Changes to DA-CPR instructions: can we reduce time to first compression and improve quality of bystander CPR?

Introduction: Dispatcher-assisted CPR (DA-CPR) can increase rates of bystander CPR, survival, and quality of life following cardiac arrest. Dispatcher protocols designed to improve rapid recognition of arrest and coach CPR may increase survival by (1) reducing preventable time delays to start of chest compressions and (2) improving the quality of bystander CPR.

Methods: We conducted a randomized controlled trial comparing a simplified DA CPR script to a conventional DA CPR script in a manikin cardiac arrest simulation with lay participants. The primary outcomes measured were the time interval from call receipt to the first chest compression and the core metrics of chest compression (depth, rate, release, and compression fraction). CPR was measured using a recording manikin for the first 3 min of participant CPR.

Results: Of the 75 participants, 39 were randomized to the simplified instructions and 36 were randomized to the conventional instructions. The interval from call receipt to first compression was 99 s using the simplified script and 124 s using the conventional script for a difference of 24s (p<0.01). Although hand position was judged to be correct more often in the conventional instruction group (88% versus 63%, p<0.01), compression depth was an average 7 mm deeper among those receiving the simplified CPR script (32 mm versus 25 mm, p<0.05). No statistically significant differences were detected between the two instruction groups for compression rate, complete release, number of hands-off periods, or compression fraction.

Discussion: Simplified DA-CPR instructions to lay callers in simulated cardiac arrest settings resulted in significant reductions in time to first compression and improvements in compression depth. These results suggest an important opportunity to improve DA CPR instructions to reduce delays and improve CPR quality.