continuous quality improvement project for telephone-assisted instruction f cardiopulmonary resuscitation increased the incidence of bystander CPR and mproved the outcomes of out-of-hospital cardiac arrests

REVIEW In 2007, the Ishikawa Medical Control Council initiated the continuous quality improvement (CQI) project for telephone-assisted cardiopulmonary resuscitation (telephone-CPR), which included instruction on chest-compression-only CPR, education on how to recognise out-of-hospital cardiac arrests (OHCAs) with agonal breathing, emesis and convulsion, recommendations for on-line or redialling instructions and feedback from emergency physicians. This study aimed to investigate the effect of this project on the incidence of bystander CPR and the outcomes of OHCAs. MATERIALS AND METHODS The baseline data were prospectively collected on 4995 resuscitation-attempted OHCAs, which were recognised or witnessed by citizens rather than emergency medical technicians during the period of February 2004 to March 2010. The incidence of telephone-CPR and bystander CPR, as well as the outcomes of the OHCAs, was compared before and after the project. RESULTS The incidence of telephone-CPR and bystander CPR significantly increased after the project (from 42% to 62% and from 41% to 56%, respectively). The incidence of failed telephone-CPR due to human factors significantly decreased from 30% to 16%. The outcomes of OHCAs significantly improved after the projects. A multiple logistic regression analysis revealed that the CQI project is one of the independent factors associated with one-year (1-Y) survival with favourable neurological outcomes (odds ratio=1.81, 95% confidence interval=1.20-2.76). CONCLUSIONS The CQI project for telephone-CPR increased the incidence of bystander CPR and improved the outcome of OHCAs. A CQI project appeared to be essential to augment the effects of telephone-CPR.

[1]  Mark Terry,et al.  Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2010, Circulation.

[2]  George A. Wells,et al.  Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest , 2004 .

[3]  A. Hallstrom,et al.  Emergency CPR instruction via telephone. , 1985, American journal of public health.

[4]  Brett Patterson,et al.  Cardiac arrest predictability in seizure patients based on emergency medical dispatcher identification of previous seizure or epilepsy history. , 2007, Resuscitation.

[5]  M. Shuster,et al.  Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update and simplification of the Utstein templates for resuscitation registries , 2004 .

[6]  S. Trent.  Intravenous Drug Administration During Out-Of-Hospital Cardiac Arrest: A Randomized Trial , 2010 .

[7]  M. Castrén,et al.  In patients with out-of-hospital cardiac arrest, does the provision of dispatch cardiopulmonary resuscitation instructions as opposed to no instructions improve outcome: a systematic review of the literature. , 2011, Resuscitation.

[8]  T. Rea,et al.  Dispatcher-Assisted Cardiopulmonary Resuscitation: Risks for Patients Not in Cardiac Arrest , 2010, Circulation.

[9]  J. Krischer,et al.  Complications of cardiac resuscitation. , 1987, Chest.

[10]  Yutaka Takei,et al.  Analysis of reasons for emergency call delays in Japan in relation to location: high incidence of correctable causes and the impact of delays on patient outcomes. , 2010, Resuscitation.

[11]  Roger D. White,et al.  Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2010, Circulation.

[12]  Council , 1954, The Aeronautical Journal (1968).

[13]  A. Zwinderman,et al.  Importance of the First Link: Description and Recognition of an Out-of-Hospital Cardiac Arrest in an Emergency Call , 2009, Circulation.

[14]  Yutaka Takei,et al.  Tracheal intubation by paramedics under limited indication criteria may improve the short-term outcome of out-of-hospital cardiac arrests with noncardiac origin , 2010, Journal of Anesthesia.

[15]  Maaret Castrén,et al.  European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators , 2010, Resuscitation.

[16]  R W Portal,et al.  Vomiting as a diagnostic aid in acute ischaemic cardiac pain. , 1980, British medical journal.

[17]  S. Corbett,et al.  Detection of traumatic complications of cardiopulmonary resuscitation by ultrasound. , 1997, Annals of emergency medicine.

[18]  Dispatcher-assisted cardiopulmonary resuscitation and survival in cardiac arrest. , 2002 .

[19]  I. Stiell,et al.  An evaluation of 9-1-1 calls to assess the effectiveness of dispatch-assisted cardiopulmonary resuscitation (CPR) instructions: design and methodology , 2008, BMC emergency medicine.

[20]  A. Demchuk,et al.  Early clinical and radiological predictors of fatal brain swelling in ischemic stroke. , 1999, Stroke.

[21]  A. R.,et al.  Review of literature , 1951, American Potato Journal.

[22]  J. Studnek,et al.  The association between prehospital endotracheal intubation attempts and survival to hospital discharge among out-of-hospital cardiac arrest patients. , 2010, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[23]  Mårten Rosenqvist,et al.  Dispatcher-assisted telephone-guided cardiopulmonary resuscitation: an underused lifesaving system , 2007, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[24]  G. Scott,et al.  Effect of a Medical Priority Dispatch System key question addition in the seizure/convulsion/fitting protocol to improve recognition of ineffective (agonal) breathing. , 2008, Resuscitation.

[25]  H. Arntz,et al.  How Sudden Is Sudden Cardiac Death? , 2006, Circulation.

[26]  C. Deakin,et al.  Evaluation of telephone CPR advice for adult cardiac arrest patients. , 2007, Resuscitation.

[27]  John E Billi,et al.  Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European , 2004, Circulation.

[28]  I. Stiell,et al.  Evaluating the effectiveness of dispatch-assisted cardiopulmonary resuscitation instructions. , 2007, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[29]  J. Grimshaw,et al.  A survey of factors associated with the successful recognition of agonal breathing and cardiac arrest by 9-1-1 call takers: design and methodology , 2009, BMC emergency medicine.

[30]  J. Finn,et al.  Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. , 2011, Resuscitation.

[31]  V. Pettilä,et al.  Effect of protocol compliance to cardiac arrest identification by emergency medical dispatchers. , 2006, Resuscitation.

[32]  T. Rea,et al.  The incidence and significance of emesis associated with out-of-hospital cardiac arrest. , 2007, Resuscitation.

[33]  M. Rosenqvist,et al.  Tuition of emergency medical dispatchers in the recognition of agonal respiration increases the use of telephone assisted CPR. , 2009, Resuscitation.

[34]  P. Pepe,et al.  Dispatcher assessments for agonal breathing improve detection of cardiac arrest. , 2009, Resuscitation.

[35]  L. Balliu,et al.  Gastric perforation after cardiopulmonary resuscitation: review of the literature. , 2010, Resuscitation.

[36]  I. Suzuki,et al.  Cardiac rupture by penetration of fractured sternum: a rare complication of cardiopulmonary resuscitation. , 2000, Resuscitation.

[37]  M. Castrén,et al.  In out-of-hospital cardiac arrest patients, does the description of any specific symptoms to the emergency medical dispatcher improve the accuracy of the diagnosis of cardiac arrest: a systematic review of the literature. , 2011, Resuscitation.

[38]  R O Cummins,et al.  Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. Task Force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. , 1991, Annals of emergency medicine.

[39]  L. Bossaert,et al.  European Resuscitation Council guidelines for resuscitation , 1998 .

[40]  Robin Hemphill,et al.  Part 5: adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. , 2010, Circulation.

[41]  P. Safar,et al.  Brain failure and resuscitation , 1981 .