CPR performance in lay people with telephone assisted CPR instructions : a prospective manikin-based observational study

Abstract

Background: It is reported that Emergency Medical Services (EMS) in Europe, annually encounter about 275,000 out-of-hospital cardiac arrests (OHCA) whilst in the United States (US) this number rises to 420,000. The chance of survival from an OHCA is dependent on recognition of cardiac arrest by Emergency Medical Dispatchers’ (EMDs), early bystander cardiopulmonary resuscitation (CPR), and early defibrillation. Telephone assisted CPR (TCPR) by EMDs (also known as dispatcher assisted CPR – DA-CPR) has been shown to double the frequency of bystander CPR so much so that it has now obtained a key position in the 2015 European Resuscitation Council guidelines. --- Method: This was a prospective, manikin-based observational study conducted in Malta between July 2018 and July 2019. The aim of this study was to test a set of TCPR instructions in Maltese on lay people with no previous knowledge of CPR. The primary endpoint was to check for understanding and correct execution of such instructions vis-à-vis hand positioning during chest compression, compressions depth and rate. Participants were recruited from 10 localities around Malta. Data was collected using Laerdal’s Resus Annie® QCPR manikin and SkillReporterTM (PC) software. --- Results: One hundred fifty-five participants were included in the study. Approximately 7 out of 10 participants performed compressions with correct hand position. Approximately 6 out of 10 participants performed a compression rate between 100 – 120/min and 2 out of 10 rescuers achieved the recommended 50-60mm compression depth. --- Conclusion: In our study we found that in Malta, laypeople with no previous CPR training can understand and execute our proposed chest compression only TCPR instructions in Maltese. The introduction of a standard operating procedure and training of EMDs on policy, expectations and performance is vital if we need to improve bystander CPR and survival rates locally. Training coupled with quality improvement projects such as call collection for review, analysis and feedback is the way forward.