limitations
The main limitation is the simulation: by considering the situation with a manikin, the real patient is probably not being represented. Because the study was designed to compare different moments in the long-term follow-up of individual CPR performance, no randomization was planned and the mean age of the participants, mostly women, does not accurately represent the most likely OHCA witness, the spouse of an elderly victim at home [38]. Because of the difficulty in completing the whole process,
Acknowledgements
Lugo Medical Association.
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2021, Canadian Journal of SurgeryCitation Excerpt :Of the 56 articles, 41 focused on improving dispatcher-directed CPR,15-55 6 focused on physician–physician consultation,56-61 and 9 examined telementoring in trauma resuscitation.8,10-12,62-66 The articles focusing on improving dispatcher-directed CPR15-55 contained 2 main themes or recommendations: the importance of the dispatcher’s identifying an out-of-hospital cardiac arrest, and providing clear instructions to the bystander to administer effective CPR and mitigate barriers. The former articles consisted primarily of retrospective and prospective observational studies.