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Ng JYX, Sim ZJ, Siddiqui FJ, Shahidah N, Leong BSH, Tiah L, Ng YY, Blewer A, Arulanandam S, Lim SL, Ong MEH, Ho AFW. Incidence, characteristics and complications of dispatcher-assisted cardiopulmonary resuscitation initiated in patients not in cardiac arrest. Resuscitation 2021; 170:266-273. [PMID: 34626729 DOI: 10.1016/j.resuscitation.2021.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
AIM Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) can increase bystander CPR rates and improve outcomes in out-of-hospital cardiac arrest (OHCA). Despite the use of protocols, dispatchers may falsely recognise some cases to be in cardiac arrest. Hence, this study aimed to find the incidence of DA-CPR initiated for non-OHCA cases, its characteristics and clinical outcomes in the Singapore population. METHODS This was a multi-centre, observational study of all dispatcher-recognised cardiac arrests cases between January to December 2017 involving three tertiary hospitals in Singapore. Data was obtained from the Pan-Asian Resuscitation Outcomes Study cohort. Audio review of dispatch calls from the national emergency ambulance service were conducted and information about patients' clinical outcomes were prospectively collected from health records. Univariate analysis was performed to determine factors associated with in-hospital mortality among non-OHCA patients who received DA-CPR. RESULTS Of the 821 patients recognised as having OHCA 328 (40.0%) were not in cardiac arrest and 173 (52.7%) of these received DA-CPR. No complications from chest compressions were found from hospital records. The top diagnoses of non-OHCA patients were cerebrovascular accidents (CVA), syncope and infection. Only final diagnoses of CVA (aOR 20.68), infection (aOR 17.34) and myocardial infarction (aOR 32.19) were significantly associated with in-hospital mortality. CONCLUSION In this study, chest compressions initiated on patients not in cardiac arrest by dispatchers did not result in any reported complications and was not associated with in-hospital mortality. This provides reassurance for the continued implementation of DA-CPR.
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Affiliation(s)
- Julia Yu Xin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zariel Jiaying Sim
- Accident & Emergency, Changi General Hospital, Singapore; SingHealth Emergency Medicine Residency Programme, Singapore
| | - Fahad Javaid Siddiqui
- Pre-hospital & Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | | - Ling Tiah
- Accident & Emergency, Changi General Hospital, Singapore
| | - Yih Yng Ng
- Home Team Medical Services Division, Ministry of Home Affairs, Singapore; Emergency Department, Tan Tock Seng Hospital, Singapore
| | - Audrey Blewer
- Department of Family Medicine and Community Health, Duke University School of Medicine, USA
| | | | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Andrew Fu Wah Ho
- Pre-hospital & Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.
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Shibahashi K, Ishida T, Kuwahara Y, Sugiyama K, Hamabe Y. Effects of dispatcher-initiated telephone cardiopulmonary resuscitation after out-of-hospital cardiac arrest: A nationwide, population-based, cohort study. Resuscitation 2019; 144:6-14. [PMID: 31499100 DOI: 10.1016/j.resuscitation.2019.08.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/23/2019] [Accepted: 08/17/2019] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to investigate the effects of dispatcher-initiated telephone cardiopulmonary resuscitation (TCPR) in Japan using a nationwide population-based registry. METHODS Adult Japanese patients with out-of-hospital cardiac arrest (OHCA; n = 582,483, age ≥18 years) were selected from a nationwide Utstein-style database (2010-2016) and divided into 3 groups: no bystander CPR (NCPR) before emergency medical service arrival (n = 448,606), bystander-initiated CPR (BCPR) performed without assistance (n = 46,964), and TCPR (n = 86,913). The primary outcome was a favourable neurological outcome 1 month after OHCA. RESULTS After adjusting for potential confounders, and relative to the NCPR group, significantly better 1-month neurological outcomes were observed in the BCPR group (odds ratio: 2.25, 95% confidence interval: 2.15-2.36; P < 0.001) and in the TCPR group (odds ratio: 1.30, 95% confidence interval: 1.24-1.36; P < 0.001). The collapse-to-CPR time was independently associated with the 1-month outcomes, with a rate of <1% for 1-month favourable neurological outcomes if CPR was initiated >5 min after the collapse. CONCLUSION Patients who received TCPR had significantly better outcomes than those who did not receive CPR. However, the TCPR outcomes were less favourable than those in the BCPR group. Better protocol development and enhanced education are needed to improve dispatcher instructions in Japan, which may help lessen the gap between the BCPR and TCPR outcomes and further improve the outcomes after OHCA.
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Affiliation(s)
- Keita Shibahashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan.
| | - Takuto Ishida
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Yusuke Kuwahara
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
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Pek JH, de Korne DF, Hannawa AF, Leong BSH, Ng YY, Arulanandam S, Tham LP, Ong MEH, Ong GY. Dispatcher-assisted cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest: A structured evaluation of communication issues using the SACCIA ® safe communication typology. Resuscitation 2019; 139:144-51. [PMID: 30999084 DOI: 10.1016/j.resuscitation.2019.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/18/2019] [Accepted: 04/03/2019] [Indexed: 12/31/2022]
Abstract
AIM To evaluate communication issues during dispatcher-assisted cardiopulmonary resuscitation (DACPR) for paediatric out-of-hospital cardiac arrest in a structured manner to facilitate recommendations for training improvement. METHODS A retrospective observational study evaluated DACPR communication issues using the SACCIA® Safe Communication typology (Sufficiency, Accuracy, Clarity, Contextualization, Interpersonal Adaptation). Telephone recordings of 31 cases were transcribed verbatim and analysed with respect to encoding, decoding and transactional communication issues. RESULTS Sixty SACCIA communication issues were observed in the 31 cases, averaging 1.9 issues per case. A majority of the issues were related to sufficiency (35%) and accuracy (35%) of communication between dispatcher and caller. Situation specific guideline application was observed in CPR practice, (co)counting and methods of compressions. CONCLUSION This structured evaluation identified specific issues in paediatric DACPR communication. Our training recommendations focus on situation and language specific guideline application and moving beyond verbal communication by utilizing the smart phone's functions. Prospective efforts are necessary to follow-up its translation into better paediatric DACPR outcomes.
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Ho AFW, Sim ZJ, Shahidah N, Hao Y, Ng YY, Leong BSH, Zarinah S, Teo WKL, Goh GSY, Jaafar H, Ong MEH. Barriers to dispatcher-assisted cardiopulmonary resuscitation in Singapore. Resuscitation 2016; 105:149-55. [PMID: 27288652 DOI: 10.1016/j.resuscitation.2016.05.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/31/2016] [Accepted: 05/09/2016] [Indexed: 11/18/2022]
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 was 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.
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Affiliation(s)
- Andrew Fu Wah Ho
- Emergency Medicine Residency, Singapore Health Services, Singapore, Singapore.
| | - Zariel Jiaying Sim
- Barts and the London School of Medicine and Dentistry, Greater London, United Kingdom
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Ying Hao
- Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore, Singapore
| | - Benjamin S H Leong
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
| | - Siti Zarinah
- Operations Department, Singapore Civil Defence Force, Singapore, Singapore
| | - Winston K L Teo
- Operations Department, Singapore Civil Defence Force, Singapore, Singapore
| | | | - Hamizah Jaafar
- Operations Department, Singapore Civil Defence Force, Singapore, Singapore
| | - Marcus E H Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Harjanto S, Na MXB, Hao Y, Ng YY, Doctor N, Goh ES, Leong BSH, Gan HN, Chia MYC, Tham LP, Cheah SO, Shahidah N, Ong MEH. A before-after interventional trial of dispatcher-assisted cardio-pulmonary resuscitation for out-of-hospital cardiac arrests in Singapore. Resuscitation 2016; 102:85-93. [PMID: 26944042 DOI: 10.1016/j.resuscitation.2016.02.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 02/10/2016] [Accepted: 02/17/2016] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the effects of a comprehensive dispatcher-assisted CPR (DACPR) training program on bystander CPR (BCPR) rate and the outcomes of out-of-hospital cardiac arrest (OHCA) in Singapore. METHODS This is an initial program evaluation of a national DACPR intervention. A before-after analysis was conducted using OHCA cases retrieved from a local registry and DACPR information derived from audio recordings and ambulance notes. The primary outcomes were survival to admission, survival at 30 days post-arrest and good functional recovery. RESULTS Data was collected before the intervention (April 2010 to December 2011), during the run-in period (January 2012 to June 2012) and after the intervention (July 2012 to February 2013). A total of 2968 cases were included in the study with a mean age of 65.6. Overall survival rate was 3.9% (116) with good functional recovery in 2.2% (66) of the patients. BCPR rate increased from 22.4% to 42.1% (p<0.001) with odds ratio (OR) of 2.52 (95% confidence interval [CI]: 2.09-3.04) and ROSC increased significantly from 26.5% to 31.2% (p=0.02) with OR of 1.26 (95%CI: 1.04-1.53) after the intervention. Significantly higher survival at 30 days was observed for patients who received BCPR from a trained person as compared to no BCPR (p=0.001, OR=2.07 [95%CI: 1.41-3.02]) and DACPR (p=0.04, OR=0.30 [95%CI: 0.04-2.18]). CONCLUSION A significant increase in BCPR and ROSC was observed after the intervention. There was a trend to suggest improved survival outcomes with the intervention pending further results from the trial.
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Affiliation(s)
| | - May Xue Bi Na
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Hao
- Division of Research, Singapore General Hospital, Singapore, Singapore
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore, Singapore
| | - Nausheen Doctor
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - E Shaun Goh
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Han Nee Gan
- Accident & Emergency, Changi General Hospital, Singapore, Singapore
| | | | - Lai Peng Tham
- Children's Emergency, KK Women's and Children's Hospital, Singapore, Singapore
| | - Si Oon Cheah
- Emergency Medicine Department, Alexandra Hospital, Singapore, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore.
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Nishi T, Kamikura T, Funada A, Myojo Y, Ishida T, Inaba H. Are regional variations in activity of dispatcher-assisted cardiopulmonary resuscitation associated with out-of-hospital cardiac arrests outcomes? A nation-wide population-based cohort study. Resuscitation 2015; 98:27-34. [PMID: 26525273 DOI: 10.1016/j.resuscitation.2015.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 08/06/2015] [Accepted: 10/11/2015] [Indexed: 11/19/2022]
Abstract
AIM Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) impacts the rates of bystander CPR (BCPR) and survival after out-of-hospital cardiac arrests (OHCAs). This study aimed to elucidate whether regional variations in indexes for BCPR and emergency medical service (EMS) may be associated with OHCA outcomes. METHODS We conducted a population-based observational study involving 157,093 bystander-witnessed, resuscitation-attempted OHCAs without physician involvement between 2007 and 2011. For each index of BCPR and EMS, we classified the 47 prefectures into the following three groups: advanced, intermediate, and developing regions. Nominal logit analysis followed by multivariable logistic regression including OHCA backgrounds was employed to examine the association between neurologically favourable 1-month survival, and regional classifications based on BCPR- and EMS-related indexes. RESULTS Logit analysis including all regional classifications revealed that the number of BLS training course participants per population or bystander's own performance of BCPR without DA-CPR was not associated with the survival. Multivariable logistic regression including the OHCA backgrounds known to be associated with survival (BCPR provision, arrest aetiology, initial rhythm, patient age, time intervals of witness-to-call and call-to-arrival at patient), the following regional classifications based on DA-CPR but not on EMS were associated with survival: sensitivity of DA-CPR [adjusted odds ratio (95% confidence intervals) for advanced region; those for intermediate region, with developing region as reference, 1.277 (1.131-1.441); 1.162 (1.058-1.277)]; the proportion of bystanders to follow DA-CPR [1.749 (1.554-1.967); 1.280 (1.188-1.380)]. CONCLUSIONS Good outcomes of bystander-witnessed OHCAs correlate with regions having higher sensitivity of DA-CPR and larger proportion of bystanders to follow DA-CPR.
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Affiliation(s)
- Taiki Nishi
- Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Takahisa Kamikura
- Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Akira Funada
- Emergency Medical Centre, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Yasuhiro Myojo
- Emergency Medical Centre, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-Higashi, Kanazawa, Ishikawa 920-8201, Japan.
| | - Tetsuya Ishida
- Emergency Department, Kaga Citizen's Hospital, 65 Hachikenmichi, Daishoji, Kaga 922-0057, Japan.
| | - Hideo Inaba
- Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
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