Telephone cardiopulmonary resuscitation after pediatric out-of-hospital cardiac arrest: An analysis of the process measures, outcomes, and barriers to delivery
MeSH SubjectsEmergency Medicine
MetadataShow full item record
PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractTelephone cardiopulmonary resuscitation (T-CPR) has been associated with improved patient outcomes after out-of-hospital cardiac arrest (OHCA) in studies worldwide, however outcomes are similarly poor for adult and pediatric patients. Additionally, relatively little is known about T-CPR process measures and barriers to delivery of T-CPR in the pediatric population when compared with adult patients. We conducted an observational study of suspected and confirmed OHCAs in Arizona between 1/2011 and 12/2014. Telephone CPR process measures and barriers were extracted from suspected OHCA audio recordings from three 9-1-1 centers and linked to EMS confirmed OHCAs and hospital outcomes. Metrics were compared across four groups: Adults (? 18 years old), and pediatrics (0-1 year old, 2-8 years old, and 9-17 years old). In the study period, 4,533 calls were made to dispatch centers, and after exclusion criteria a total of 3,396 calls were included in the outcomes analysis. There was no difference in survival to hospital discharge (p = 0.6395) or functional neurological outcome (p = 0.1189) when comparing the adult and pediatric patients. A total of 2,007 calls were included in the process measures analysis after exclusions. In the pediatric population, there was a higher rate of call-takers starting CPR instructions (p = 0.0009) and bystanders starting chest compressions (p = 0.0011) and rescue breaths (p < 0.0001). Additionally, time to start of CPR instructions (p < 0.0001), first compressions (p = 0.019), and first rescue breaths (p < 0.0001) were significantly shorter for the pediatric population than for adults. Analysis of barriers to delivery of T-CPR revealed that the inability to get a patient to a hard, flat surface was statistically different in frequency between the adult and pediatric calls. Conclusion: Despite better process measures for the pediatric group, survival and functional neurological outcomes are similarly poor for the adult and pediatric populations after OHCA. The inability to get a patient to a hard, flat surface is a significant barrier in adult patients, and further evaluation of barriers to recognition of need for T-CPR in pediatric 9-1-1 calls is needed.