Pediatric Out-of-Hospital Cardiac Arrest: The Role of the Telecommunicator in Recognition of Cardiac Arrest and Delivery of Bystander Cardiopulmonary Resuscitation

Overview

Journal J Am Heart Assoc

Specialty Cardiology & Vascular Diseases

Date 2024 Jan 12

PMID 38214298

Authors

Miranda M Lewis

Killian Pache

Sally Guan

Jenny Shin

Megin Parayil

Catherine R Counts

Chris Drucker

Michael R Sayre

Peter J Kudenchuk

Mickey Eisenberg

Thomas D Rea

Affiliations

Soon will be listed here.

Abstract

Background: Telecommunicator CPR (T-CPR), whereby emergency dispatch facilitates cardiac arrest recognition and coaches CPR over the telephone, is an important strategy to increase early recognition and bystander CPR in adult out-of-hospital cardiac arrest (OHCA). Little is known about this treatment strategy in the pediatric population. We investigated the role of T-CPR and related performance among pediatric OHCA.

Methods And Results: This study was a retrospective cohort investigation of OHCA among individuals <18 years in King County, Washington, from April 1, 2013, to December 31, 2019. We reviewed the 911 audio recordings to determine if and how bystander CPR was delivered (unassisted or T-CPR), key time intervals in recognition of arrest, and key components of T-CPR delivery. Of the 185 eligible pediatric OHCAs, 23% (n=43) had bystander CPR initiated unassisted, 59% (n=109) required T-CPR, and 18% (n=33) did not receive CPR before emergency medical services arrival. Among all cases, cardiac arrest was recognized by the telecommunicator in 89% (n=165). Among those receiving T-CPR, the median (interquartile range) interval from start of call to OHCA recognition was 59 seconds (38-87) and first CPR intervention was 115 seconds (94-162). When stratified by age (≤8 versus >8), the older age group was less likely to receive CPR before emergency medical services arrival (88% versus 69%, =0.002). For those receiving T-CPR, bystanders spent a median of 207 seconds (133-270) performing CPR. The median compression rate was 93 per minute (82-107) among those receiving T-CPR.

Conclusions: T-CPR is an important strategy to increase early recognition and early CPR among pediatric OHCA.

References

Rea T, Eisenberg M, Culley L, Becker L . Dispatcher-assisted cardiopulmonary resuscitation and survival in cardiac arrest. Circulation. 2001; 104(21):2513-6. DOI: 10.1161/hc4601.099468. View

Topjian A, Raymond T, Atkins D, Chan M, Duff J, Joyner Jr B . Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020; 142(16_suppl_2):S469-S523. DOI: 10.1161/CIR.0000000000000901. View

Goto Y, Maeda T, Goto Y . Impact of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological outcomes in children with out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. J Am Heart Assoc. 2014; 3(3):e000499. PMC: 4309039. DOI: 10.1161/JAHA.113.000499. View

Fink E, Prince D, Kaltman J, Atkins D, Austin M, Warden C . Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America. Resuscitation. 2016; 107:121-8. PMC: 5037038. DOI: 10.1016/j.resuscitation.2016.07.244. View

Culley L, Clark J, Eisenberg M, Larsen M . Dispatcher-assisted telephone CPR: common delays and time standards for delivery. Ann Emerg Med. 1991; 20(4):362-6. DOI: 10.1016/s0196-0644(05)81655-5. View

Bobrow B, Spaite D, Vadeboncoeur T, Hu C, Mullins T, Tormala W . Implementation of a Regional Telephone Cardiopulmonary Resuscitation Program and Outcomes After Out-of-Hospital Cardiac Arrest. JAMA Cardiol. 2016; 1(3):294-302. DOI: 10.1001/jamacardio.2016.0251. View

Atkins D, Everson-Stewart S, Sears G, Daya M, Osmond M, Warden C . Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. Circulation. 2009; 119(11):1484-91. PMC: 2679169. DOI: 10.1161/CIRCULATIONAHA.108.802678. View

Akahane M, Ogawa T, Tanabe S, Koike S, Horiguchi H, Yasunaga H . Impact of telephone dispatcher assistance on the outcomes of pediatric out-of-hospital cardiac arrest. Crit Care Med. 2012; 40(5):1410-6. DOI: 10.1097/CCM.0b013e31823e99ae. View

Perkins G, Jacobs I, Nadkarni V, Berg R, Bhanji F, Biarent D . Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison.... Circulation. 2014; 132(13):1286-300. DOI: 10.1161/CIR.0000000000000144. View

10.

Tsao C, Aday A, Almarzooq Z, Anderson C, Arora P, Avery C . Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation. 2023; 147(8):e93-e621. DOI: 10.1161/CIR.0000000000001123. View

11.

Kurz M, Bobrow B, Buckingham J, Cabanas J, Eisenberg M, Fromm P . Telecommunicator Cardiopulmonary Resuscitation: A Policy Statement From the American Heart Association. Circulation. 2020; 141(12):e686-e700. DOI: 10.1161/CIR.0000000000000744. View

12.

Fujie K, Nakata Y, Yasuda S, Mizutani T, Hashimoto K . Do dispatcher instructions facilitate bystander-initiated cardiopulmonary resuscitation and improve outcomes in patients with out-of-hospital cardiac arrest? A comparison of family and non-family bystanders. Resuscitation. 2013; 85(3):315-9. DOI: 10.1016/j.resuscitation.2013.11.013. View

13.

Song K, Shin S, Park C, Kim J, Kim D, Kim C . Dispatcher-assisted bystander cardiopulmonary resuscitation in a metropolitan city: a before-after population-based study. Resuscitation. 2013; 85(1):34-41. DOI: 10.1016/j.resuscitation.2013.06.004. View