BARRIERS TO DISPATCHER-ASSISTED CARDIOPULMONARY RESUSCITATION IN SINGAPORE

• Published in: Resuscitation 2016-08, Vol.105, p.149-155
• Main Authors: Ho, Andrew Fu Wah, MBBS, Sim, Zariel Jiaying, Shahidah, Nur, BA, Hao, Ying, PhD, Ng, Yih Yng, MBBS, Leong, Benjamin S.H., MBBS, Zarinah, Siti, Teo, Winston K.L., B.Com, Goh, Geraldine Shu Yi, BSc, Jaafar, Hamizah, Ong, Marcus E.H., MBBS
• Format: Article
• Language: English
• Subjects: Bystander; Cardiac arrest; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - education; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - statistics & numerical data; Dispatcher-assisted; Emergency; Emergency Medical Service Communication Systems - statistics & numerical data; Heart Massage; Humans; Out-of-Hospital Cardiac Arrest - diagnosis; Out-of-Hospital Cardiac Arrest - epidemiology; Out-of-Hospital Cardiac Arrest - therapy; Program Evaluation; Singapore - epidemiology; Telephone CPR; Time-to-Treatment
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2016.05.006

Abstract Background Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is effective in increasing bystander CPR in out-of-hospital cardiac arrests (OHCA). Singapore has recently implemented a DA-CPR program. We aimed to characterize barriers to commencement of chest compressions by callers in Singapore. Methods We analyzed dispatch recordings of OHCA cases received by the ambulance call center between July 2012 and March 2015. Audio recordings of poor quality were excluded. Trained reviewers noted the sequential stages of the dispatcher's recognition of CPR, delivering CPR instructions and caller performing CPR. Time taken to reach these milestones were noted. Barriers to chest compressions were identified. Results A total of 4897 OHCA occurred during the study period, overall bystander CPR rate was 45.7%. 1885 dispatch recordings were reviewed with 1157 cases qualified for dispatcher CPR. In 1128 (97.5%) cases, the dispatcher correctly recognized the need for CPR. CPR instructions were delivered in 1056 (91.3%) cases. Of these, 1007 (87.0%) callers performed CPR to instruction. One or more barriers to chest compressions were identified in 430 (37.2%) cases. The commonest barrier identified was “could not move patient” (27%). Cases where barriers were identified were less likely to have the need for CPR recognized by the dispatcher (94.9% vs 99.0%, p < 0.001), CPR instructions given (79.3% vs 98.3%, p < 0.001) and CPR started (67.9% vs 98.3%, p < 0.001), while the time taken to reach each of these stages were significantly longer (p < 0.001). Conclusion Barriers were present in 37% of cases. They were associated with lower proportion of CPR started and longer delay to CPR.