Background:
Bystander actions upon witnessing a cardiac arrest are crucial to improving patient survival. Bystander perceptions and actions when witnessing a cardiac arrest are complex and not well understood. Our study has three primary aims: 1) To characterize CA bystanders demographics, 2) To understand the events from patient collapse until EMS arrival, with a focus on telecommunicator or dispatcher-assisted CPR (T-CPR), and 3) Bystander knowledge/ training in CPR and their actions at the time of CA.
Methods:
This is a prospective observational study conducted on bystanders of out of hospital cardiac arrests (OHCA) serviced by EMS agencies in southeast Michigan. OHCA patients were identified from 3/2018- 12/2019, and bystanders of these events surveyed. Surveys were mailed to non-medical addresses with an introductory letter and paper survey. A phone interview was conducted to describe bystander demographics, events from collapse to EMS arrival, and their actions including CPR performance. We inquired regarding telecommunicator CPR instructions (T-CPR), and if CPR was not performed what were the barriers.
Results:
During our study period, 126 surveys were mailed, and of these 47 bystander surveys were completed. The majority of events occurred in private homes (37/47,78.7%). Few patients (10, 21.2%) survived to discharge. The bystander and patient age were (mean, range)were 62.9 (30-91 ) and 69.3 (30-100) respectively. The majority were female 27/47(57.4%), most 43/47 (91.4%) knew the patient and were family (34/47,72.3%). Bystanders knew the patient a median(range) of 32 (0-68) years. A majority of bystanders (31/47,66.0%) had CPR training and 19 performed CPR. Of the 14/47 (27.8%) that received T-CPR instructions, 9 performed CPR. CPR trained bystanders that did not perform CPR(8/31), identified panic, assessment barriers and physical reasons for not performing CPR.
Conclusion:
In this preliminary work, we identify that bystanders to OHCA are most often family, of similar age to the patient and knew the patient for decades. CPR educational programs should prepare trainees to know that they may well respond to loved ones. Further researcher characterizing bystanders and their actions are needed to improve cardiac arrest outcomes.
Improved Patient Survival Using a Modified Resuscitation Protocol for Out-of-Hospital Cardiac Arrest