Improving Bystander CPR Quality Through Dispatcher-assisted Basic Life Support Education Program

Bystander cardiopulmonary resuscitation (CPR) is a crucial component of survival after out-of hospital cardiac arrest (OHCA). Not only the rate of bystander CPR has been associated with higher OHCA survival rate, but the quality of bystander CPR as measured by proportion of correct chest compression and earlier administration has been highly indicative of positive outcomes as well.

However, bystander CPR rates have been reported to be low in many communities due to low access to CPR training. To address this, among many attempts to improve OHCA survival, enhancing bystander CPR rate and quality through dispatcher-assisted CPR (DA-CPR) to the right target group may be an effective and promising approach.

In DA-CPR, the dispatcher on the emergency line provides CPR instruction over the phone. Over-the-telephone CPR instruction was intended to primarily benefit bystanders who have little or no training, but studies have shown that it can also benefit trained bystanders who are in panic in emergency situations to prompt CPR administration. Trained bystanders who received dispatcher assistance during CPR also showed improved CPR quality.

Previous studies reported that 50-81% of OHCA occurs at home. However, the outcome in private homes was very poor compared to outside private home including public places. One possible reason of such lower survival rate may be that the current CPR education programs for home bystanders are inefficient in properly educating home bystanders to provide quality CPR to the patient. In other words, despite the reported benefits of DA-CPR in both trained and untrained bystanders, performing bystander CPR according to phone instruction provided by the dispatcher may not be easy to follow for certain home bystanders such as women and elderly.

According to a recent analysis of 2012 National OHCA Registry, outcomes after OHCA were significantly lower (adjusted odds ratio; 0.36, 95% confidence intervals; 0.18-0.71) in patients who received home bystander CPR with dispatcher assistance than in patients who received either public or who received home bystander CPR without dispatcher assistance. These results suggest that home bystander CPR with dispatcher assistance did not improve the outcomes due to low compliance of CPR instruction and low CPR performance quality by home bystanders. Considering that the in-home OHCA patients are less likely to receive bystander CPR, there needs a new approach to optimize the low compliance rate and CPR quality in possible home bystanders.