Research Article: Quality of dispatch‐assisted cardiopulmonary resuscitation by lay rescuers following a standard protocol in Japan: an observational simulation study

Date Published: October 11, 2017

Publisher: John Wiley and Sons Inc.

Author(s): Hideki Asai, Hidetada Fukushima, Francesco Bolstad, Kazuo Okuchi.


Bystander cardiopulmonary resuscitation (CPR) is essential for improving the outcomes of sudden cardiac arrest patients. It has been reported that dispatch‐assisted CPR (DACPR) accounts for more than half of the incidence of CPR undertaken by bystanders. Its quality, however, can be suboptimal. We aimed to measure the quality of DACPR using a simulation study.

We recruited laypersons at a shopping mall and measured the quality of CPR carried out in our simulation. Dispatchers provided instruction in accordance with the standard DACPR protocol in Japan.

Twenty‐three laypersons (13 with CPR training experience within the past 2 years and 10 with no training experience) participated in this study. The median chest compression rate and depth were 106/min and 33 mm, respectively. The median time interval from placing the 119 call to the start of chest compressions was 119 s. No significant difference was found between the groups with and without training experience. However, subjects with training experience more frequently placed their hands correctly on the manikin (84.6% versus 40.0%; P = 0.026). Twelve participants (52.2%, seven in trained and five in untrained group) interrupted chest compressions for 3–18 s, because dispatchers asked if the patient started breathing or moving.

This current simulation study showed that the quality of DACPR carried out by lay rescuers can be less than optimal in terms of depth, hand placement, and minimization of pauses. Further studies are required to explore better DACPR instruction methods to help lay rescuers perform CPR with optimal quality.

Partial Text

Sudden cardiac arrest (CA) is a leading cause of death in industrialized nations and effective bystander cardiopulmonary resuscitation (CPR) is essential to increase patients’ chance of survival from out‐of‐hospital sudden CA.1, 2, 3 The rate of bystander CPR, however, generally remains low in most communities.2, 4, 5 Thus emergency medical service (EMS) dispatchers who take emergency calls may instruct callers to perform CPR.6 Bystander CPR undertaken by lay rescuers under dispatch instruction is called dispatch‐assisted CPR (DACPR).4, 7, 8 It has been reported that DACPR can double the rate of bystander CPR and is associated with a better outcome for sudden CA victims.9 However, in terms of the quality of CPR performed by lay rescuers, simulation studies have shown it is generally low10, 11, 12 and the quality of DACPR can also be suboptimal in real cardiac arrest cases. Even in lay rescuers with CPR training experience, performance can be poor as the skills and knowledge deteriorate soon after training.13 These lay rescuers, however, are still the best candidates to perform DACPR until EMS personal arrive and dispatchers should understand how they perform CPR. In this study, we hypothesized that the quality of DACPR performed by lay rescuers is suboptimal. To test this hypothesis, we undertook a study to simulate lay rescuers encountering a CA situation, and observed how they perform CPR under EMS dispatch instruction.

Twenty‐three participants were recruited at the shopping mall in this study. The majority of the participants were female (19/23 [82.6%]). Table 1 shows the characteristics of the participants. Among them, thirteen participants had previous CPR training two or more years before (trained group).

In this simulation study, we found that the quality of DACPR by lay rescuers was suboptimal in terms of compression depth. When comparing participants with CPR training experience to those without training experience, the quality of CPR was similar except for the correct hand position.

This current observational simulation study showed that the quality of DACPR by lay rescuers can be less than optimal in terms of compression depth, hand placement and the minimization of compression pauses. Several specific areas of concern were identified as needing further investigation in order to optimize DACPR. Further studies are required to explore these areas and provide better DACPR instruction that will help lay rescuers perform CPR with optimal quality.

The study protocol was approved by the eithics committee of Nara Medical University.




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