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2017

Dispatcher-Assisted CPR Time to First Compression

Author

Greg Scott, MBA

Associate authors: Christopher Olola, PhD, Isabel Gardett, PhD, Jeff Clawson, MD

Introduction—Rapid identification of out-of-hospital cardiac arrest (OHCA) and delivery of bystander chest compressions in patients with ventricular fibrillation are key elements in the chain of patient survival. The timeliness of dispatcher-assisted CPR may improve survival in such patients.

Objective—The primary objective was to determine elapsed time to start of instructions and time to initiate chest compression by bystanders for cases where EMDs used the MPDS v13 Obviously Not Breathing Fast Track feature. A secondary objective was to identify barriers—problems encountered by bystanders—in completing the delivery of prompt chest compressions.

Methods—A retrospective, observational study of adult cardiac arrest dispatcher-assisted CPR cases was performed. Case audio was downloaded from the emergency medical dispatch center audio system. Elapsed time was recorded for seven key steps in the call relevant to the dispatcher-assisted CPR sequence. Barriers that impeded progress of bystanders to deliver prompt chest compressions were identified.

Results—The study found 60% (18/30) had barriers that impeded the time to chest compression instructions and bystander delivery of chest compressions. The most frequent barrier, at 36.7% (11/30), was difficulty getting the patient from a bed to the floor/ground. The median elapsed time from address verification to identification and entry of cardiac arrest (CA) chief complaint was 65 seconds overall (with or without barriers). The median time to start chest compression instructions was 140 seconds overall (89 seconds without barriers, and 182 seconds with barriers, p<0.001).

Conclusion—A significant difference exists in both time to compression instructions and time to compressions delivered between cases with no barriers and those with barriers. Differences also exist between cases using a “fast-track” cardiac arrest identification feature and cases that do not. Very fast times to hands-on-chest are possible with early dispatcher identification of cardiac arrest.

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