Evaluation of telephone-assisted cardiopulmonary resuscitation recommendations for out-of-hospital cardiac arrest,Resuscitation

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Evaluation of telephone-assisted cardiopulmonary resuscitation recommendations for out-of-hospital cardiac arrest
Resuscitation ( IF 6.5 ) Pub Date : 2022-07-21 , DOI: 10.1016/j.resuscitation.2022.07.021
Angel Guerrero ₁ , Audrey L Blewer ₂ , Anjni P Joiner ₃ , Benjamin S H Leong ₄ , Nur Shahidah ₅ , Pin Pin Pek ₆ , Yih Yng Ng ₇ , Shalini Arulanandam ₈ , Truls Østbye ₉ , Alexander Gordee ₁₀ , Maragatha Kuchibhatla ₁₀ , Marcus E H Ong ₁₁

Affiliation

Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
Emergency Medicine Department, National University Hospital, Singapore, Singapore.
Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore.
Emergency Department, Tan Tock Seng Hospital, Singapore.
Emergency Medical Services Department, Singapore Civil Defence Force, Singapore.
Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
BERD Methods Core, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.

Aim of the study

While out-of-hospital cardiac arrest (OHCA) is associated with poor survival, early bystander CPR (B-CPR) and telephone CPR (T-CPR) improves survival from OHCA. American Heart Association (AHA) Scientific Statements outline recommendations for T-CPR. We assessed these recommendations and hypothesized that meeting performance standards is associated with increased likelihood of survival. Additional variables were analyzed to identify future performance measurements.

Methods

We conducted a retrospective cohort study of non-traumatic, adult, OHCA using the Singapore Pan-Asian Resuscitation Outcomes Study. The primary outcome was likelihood of survival; secondary outcomes were pre-hospital Return of Spontaneous Circulation (ROSC) and B-CPR.

Results

From 2012 to 2016, 2,574 arrests met inclusion criteria. Mean age was 68 ± 15; of 2,574, 1,125 (44%) received T-CPR with 5% (135/2574) survival. T-CPR cases that met the Lerner et al. performance metrics analyzed, demonstrated no statistically significant association with survival. Cases which met the Kurz et al. criteria, “Time for Dispatch to Recognize Need for CPR” and “Time to First Compression,” had adjusted odds ratios of survival of 1.01 (95% CI:1.00, 1.02; p = <0.01) and 0.99 (95% CI:0.99, 0.99; p = <0.01), respectively. Identified barriers to CPR decreased the odds of T-CPR and B-CPR being performed. Patients with prehospital ROSC had higher odds of B-CPR being performed. EMS response time < 8 minutes was associated with increased survival among patients receiving T-CPR.

Conclusion

AHA scientific statements on T-CPR programs serve as ideal starting points for increasing the quality of T-CPR systems and patient outcomes. More work is needed to identify other system performance measures.

中文翻译：

院外心脏骤停电话辅助心肺复苏建议的评估

研究目的

虽然院外心脏骤停 (OHCA) 与生存率较低有关，但早期旁观者心肺复苏 (B-CPR) 和电话心肺复苏 (T-CPR) 可提高 OHCA 的生存率。美国心脏协会 (AHA) 科学声明概述了 T-CPR 的建议。我们评估了这些建议，并假设满足绩效标准与生存可能性的增加有关。分析了其他变量以确定未来的性能测量。

方法

我们利用新加坡泛亚复苏结果研究对非创伤性成人 OHCA 进行了回顾性队列研究。主要结果是生存的可能性；次要结局是院前自主循环恢复 (ROSC) 和 B-CPR。

结果

从 2012 年到 2016 年，有 2,574 人被捕符合纳入标准。平均年龄为 68 ± 15；在 2,574 名患者中，1,125 名 (44%) 接受了 T-CPR，存活率为 5% (135/2574)。 Lerner 等人遇到的 T-CPR 案例。分析的性能指标表明与生存没有统计学上的显着关联。库尔兹等人遇到的案件。标准“识别需要 CPR 的派遣时间”和“首次按压时间”调整后的生存比值比为 1.01（95% CI：1.00, 1.02； p = <0.01）和 0.99（95% CI）：0.99、0.99； p = <0.01)。已确定的心肺复苏障碍降低了进行 T-CPR 和 B-CPR 的几率。院前 ROSC 患者接受 B-CPR 的几率较高。 EMS 响应时间 < 8 分钟与接受 T-CPR 的患者生存率增加相关。