Dispatcher assisted cardiopulmonary resuscitation implementation in Kuwait: A before and after study examining the impact on outcomes of out of hospital cardiac arrest victims

Dalal Al Hasan 1, Jonathan Drennan 2, Eloise Monger 3, Salim Al Mahmid 4, Haitham Ahmad 5, Mohmmad Ameen 5, Mazen El Sayed 6

Affiliations

11 January 2019

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doi: 10.1097/MD.0000000000017752

Abstract

Dispatcher assisted cardiopulmonary resuscitation (DACPR) by Emergency medical services has been shown to improve rates of early out of hospital cardiac arrest (OHCA) recognition and early cardiopulmonary resuscitation (CPR) for OHCA. This study measures the impact of introducing DACPR on OHCA recognition, CPR rates and on patient outcomes in a pilot region in Kuwait.EMS treated OHCA data over 10 months period (February 21-December 31, 2017) before and after the intervention was prospectively collected and analyzed.Comprehensive DACPR in the form of: a standardized dispatch protocol, 1-day training package and quality assurance and improvement measures were applied to Kuwait EMS central Dispatch unit only for pilot region. Primary outcomes: OHCA recognition rate, CPR instruction rate, and Bystander CPR rate. Secondary outcome: survival to hospital discharge.A total of 332 OHCA cases from the EMS archived data were extracted and after exclusion 176 total OHCA cases remain. After DACPR implementation OHCA recognition rate increased from 2% to 12.9% (P = .037), CPR instruction rate increased from 0% to 10.4% (P = .022); however, no significant change was noted for bystander CPR rates or prehospital return of spontaneous circulation. Also, survival to hospital discharge rate did not change significantly (0% before, and 0.8% after, P = .53)In summary, DACPR implementation had positive impacts on Kuwait EMS system operational outcomes; early OHCA recognition and CPR instruction rates in a pilot region of Kuwait. Expanding this initiative to other regions in Kuwait and coupling it with other OHCA system of care interventions are needed to improve OHCA survival rates.

Figures

Figure 1 OHCA patient's selection and inclusion in the study periods; pre-intervention (February 21–May 31, 2017) and post-intervention (June 1–December 31, 2017). OHCA = out of hospital cardiac arrest.

Figure 1 OHCA patient's selection and inclusion in the study periods; pre-intervention (February 21–May 31, 2017) and post-intervention (June 1–December 31, 2017). OHCA = out of hospital cardiac arrest.

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References

  1.  
    1. Sasson C, Rogers M, Dahl, et al. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010;3:63–81. - PubMed
  2.  
    1. Fischera MS Kamp##J. Comparing emergency medical service systems—a project of the European Emergency Data (EED) Project. Resuscitation 2010;82:285–93. - PubMed
  3.  
    1. McCarthy J, Carr B, Sasson C, et al. AHA scientific statement; out-of-hospital cardiac arrest resuscitation systems of care: a scientific statement from the American Heart Association. Circulation 2018;137:1–6. - PubMed
  4.  
    1. Global Resuscitation Alliance. Improving Survival of Out-of-Hospital Cardiac Arrest; Acting on the Call. 2018 Update from the Global Resuscitation Alliance. Including 27 Case Reports. United States. 2018. Available at: https://www.cercp.org/images/stories/recursos/articulos_docs_interes/doc... [Accessed on September 20, 2018]
  5.  
    1. Arizona Department of Health Services. Save Hearts in Arizona Registry and Education. Arizona; Save Hearts in Arizona Registry and Education Training Resources. 2017. Available at: https://www.azdhs.gov/preparedness/emergency-medical-services-trauma-sys..., [Accessed on March 1, 2018]
  6.  
    1. Boyce L, Vlietvlieland T, Bosch J, et al. High survival rate of 43% in out-of-hospital cardiac arrest patients in an optimised chain of survival. Netherland Heart J 2015;23:20–5. - PMC - PubMed
  7.  
    1. Bobrow B, Spaite D, Vadeboncoeur T, et al. Implementation of a regional telephone cardiopulmonary resuscitation program and outcomes after out-of-hospital cardiac arrest. J Am Med Assoc Cardiol 2016;1:294–302. - PubMed
  8.  
    1. Public Health Seattle and King County. Citizen Cardio Pulmonary Resuscitation (CPR). Public Health Seattle and King county, King County Medic One, 2018. Available at: https://www.kingcounty.gov/depts/health/emergency-medical-services/medic... Accessed September 20, 2018.
  9.  
    1. Seattle & King County Emergency Medical Services. 2015 Annual Report to the King County Council’ Seattle & King County Emergency Medical Services. King County Reports and Publications, 2015. Available at: https://www.skagitcounty.net/EmergencyMedicalServices/Documents/Advisory... Accessed September 20, 2018.
  10.  
    1. King County Emergency Medical Services. Emergency Medical Dispatch (EMD) Program Basic Criteria-based Dispatch Training, Continuing Education Instructor Development Course. King County; Emergency Medical Dispatch, 2018. Available at: https://www.kingcounty.gov/depts/health/emergency-medical-services/emd.aspx Accessed September 20, 2018.
  11.  
    1. Resuscitation Academy. The Road to Recognition and Resuscitation; The Role of Telecommunicators and Telephone CPR Quality Improvement in Cardiac Arrest Survival. Resuscitation Academy 2017.
  12.  
    1. American Heart association, American Heart Association. American Heart Association Recommends Standards to Improve Dispatcher-Assisted CPR. 2016;Available at: https://newsroom.heart.org/news/american-heart-association-recommends-st... [Accessed on March 1, 2018].
  13.  
    1. General Population Census. Kuwait Population. Kuwait: General Population Census Office; 2011.
  14.  
    1. Kuwait Central Statistical Bureau. Population Statistics. Kuwait: Kuwait Central Statistical Bureau Office; 2016.
  15.  
    1. The Public Authority of Civil Information. Distribution of the Population by Gender and Nationality in each Governorate. Kuwait: Statistics Services System; 2017.
  16.  
    1. Kuwait Emergency Medical Services Training Department. Cardiac Arrest Refreshment Program; Instructor in Field Kuwait. Kuwait: Kuwait Emergency Medical Services; 2015.
  17.  
    1. Kuwait Operation Unit, Kuwait Emergency Medical Services. Operation Department Annual Report. 2013.
  18.  
    1. Arizona Department of Health Services. Save Hearts in Arizona Registry and Education. Arizona; Save Hearts in Arizona Registry and Education Training Resources. 2017. Available at: https://www.azdhs.gov/preparedness/emergency-medical-services-trauma-sys... [Accessed on March 1, 2018]
  19.  
    1. Deakin C, England S, Diffey D. Ambulance telephone triage using ‘NHS pathways’ to identify adult cardiac arrest. Heart BMJ 2017;103:738–44. - PubMed
  20.  
    1. Deakin C. The chain of survival: not all links are equal. Resuscitation 2018;126:80–2. - PubMed
  21.  
    1. Harjnato SN, MX N, Hoa Y, et al. A before-after interventional trial of dispatcher-assisted cardio-pulmonary resuscitation for out-of-hospital cardiac arrests in Singapore. Resuscitation 2016;102:85–93. - PubMed
  22.  
    1. Huang C, Fan H, Chein C, et al. Validation of a dispatch protocol with continuous quality control for cardiac arrest: a before-and-after study at a city fire department-based dispatch center. J Emerg Med 2017;53:697–707. - PubMed
  23.  
    1. Ro Y, Shin S, Lee Y, et al. Effect of dispatcher-assisted cardiopulmonary resuscitation program and location of out-of-hospital cardiac arrest on survival and neurologic outcome. Ann Emerg Med 2017;69:52–61. - PubMed
  24.  
    1. Song K, Shin S, Park C, et al. Dispatcher-assisted bystander cardiopulmonary resuscitation in a metropolitan city: a before-after population-based study. Resuscitation 2014;85:34–41. - PubMed
  25.  
    1. Franěk O, Pekara J, Sukupova P, et al. 16 long term effects of dispatcher- assisted CPR – did we touch the ceiling? BMJ Open 2019;9:A1–6.
  26.  
    1. Asai H, FuKuShima H, Bolstad F, et al. Quality of dispatcher-assisted cardiopulmonary resuscitation by lay rescuers following standard protocol in Japan; observational simulation study. Acute Med Surg 2018;5:133–9. - PMC - PubMed
  27.  
    1. American Heart Association, Doshi A, Pinchalk M, Roberts R. High quality CPR demonstration and analysis. 2017;Available at: https://www.heart.org/-/media/data-import/downloadables/high-quality-cpr.... [Accessed on Sept 20, 2018].
  28.  
    1. Hardeland C, Skare C, Kramer-Johnson J, et al. Targeted simulation and education to improve cardiac arrest recognition and telephone assisted CPR in an emergency medical communication centre. Resuscitation 2017;114:21–6. - PubMed
  29.  
    1. Shah M, Bartram C, Irwin K, et al. Evaluating dispatch-assisted CPR using the CARES registry. Prehospital Emerg Care 2018;22:222–8. - PubMed
  30.  
    1. Viereck S, Moller T, Ersball A, et al. Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival. Resuscitation 2017;115:141–7. - PubMed
  31.  
    1. Tanaka Y, Taniguchi J, Wato Y, et al. The continuous quality improvement project for telephone- assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests. Resuscitation 2012;83:1235–41. - PubMed
  32.  
    1. Wu Z, Panczyk M, Spaite D, et al. Telephone cardiopulmonary resuscitation is independently associated with improved survival and improved functional outcome after out-of-hospital cardiac arrest. Resuscitation 2018;122:135–40. - PubMed
  33.  
    1. Batt A, Alhajeri A, Cummins F. A profile of out-of-hospital cardiac arrests in Northern Emirates, United Arab Emirate. Saudi Med J 2016;37:1206–13. - PMC - PubMed
  34.  
    1. Bin Salleeh H, Gabralla K, LEggio W, et al. Out-of-hospital adult cardiac arrests in a university hospital in central Saudi Arabia. Saudi Med J 2015;36:1071–5. - PMC - PubMed
  35.  
    1. Irfan F, Bhtta Z, Castren M, et al. Epidemiology and outcomes of out-of-hospital cardiac arrest in Qatar: a nationwide observational study. Int J Cardiol 2016;223:1007–13. - PubMed

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