Aldridge Emogene S, Perera Nirukshi, Ball Stephen, Birnie Tanya, Morgan Alani, Whiteside Austin, Bray Janet, Finn Judith
Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia.
Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Western Australia, Australia.
Resuscitation. 2024 Feb;195:110104. doi: 10.1016/j.resuscitation.2023.110104. Epub 2023 Dec 30.
To describe the barriers to cardiopulmonary resuscitation (CPR) initiation and continuation in emergency calls for out-of-hospital cardiac arrest (OHCA).
We analysed 295 consecutive emergency calls relating to OHCA over a four-month period (1 January - 30 April 2021). Calls included were paramedic-confirmed, non-traumatic, non-EMS-witnessed OHCA, where the caller was with the patient. Calls were listened to in full and coded in terms of barriers to CPR initiation and continuation, and patient and caller characteristics.
Overall, CPR was performed in 69% of calls and, in 85% of these, callers continued performing CPR until EMS arrival. Nearly all callers (99%) experienced barriers to CPR initiation and/or continuation during the call. The barriers identified were classified into eight categories: reluctance, appropriateness, emotion, bystander physical ability, patient access, leaving the scene, communication failure, caller actions and call-taker instructions. Of these, bystander physical ability was the most prevalent barrier to both CPR initiation and continuation, occurring in 191 (65%) calls, followed by communication failure which occurred in 160 (54%) calls. Callers stopping or interrupting CPR performance due to being fatigued was lower than expected (n = 54, 26% of callers who performed CPR). Barriers to CPR initiation that related to bystander physical ability, caller actions, communication failure, emotion, leaving the scene, patient access, procedural barriers, and reluctance were mostly overcome by the caller (i.e., CPR was performed).
Barriers to CPR initiation and continuation were commonly experienced by callers, however they were frequently overcome. Future research should investigate the strategies that were successful.
描述院外心脏骤停（OHCA）急救电话中启动和持续进行心肺复苏（CPR）的障碍。
我们分析了2021年1月1日至4月30日这四个月期间连续的295个与OHCA相关的急救电话。纳入的电话为护理人员确认的、非创伤性的、非急救医疗服务人员目睹的OHCA，且呼叫者当时与患者在一起。对所有电话进行完整收听，并根据启动和持续进行CPR的障碍以及患者和呼叫者的特征进行编码。
总体而言，69%的电话中进行了CPR，其中85%的呼叫者在急救医疗服务人员到达之前持续进行CPR。几乎所有呼叫者（99%）在通话过程中都遇到了启动和/或持续进行CPR的障碍。识别出的障碍分为八类：不情愿、适当性、情绪、旁观者身体能力、接近患者、离开现场、沟通失败、呼叫者行为和接听者指示。其中，旁观者身体能力是启动和持续进行CPR最常见的障碍，在191个（65%）电话中出现，其次是沟通失败，在160个（54%）电话中出现。因疲劳而停止或中断CPR操作的呼叫者低于预期（n = 54，占进行CPR呼叫者的26%）。与旁观者身体能力、呼叫者行为、沟通失败、情绪、离开现场、接近患者、程序障碍和不情愿相关的启动CPR的障碍大多被呼叫者克服（即进行了CPR）。
呼叫者普遍遇到启动和持续进行CPR的障碍，但这些障碍经常被克服。未来的研究应调查成功的策略。
