Elsevier

Resuscitation

Volume 81, Issue 7, July 2010, Pages 853-856
Resuscitation

Clinical paper
Evaluation of telephone-cardiopulmonary resuscitation advice for paediatric cardiac arrest

https://doi.org/10.1016/j.resuscitation.2010.02.007Get rights and content

Abstract

Introduction

Telephone-cardiopulmonary resuscitation (CPR) advice aims to increase the quality and quantity of bystander CPR, one of the few interventions shown to improve outcome in cardiac arrest. We evaluated a current paediatric telephone protocol (AMPDS v11.1) to assess the effectiveness of verbal CPR instructions in paediatric cardiac arrest.

Methods

Consecutive emergency calls classified by the AMPDS as cardiac arrests in children <8 years old, over an 11 month period, were compared with their corresponding patient report forms (PRFs) to confirm the diagnosis. Audio recordings and PRFs were then evaluated to assess whether bystander CPR was given, and when it was, the time taken to perform CPR interventions, before paramedic arrival.

Results

Of the 42 calls reviewed, 19 (45.2%) were confirmed as cardiac arrest. CPR was already underway in two cases (10.5%). Of the remaining callers, 11 (64.7%) agreed to attempt T-CPR, resulting in an overall bystander-CPR rate of 68.4%. The median time to open the airway was 126 s (62–236 s, n = 11), deliver the first ventilation was 180 s (135–360 s, n  = 11), and perform the first chest compression was 280 s (164–420 s, n  = 9).

Conclusion

Although current telephone-CPR instructions improve the numbers of children in whom bystander CPR is attempted, effectiveness is likely to be limited by the significant delays in actually delivering basic life support.

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.

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 Plus
    Citation 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.

  • Asking the right questions

    2017, Resuscitation
View all citing articles on Scopus

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.

View full text