Centre de Recherche en Linguistique Appliquée (CeRLA), Université Lumière Lyon 2, Lyon, 69007, France; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia.
Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance WA, Belmont, WA 6104, Australia.
Resuscitation. 2021 Mar;160:1-6. doi: 10.1016/j.resuscitation.2021.01.001. Epub 2021 Jan 11.
In emergency calls for out-of-hospital cardiac arrest (OHCA), dispatchers are instrumental in the provision of bystander cardiopulmonary resuscitation (CPR) through the recruitment of the caller. We explored the impact of caller perception of patient viability on initial recognition of OHCA by the dispatcher, rates of bystander CPR and early patient survival outcomes.
We conducted a retrospective cohort study of 422 emergency calls where OHCA was recognised by the dispatcher and resuscitation was attempted by paramedics. We used the call recordings, dispatch data, and electronic patient care records to identify caller statements that the patient was dead, initial versus delayed recognition of OHCA by the dispatcher, caller acceptance to perform CPR, provision of bystander-CPR, prehospital return of spontaneous circulation (ROSC), and ROSC on arrival at the Emergency Department.
Initial recognition of OHCA by the dispatcher was more frequent in cases with a declaration of death by the caller than in cases without (92%, 73/79 vs. 66%, 227/343, p < 0.001). Callers who expressed such a view (19% of cases) were more likely to decline CPR (38% vs. 10%, adjusted odds ratio 4.59, 95% confidence interval 2.49-8.52, p < 0.001). Yet, 15% (12/79) of patients described as non-viable by callers achieved ROSC.
Caller statements that the patient is dead are helpful for dispatchers to recognise OHCA early, but potentially detrimental when recruiting the caller to perform CPR. There is an opportunity to improve the rate of bystander-CPR and patient outcomes if dispatchers are attentive to caller statements about viability.
在院外心脏骤停（OHCA）的紧急呼叫中，调度员通过招募呼叫者，在提供旁观者心肺复苏术（CPR）方面发挥着重要作用。我们探讨了呼叫者对患者生存能力的感知对调度员最初识别 OHCA、旁观者 CPR 实施率和早期患者生存结局的影响。
我们对 422 个经调度员识别出 OHCA 并由护理人员尝试复苏的紧急呼叫进行了回顾性队列研究。我们使用呼叫记录、调度数据和电子患者护理记录来识别呼叫者声明患者已死亡、调度员对 OHCA 的初始识别与延迟识别、呼叫者是否接受进行 CPR、旁观者-CPR 的提供、院前自主循环恢复（ROSC）以及到达急诊室时的 ROSC。
与无呼叫者宣告死亡的情况相比（92%，73/79 例），调度员更频繁地在呼叫者宣告死亡的情况下初始识别出 OHCA（66%，227/343 例）（p<0.001）。表达这种观点的呼叫者（占病例的 19%）更有可能拒绝 CPR（38% 比 10%，调整后的优势比 4.59，95%置信区间 2.49-8.52，p<0.001）。然而，15%（12/79）被呼叫者描述为无生命迹象的患者实现了 ROSC。
呼叫者声称患者已死亡有助于调度员早期识别 OHCA，但在招募呼叫者进行 CPR 时可能会产生不利影响。如果调度员注意到呼叫者关于生存能力的陈述，那么提高旁观者 CPR 实施率和患者结局的机会就存在。
