Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2021 Mar 16;10(6):e017930.
doi: 10.1161/JAHA.120.017930. Epub 2021 Mar 4.

Bystander Cardiopulmonary Resuscitation Quality: Potential for Improvements in Cardiac Arrest Resuscitation

Affiliations
Multicenter Study

Bystander Cardiopulmonary Resuscitation Quality: Potential for Improvements in Cardiac Arrest Resuscitation

Richard Chocron et al. J Am Heart Assoc. .

Abstract

Background Bystander cardiopulmonary resuscitation (CPR) is a critical intervention to improve survival following out-of-hospital cardiac arrest. We evaluated the quality of bystander CPR and whether performance varied according to the number of bystanders or provision of telecommunicator CPR (TCPR). Methods and Results We investigated non-traumatic out-of-hospital cardiac arrest occurring in a large metropolitan emergency medical system during a 6-month period. Information about bystander care was ascertained through review of the 9-1-1 recordings in addition to emergency medical system and hospital records to determine bystander CPR status (none versus TCPR versus unassisted), the number of bystanders on-scene, and CPR performance metrics of compression fraction and compression rate. Of the 428 eligible out-of-hospital cardiac arrest, 76.4% received bystander CPR including 43.7% unassisted CPR and 56.3% TCPR; 35.2% had one bystander, 33.3% had 2 bystanders, and 31.5% had ≥3 bystanders. Overall compression fraction was 59% with a compression rate of 88 per minute. CPR differed according to TCPR status (fraction=52%, rate=87 per minute for TCPR versus fraction=69%, rate=102 for unassisted CPR, P<0.05 for each comparison) and the number of bystanders (fraction=55%, rate=87 per minute for 1 bystander, fraction=59%, rate=89 for 2 bystanders, fraction=65%, rate=97 for ≥3 bystanders, test for trend P<0.05 for each metric). Additional bystander actions were uncommon to include rotation of compressors (3.1%) or application of an automated external defibrillator (8.0%). Conclusions Bystander CPR quality as gauged by compression fraction and rate approached guideline goals though performance depended upon the type of CPR and number of bystanders.

Keywords: dispatch‐assisted cardiopulmonary resuscitation; out of hospital cardiac arrest; quality in health care; telecommunicator cardiopulmonary resuscitation.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1
Figure 1. Flow diagram: bystander cardiopulmonary resuscitation according to telephone cardiopulmonary resuscitation and bystander count.
CPR indicates cardiopulmonary resuscitation; EMS, emergency medical service; and OHCA, out‐of‐hospital cardiac arrest; TCPR, telecommunicator CPR. TCPR instruction for adult arrest consists of chest compressions during which the telecommunicator coaches the rescuer on the compression rate and to count out loud with each compression.
Figure 2
Figure 2. Cardiopulmonary resuscitation fraction and compression rate by the type of bystander cardiopulmonary resuscitation and the number of rescuers at the scene.
Inside each box plot the dot represents the mean and the line represent the median. Cardiopulmonary resuscitation fraction means the proportion of time during bystander phase of the arrest during which cardiopulmonary resuscitation is performed. CPR indicates cardiopulmonary resuscitation; EMS, emergency medical system; OHCA, out‐of‐hospital cardiac arrest; and TCPR, telecommunicator CPR.

Similar articles

Cited by

References

    1. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation. 2019;139:e56–e528. DOI: 10.1161/CIR.0000000000000659. - DOI - PubMed
    1. Nakashima T, Noguchi T, Tahara Y, Nishimura K, Yasuda S, Onozuka D, Iwami T, Yonemoto N, Nagao K, Nonogi H, et al. Public‐access defibrillation and neurological outcomes in patients with out‐of‐hospital cardiac arrest in Japan: a population‐based cohort study. Lancet. 2020;394:2255–2262. DOI: 10.1016/S0140-6736(19)32488-2. - DOI - PubMed
    1. Kobayashi D, Kitamura T, Kiyohara K, Nishiyama C, Hayashida S, Matsuyama T, Katayama Y, Shimamoto T, Kiguchi T, Okabayashi S, et al. Cardiopulmonary resuscitation performed by off‐duty medical professionals versus laypersons and survival from out‐of‐hospital cardiac arrest among adult patients. Resuscitation. 2019;135:66–72. DOI: 10.1016/j.resuscitation.2019.01.005. - DOI - PubMed
    1. Bækgaard JS, Viereck S, Møller TP, Ersbøll AK, Lippert F, Folke F. The effects of public access defibrillation on survival after out‐of‐hospital cardiac arrest: a systematic review of observational studies. Circulation. 2017;136:954–965. DOI: 10.1161/CIRCULATIONAHA.117.029067. - DOI - PubMed
    1. Derkenne C, Jost D, Thabouillot O, Briche F, Travers S, Frattini B, Lesaffre X, Kedzierewicz R, Roquet F, de Charry F, et al. Improving emergency call detection of Out‐of‐Hospital Cardiac Arrests in the Greater Paris area: efficiency of a global system with a new method of detection. Resuscitation. 2020;146:34–42. DOI: 10.1016/j.resuscitation.2019.10.038. - DOI - PubMed

Publication types

LinkOut - more resources