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Coaching bystanders in CPR boosts chances for survival from cardiac arrest
Lerner EB. Circulation. 2012;doi:10.1161/CIR.0b013e31823ee5fc.
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Emergency medical service dispatchers can save more lives by helping callers identify sudden cardiac arrest and dispensing instructions on how to perform CPR, according to a new scientific statement from the American Heart Association.
In the statement, E. Brooke Lerner, PhD, writing group member and associate professor of emergency medicine at the Medical College of Wisconsin, Milwaukee, and colleagues said bystander CPR can more than double a patient’s chance of survival, but in many communities, fewer than one-third of cardiac arrest patients receive this action before the arrival of emergency medical services (EMS).
“I think [the scientific statement] is a call to arms,” Lerner said in a press release. “It isn’t as common as you think; that you call 911 and they tell you what to do.”
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In the 2010 resuscitation guidelines, the AHA advised dispatchers to aid bystanders in evaluating a person who may have had a cardiac arrest and then direct them to administer CPR. The new statement, however, offers more specific information on how dispatchers should provide this help and emphasizes the importance of evaluating the performance of both individual dispatchers and the overall system.
In particular, the document highlights four recommendations for EMS systems and dispatchers:
- Dispatchers should determine and help a caller recognize potential cardiac arrest and immediately instruct the caller in how to perform CPR if necessary.
- Dispatchers should confidently give hands-only CPR instructions to the caller for adults who have had a cardiac arrest that is not caused by asphyxia, as in drowning.
- Communities should measure performance of dispatchers and local EMS agencies, including how long it takes until CPR is initiated.
- Performance measurements should be part of a quality assurance program involving the entire emergency response system, including EMS and hospitals.
Callers without training are often hesitant to act for a number of reasons. Nevertheless, Lerner said the odds of hurting someone by performing CPR, even if they have not had a cardiac arrest, are minimal. Additionally, research has shown that skipping mouth-to-mouth breaths during conventional CPR does not reduce survival rates in the first few minutes of CPR and actually enables chest compressions to begin approximately 1 minute earlier. Therefore, unless the potential patient is a child or someone whose cardiac arrest may have been caused by asphyxia, callers should not feel uncomfortable initiating CPR because they are reluctant to make mouth-to-mouth contact.
“Implementing telephone pre-arrival CPR instructions can significantly strengthen the chain of survival and save lives from [out-of-hospital cardiac arrest],” Lerner and colleagues wrote. However, this requires commitment from an entire community.
“It takes a lot of people believing in it to make it happen,” she said. – by Melissa Foster
Disclosure: Dr. Lerner and colleagues report no relevant financial disclosures.
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