Ho Andrew Fu Wah, Sim Zariel Jiaying, Shahidah Nur, Hao Ying, Ng Yih Yng, Leong Benjamin S H, Zarinah Siti, Teo Winston K L, Goh Geraldine Shu Yi, Jaafar Hamizah, Ong Marcus E H
Emergency Medicine Residency, Singapore Health Services, Singapore, Singapore.
Barts and the London School of Medicine and Dentistry, Greater London, United Kingdom.
Resuscitation. 2016 Aug;105:149-55. doi: 10.1016/j.resuscitation.2016.05.006. Epub 2016 Jun 8.
Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is effective in increasing bystander CPR in out-of-hospital cardiac arrests (OHCA). Singapore has recently implemented a DA-CPR program. We aimed to characterize barriers to commencement of chest compressions by callers in Singapore.
We analyzed dispatch recordings of OHCA cases received by the ambulance call center between July 2012 and March 2015. Audio recordings of poor quality were excluded. Trained reviewers noted the sequential stages of the dispatcher's recognition of CPR, delivering CPR instructions and caller performing CPR. Time taken to reach these milestones was noted. Barriers to chest compressions were identified.
A total of 4897 OHCA occurred during the study period, overall bystander CPR rate was 45.7%. 1885 dispatch recordings were reviewed with 1157 cases qualified for dispatcher CPR. In 1128 (97.5%) cases, the dispatcher correctly recognized the need for CPR. CPR instructions were delivered in 1056 (91.3%) cases. Of these, 1007 (87.0%) callers performed CPR to instruction. One or more barriers to chest compressions were identified in 430 (37.2%) cases. The commonest barrier identified was "could not move patient" (27%). Cases where barriers were identified were less likely to have the need for CPR recognized by the dispatcher (94.9% vs. 99.0%, p<0.001), CPR instructions given (79.3% vs. 98.3%, p<0.001) and CPR started (67.9% vs. 98.3%, p<0.001), while the time taken to reach each of these stages were significantly longer (p<0.001).
Barriers were present in 37% of cases. They were associated with lower proportion of CPR started and longer delay to CPR.
调度员辅助心肺复苏（DA-CPR）在提高院外心脏骤停（OHCA）旁观者心肺复苏实施率方面是有效的。新加坡最近实施了一项DA-CPR计划。我们旨在确定新加坡来电者开始胸外按压的障碍因素。
我们分析了2012年7月至2015年3月期间救护车呼叫中心接到的OHCA病例的调度记录。排除了质量差的音频记录。经过培训的审查人员记录了调度员识别心肺复苏、下达心肺复苏指令以及来电者进行心肺复苏的连续阶段。记录了达到这些关键节点所需的时间。确定了胸外按压的障碍因素。
研究期间共发生4897例OHCA，总体旁观者心肺复苏率为45.7%。审查了1885份调度记录，其中1157例符合调度员指导心肺复苏的条件。在1128例（97.5%）病例中，调度员正确识别了心肺复苏的需求。1056例（91.3%）病例下达了心肺复苏指令。其中1007例（87.0%）来电者按照指令进行了心肺复苏。在430例（37.2%）病例中识别出了一个或多个胸外按压的障碍因素。最常见的障碍因素是“无法移动患者”（27%）。识别出存在障碍因素的病例中，调度员识别心肺复苏需求的可能性较小（94.9%对99.0%，p<0.001），下达心肺复苏指令的可能性较小（79.3%对98.3%，p<0.001），开始心肺复苏的可能性较小（67.9%对98.3%，p<0.001）；而达到这些阶段所需的时间明显更长（p<0.001）。
37%的病例存在障碍因素。这些因素与较低的心肺复苏启动比例以及较长的心肺复苏延迟时间相关。
