• Resuscitation · Jul 2023

    Association Between Bystander Physical Limitations, Delays in Chest Compression During Telecommunicator-Assisted Cardiopulmonary Resuscitation, and Outcome After Out-of-Hospital Cardiac Arrest.

    • Amanda L Missel, Christopher J Drucker, Kosuke Kume, Jenny Shin, Lindsey Hergert, Robert W Neumar, Peter J Kudenchuk, and Thomas Rea.
    • Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: missaman@umich.edu.
    • Resuscitation. 2023 Jul 1; 188: 109816109816.

    BackgroundPromptly initiated bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest (OHCA). Many OHCA patients require repositioning to a firm surface. We examined the association between repositioning, chest compression (CC) delay, and patient outcomes.MethodsWe used a quality improvement registry from review of 9-1-1 dispatch audio recordings of OHCA among adults eligible for telecommunicator-assisted CPR (T-CPR) between 2013 and 2021. OHCA was categorized into 3 groups: CC not delayed, CC delayed due to bystander physical limitations to reposition the patient, or CC delayed for other (non-physical) reasons. The primary outcome was the repositioning interval, defined as the interval between the start of positioning instructions and CC onset. We used logistic regression to assess the odds ratio of survival according to CPR group, adjusting for potential confounders.ResultsOf the 3,482 OHCA patients eligible for T-CPR, CPR was not delayed in 1,223 (35%), delayed due to repositioning in 1,413 (41%), and delayed for other reasons in 846 (24%). The repositioning interval was longest for the physical limitation delay group (137 secs, IQR-148) compared to the other delay group (81 secs, IQR-70) and the no delay group (51 secs, IQR-32) (p < 0.001). Unadjusted survival was lowest in the physical limitation delay group (11%) versus the no delay (17%) and other delay (19%) groups and persisted after adjustment (p = 0.009).ConclusionBystander physical limitations are a common barrier to repositioning patients to begin CPR and are associated with lower likelihood of receiving CPR, longer times to begin CC, and lower survival.Copyright © 2023 Elsevier B.V. All rights reserved.

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