Original Contribution
Dispatcher assisted CPR: Is it still important to continue teaching lay bystander CPR?

https://doi.org/10.1016/j.ajem.2016.12.014Get rights and content

Abstract

Purpose

The aim of this study was to compare on manikin chest compressions only CPR performance carried out by untrained volunteers following Dispatcher assisted Cardiopulmonary Resuscitation (DACPR), and then by the same trained volunteers immediately after chest compressions only CPR course and 4 months after the CPR course.

Method

38 university student volunteers with no previous experience in CPR took part in three on manikin chest compressions only CPR skill evaluations: first in a DACPR, then after chest compressions only CPR course (ACPRC) and lastly, four months after a CPR course (4MACPRC). Only 22 completed the whole process.

Results

In DACPR 7.89% of participants carried out cardiac compressions outside the thorax. The mean average time from collapse to first compression was reduced in 4MACPRC (40.77 s), as compared to DACPR (144.54 s); p < 0.001).

The following parameters were significantly better in 4MACPRC than in DACPR: Average compression depth (44.72 vs 25.22; p < 0.001), average compression rate (106.1 vs 87.90; p < 0.001), total number of compressions in 3 min (317 vs 245; p < 0.001), percentage of correct compressions (53.00% vs 4.72 %; p < 0.001) and percentage of correct hand positioning (95.40 vs 91.09; p < 0.001).

Conclusions

Even though chest compressions only DACPR allows lay bystanders to be able to carry out cardiac compressions in 92.1% of cases, these were delivered later and were less efficient than chest compressions only CPR given by trained bystanders after a CPR course and four months after the course.

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.

References (41)

  • K. Bohm et al.

    In patients with out-of-hospital cardiac arrest, does the provision of dispatch cardiopulmonary resuscitation instructions as opposed to not instructions improve outcome: a systematic review of the literature

    Resuscitation

    (2011)
  • Y.S. Ro et al.

    Effects of dispatcher-assisted cardiopulmonary resuscitation on survival outcomes in infants, children, and adolescents with out-of-hospital cardiac arrest

    Resuscitation

    (2016)
  • W.B. Carter et al.

    Development and implementation of emergency CPR instructions via telephone

    Ann Emerg Med

    (1984)
  • J. García del Águila et al.

    Recomendaciones para el soporte telefónico a la reanimación por testigos desde los centros de coordinación de urgencias y emergencias

    Med Intensiva

    (2015)
  • R. Greif et al.

    European Resuscitation Guidelines for Resuscitation 2015. Education and implementation of resuscitation

    Resuscitation

    (2015)
  • M. Beard et al.

    How effectively can young people perform dispatcher-instructed cardiopulmonary resuscitation without training?

    Resuscitation

    (2015)
  • M. Woollard et al.

    To blow or not to blow: a randomized controlled trial of compression-only and standard telephone CPR instructions in simulated cardiac arrest

    Resuscitation

    (2003)
  • G. Oman et al.

    Use of telephone CPR advice in Ireland: uptake by callers and delays in the assessment process

    Resuscitation

    (2016)
  • H. Choi et al.

    Identifying the optimal hand placement site for chest compression by measuring hand width and sternal length in young adults

    Am J Emerg Med

    (2016)
  • J. Wang et al.

    Compressing with dominant hand improves quality of manual chest compressions for rescuers who performed suboptimal CPR in manikins

    Am J Emerg Med

    (2015)
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