Evaluation of telephone CPR advice for adult cardiac arrest patients.

INTRODUCTION: Telephone cardiopulmonary resuscitation (CPR) advice aims to increase the quality and quantity of bystander CPR, one of the few interventions shown to improve outcome in cardiac arrest. We evaluated a current telephone protocol (based on 2000 ILCOR guidelines) to assess the effectiveness of verbal CPR instructions.

METHODS: Emergency calls were identified from AMPDS codes for cardiac arrest and checked against the ambulance patient record form to confirm the diagnosis. Calls over a seven month period were analysed retrospectively, and the time taken to perform interventions calculated.

RESULTS: 176 calls were analysed; of those 145 (82.4%) were confirmed cases of cardiac arrest. CPR was already underway in 11 cases (7.5%), 101 callers (69.7%) agreed to attempt CPR with telephone instructions. The median time to open the airway was 128s (62-482s), to perform the first ventilation was 247s (80-633s), and to perform the first chest compression was 315s (153-750s). Of those attempting CPR, 21 (20.8%) stopped because they were unable to move the patient onto a hard surface, and 28 (27.7%) required multiple attempts to perform effective ventilations. In the telephone CPR group 42/101 (40.6%) did not receive any chest compressions before the arrival of the ambulance crew.

CONCLUSIONS: Although current telephone-CPR instructions significantly improve the numbers of patients in whom bystander CPR is attempted, significant delays and poor quality CPR are likely to limit any benefits.