21 Nov Telephone CPR May Improve Out-of-Hospital Cardiac Arrest Survival

Posted at 11:32h in Emergency Care, Heart Disease by

Bentley Bobrow, MD, Medical Director Bureau of Emergency Medicine Services and Trauma System Arizona Department of Health Services, Phoenix Professor, University of ArizoneaMedicalResearch.com Interview with:
Bentley Bobrow, MD,
Medical Director
Bureau of Emergency Medicine Services and Trauma System
Arizona Department of Health Services, Phoenix
Professor, University of Arizona

Medical Research: What is the background for this study? What are the main findings?

Dr. Bobrow: Out-of-Hospital Cardiac Arrest is a leading cause of death worldwide. There are nearly half a million EMS-assessed Out-of-Hospital Cardiac Arrest s in the United States annually. Bystander CPR (B-CPR) before arrival of EMS can double or even triple survival from OHCA. Yet it occurs in only 1/3 of cases. Telephone CPR – the provision of B-CPR with a 9-1-1 telecommunicator’s instructions – is independently associated with increased rates of Bystander CPR and patient survival and requires almost no capital investment. For this reason, we believe Telephone CPR may be THE most effective and efficient way to move the needle on OHCA survival. In order to achieve this potential, however, EMS systems must adopt the latest guideline recommendations for T-CPR and continuously measure system performance. Very few systems do this. The aim of our project was to do just this at multiple 9-1-1 centers in Arizona. We implemented the guidelines and measured the impact on process metrics and patient outcomes. Our findings confirmed what we expected: a significant increase in the proportion of cases where T-CPR was performed, a significant reduction in time from call-receipt to first bystander chest compression, and, most importantly, significant increases in patient survival and survival with positive neurologic outcome.

Medical Research: What should clinicians and patients take away from your report?

Dr. Bobrow: Prehospital and in hospital therapies depend greatly on B-CPR. Successful defibrillation, for example, is far more likely if EMS find the patient’s heart in a shockable rhythm on arrival. In addition to circulating blood to the heart and brain, B-CPR can prolong the period the heart fibrillates. The potential of T-CPR to increase rates of B-CPR is thus enormously important. This simple, effective intervention can save tens of thousands of lives worldwide every year.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Bobrow: We know T-CPR improves patient outcomes – it is nearly as effective as B-CPR without telephone assistance.

Medical Research: What future research do you suggest as a result of this work?
Dr. Bobrow: Future research can now look to refine scripts for

(1) overcoming barriers that often prevent or delay T-CPR and

(2) optimizing T-CPR instructions to create and maintain high CPR quality until EMS takes over the rescue. In an effort to maximize lay defibrillation, future efforts should also work to integrate the location of AEDs into Computer-Aided Dispatch systems.

Citation:

2014 AHA abstract:

Statewide Implementation of a Standardized Prearrival Telephone CPR Program

 

Last Updated on November 21, 2014 by Marie Benz MD FAAD

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