• K Bohm, B Stålhandske, M Rosenqvist, J Ulfvarson, J Hollenberg, and L Svensson.
• Department of Clinical Science and Education, Section of Cardiology, Karolinska Institutet, SE 118 83 Södersjukhuset, Stockholm, Sweden. katarina.bohm@sodersjukhuset.se
• Resuscitation. 2009 Sep 1;80(9):1025-8.

ObjectivesBystanders cardiopulmonary resuscitation (CPR) increases survival in out-of-hospital cardiac arrest (OHCA). Emergency medical dispatchers (EMDs) can provide even totally inexperienced bystanders with instructions by telephone on how to resuscitate victims (T-CPR) until the emergency medical services (EMS) arrive. Agonal respiration makes it difficult for EMDs to identify cardiac arrests (CAs) which will prevent or delay initiation of T-CPR. The aim of this investigation was to study if tuition of EMDs can improve their ability to identify agonal respiration in OHCA to allow for more frequent offers of T-CPR.MethodsAn observational study was made in 2004 and subsequently, a repeat study was made in 2006. All OHCA (n=315 in 2004, n=255 in 2006) in the Stockholm region reported to the Swedish Cardiac Arrest Register were included and all corresponding EMS reports were reviewed. Emergency calls were recorded during the event. Witnessed cases of OHCA (n=76 in both 2004 and 2006) were analyzed using a structured data collection tool.ResultsThe frequency of offered T-CPR to all bystanders of OHCA in 2004 was 47%. After special tuition on agonal respiration in OHCA it rose to 68% in 2006 (p=0.01). An even more marked rise was observed in OHCA cases with agonal respiration. In 2004 T-CPR was offered in 23% of these situations whereas the corresponding figures in 2006 had risen to 56% (p=0.006).ConclusionsTeaching EMDs to understand and recognize bystander descriptions of agonal respiration in patients with OHCA has resulted in a significant increase in offers of T-CPR in these situations.

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