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

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.

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. 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.