Dispatcher-Assisted Cardiopulmonary Resuscitation Time to Identify Cardiac Arrest and Deliver Chest Compression Instructions
Dispatcher-Assisted Cardiopulmonary Resuscitation Time to Identify Cardiac Arrest and Deliver Chest Compression Instructions
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DOI：
10.1161/circulationaha.113.002627
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发表时间：
2013-10-01
期刊：
影响因子：
37.8
通讯作者：
Eisenberg, Mickey S.
中科院分区：
文献类型：
--
作者：
Lewis, Miranda;Stubbs, Benjamin A.;Eisenberg, Mickey S.
背景 调度员辅助心肺复苏 (DA-CPR)，其中 9-1-1 调度员通过电话提供心肺复苏指令，已被证明可以使旁观者心肺复苏率几乎提高一倍。我们试图找出阻碍 9-1-1 调度员识别心脏骤停并阻止或延迟提供调度员辅助 CPR 胸部按压的因素。方法和结果 我们审查了 2011 年 1 月 1 日至 2011 年 12 月 31 日期间发生的 476 例院外心脏骤停的调度记录。我们发现调度员在 80% 的审查病例和 92% 的病例中正确识别了心脏骤停。能够评估患者的意识和呼吸。承认逮捕的中位时间为 75 秒。当调度员有机会评估意识和呼吸且旁观者尚未开始心肺复苏时，62% 的病例会按照调度员协助的心肺复苏指令进行胸外按压。首次调度员辅助心肺复苏胸部按压的中位时间为 176 秒。 结论 调度员能够通过电话准确诊断心脏骤停，但不可能在所有情况下都能识别。在某些情况下，通过临终呼吸检测训练可以提高对心脏骤停的识别。调度员辅助心肺复苏胸部按压的延迟很常见，这可归因于调度员行为和调度员无法控制的因素。应采用成功、快速识别心脏骤停和进行首次胸外按压的绩效标准，作为紧急医疗服务系统衡量其绩效的指标。
Background Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), in which 9-1-1 dispatchers provide CPR instructions over the telephone, has been shown to nearly double the rate of bystander CPR. We sought to identify factors that hampered the identification of cardiac arrest by 9-1-1 dispatchers and prevented or delayed the provision of dispatcher-assisted CPR chest compressions.Methods and Results We reviewed dispatch recordings for 476 out-of-hospital cardiac arrests occurring between January 1, 2011, and December 31, 2011. We found that the dispatcher correctly identified cardiac arrest in 80% of reviewed cases and 92% of cases in which they were able to assess patient consciousness and breathing. The median time to recognition of the arrest was 75 seconds. Chest compressions following dispatcher-assisted CPR instructions occurred in 62% of cases when the dispatcher had the opportunity to asses for consciousness and breathing and bystander CPR was not already started. The median time to first dispatcher-assisted CPR chest compression was 176 seconds.Conclusions Dispatchers are able to accurately diagnose cardiac arrest over the telephone, but recognition is likely not possible in all circumstances. In some cases, recognition of cardiac arrest may be improved through training in the detection of agonal respirations. Delays in the delivery of dispatcher-assisted CPR chest compressions are common and are attributable to a mixture of dispatcher behavior and factors beyond the control of the dispatcher. Performance standards for the successful and quick recognition of cardiac arrest and delivery of first chest compressions should be adopted as metrics against which emergency medical services systems can measure their performance.