Clinical paperEvaluation of telephone-cardiopulmonary resuscitation advice for paediatric cardiac arrest☆
Introduction
The incidence of paediatric out-of-hospital cardiac arrest is approximately 1/10,000 children per annum,1, 2 equating to approximately 400 infant deaths per year in the UK.3 Although paediatric cardiac arrest is therefore a relatively uncommon pre-hospital emergency, few other medical emergencies are of greater impact in relation to potential life years lost and the subsequent impact on family members. The paediatric chain of survival comprises four links; the second being early basic life support and the third being early access to emergency medical service (EMS) systems.4 The effectiveness of the pre-hospital element of paediatric cardiac arrest is therefore key in determining outcome from cardiac arrest.
In the absence of trained medical help, bystander cardiopulmonary resuscitation is encouraged prior to ambulance arrival through delivery of telephone resuscitation instructions. Although paediatric bystander CPR tends to be performed more frequently than in adults, rates no higher than 22.9–32.4%1, 5, 6 have been reported. The benefits of bystander CPR for paediatric cardiac arrest are not as well documented as for adults, but the majority of studies, as with adult literature, have shown that bystander CPR is a significant determinant of overall survival.2, 7, 6 with one study demonstrating a doubling of paediatric survival rates.6 Although the prevalence of patients receiving CPR is low, and it is often of poor quality,8, 9, 10, 11, 12 giving verbal instructions by telephone increases both the numbers of patients who receive telephone CPR13, 14 and the quality of the CPR delivered, an independent factor in determining survival.9, 15, 16
With the recognition that early and effective bystander CPR is generally associated with improvement in outcome from paediatric cardiac arrest, it is now routine for EMS systems to give CPR instructions over the telephone (telephone-cardiopulmonary resuscitation, T-CPR) whilst an emergency response vehicle is en route. This aims to encourage the caller to perform CPR and also improve the quality of CPR that is given, particularly for untrained bystanders. Various telephone triage scripts exist to identify the cardiac arrest and give set verbal CPR instructions; in the UK, all but one county use the Advanced Medical Priority Dispatch System (AMPDS) for this purpose.
Little is know about the ability of telephone scripts to provide effective instruction in cardiopulmonary resuscitation. We have previously examined the delivery of telephone-directed CPR (T-CPR) advice by ambulance call takers for adult cardiac arrest and demonstrated significant delays in the delivery of basic life support interventions, together with poor quality resuscitation. We therefore analysed emergency calls to the Hampshire Division of South Central Ambulance Service, a population of approximately 1.7 million people, of whom 10% are <8 years age, to identify paediatric cardiac arrests in order to ascertain the quality of bystander CPR that results from ambulance call taker-delivered telephone instructions.
Section snippets
Materials and methods
Emergency calls to the Hampshire division of South Central Ambulance Service NHS Trust involving children ≤8 years age were identified retrospectively over a 12 month period (6 April 2007 and 30 March 2008). The calls were received by accredited and audited call handlers using the Advanced Medical Priority Dispatch System (AMPDS v11.1, Priority Dispatch Inc., Salt Lake City, UT, USA). Through a series of structured questions each call is assigned a diagnostic code. All calls that were assigned
Results
During the data collection period (6 April 2007–30 March 2008), a total of 8498 calls involving children ≤8 years age were logged. Of these, 42 calls were classified as paediatric cardiac arrest by AMPDS. During this period, a total of 49 paediatric cardiac arrests were recorded by corresponding patient report forms (PRFs). Corresponding PRFs completed by the ambulance crews confirmed cardiac arrest in 19 (45.2%) of the 42 AMPDS calls classified as cardiac arrest. This constitutes approximately
Discussion
This is the first study that we are aware of that examines the ability of telephone scripts to promptly and effectively deliver paediatric T-CPR. The results highlight significant delays in actually commencing basic life support, with a median time of 3 min from answering the emergency call to delivery of the first rescue breath and over 4 min to deliver the first external chest compression. These findings are considerably longer than those documented by our previous manikin-based studies. The
Conflict of interest
None to declare.
Acknowledgements
We thank the Resuscitation Council (UK) for a research grant to conduct this study.
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Cited by (19)
A scoping review to determine the barriers and facilitators to initiation and performance of bystander cardiopulmonary resuscitation during emergency calls
2022, Resuscitation PlusCitation Excerpt :Study sizes ranged from 21 participants35 to 3000 participants.43 Four26,36,53,55 of the included studies reported the introduction of and/or the impact of DA-CPR per se, with the other 27 studies describing the impact of various factors on B-CPR initiation and performance.25,27–35,37–53 All studies were performed within systems that utilised a standardised DA-CPR script for OHCA calls.
Does dispatcher-assisted CPR generate the same outcomes as spontaneously delivered bystander CPR in Japan?
2018, American Journal of Emergency MedicineAsking the right questions
2017, Resuscitation
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.02.007.