Department of Emergency Medicine, Singapore General Hospital, Singapore.
Emergency Medicine Department, National University Hospital, Singapore.
Singapore Med J. 2021 Dec;62(12):647-652. doi: 10.11622/smedj.2020080. Epub 2020 May 27.
In our national emergency dispatch centre, the standard protocol for dispatcher-assisted cardiopulmonary resuscitation (DACPR) in out-of-hospital cardiac arrests (OHCAs) involves the instruction 'push 100 times a minute 5 cm deep'. As part of quality improvement, the instruction was simplified to 'push hard and fast'.
We analysed all dispatcher-diagnosed OHCAs over four months in 2018: January to February ('push 100 times a minute 5 cm deep') and August to September ('push hard and fast'). We also performed secondary per-protocol analysis based on the protocol used: (a) standard (n = 48); (b) simplified (n = 227); and (c) own words (n = 231).
A total of 506 cases were included: 282 in the 'before' group and 224 in the 'after' group. Adherence to the protocol was 15.2% in the 'before' phase and 72.8% in the 'after' phase (p < 0.001). The mean time between instruction and first compression for the 'before' and 'after' groups was 34.36 seconds and 26.83 seconds, respectively (p < 0.001). Time to first compression was 238.62 seconds and 218.83 seconds in the 'before' and 'after' groups, respectively (p = 0.016). In the per-protocol analysis, the interval between instruction and compression was 37.19 seconds, 28.31 seconds and 32.40 seconds in the standard protocol, simplified protocol and 'own words' groups, respectively (p = 0.005). The need for paraphrasing was 60.4% in the standard protocol group and 81.5% in the simplified group (p < 0.001).
Simplified instructions were associated with a shorter interval between instruction and first compression. Efforts should be directed at simplifying DACPR instructions.
在我们的国家急救中心，院外心脏骤停（OHCAs）的调度员辅助心肺复苏（DACPR）标准方案包括“每分钟按压 100 次，深度 5 厘米”的指导。作为质量改进的一部分，该指导被简化为“用力快速按压”。
我们分析了 2018 年四个月内所有调度员诊断的 OHCAs：1 月至 2 月（“每分钟按压 100 次，深度 5 厘米”）和 8 月至 9 月（“用力快速按压”）。我们还根据使用的方案进行了次要的按方案分析：（a）标准（n = 48）；（b）简化（n = 227）；和（c）自己的话（n = 231）。
共纳入 506 例：前组 282 例，后组 224 例。在前一阶段，方案的依从性为 15.2%，在后一阶段为 72.8%（p < 0.001）。指令和第一次按压之间的平均时间在前组和后组分别为 34.36 秒和 26.83 秒（p < 0.001）。在前组和后组，第一次按压的时间分别为 238.62 秒和 218.83 秒（p = 0.016）。在按方案分析中，指令和按压之间的间隔分别为标准方案、简化方案和“自己的话”组的 37.19 秒、28.31 秒和 32.40 秒（p = 0.005）。标准方案组需要解释的比例为 60.4%，简化组为 81.5%（p < 0.001）。
简化的指令与指令和第一次按压之间的间隔更短有关。应努力简化 DACPR 指令。
