Authors : Sot SH Liu (1), KM Chong (1), HC Wang (1), YW Chen (2), CM Hsu (2), CR Tseng (2), CL Hung (2), CH Huang (2), HS Lin (2), YC Yang (2), MF Yang (1), ChihWei Yang (1), YuehPing Liu (3), Matthew HeuiMing Ma (1), Patrick ChowIn Ko (1)(1) Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan(2) Taipei Fire Department, Taipei City Government, Taipei, Taiwan(3) Department of Health, Taipei City Government, Taipei, Taiwan

Implementation of a Multidimensional Bundle for

Dispatcher-assisted CPR in a Horizontal Dispatch System

is Associated with Increased Bystander CPR and

Good Neurological Survival from OHCA

Background

Bystander CPR(BCPR): increase OHCA survival

The guidelines indicate pre-arrival DATCPR instructions/measurement to increase the % of BCPR

However the impact of those guidelines on survival is not well known.

• Understanding and improving low bystander CPR rates: a systematic review of the literature. CJEM 2008;10:51–65.• CPR with chest compression alone or with rescue breathing. N Engl J Med 2010;363:423–33.5.• Emergency medical service dispatch cardiopulmonary resuscitation pre-arrival instructions to improve survival from OHCA: A Scientific statement from the American

Heart Association. Circulation. 2012;125:648-655.• International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2010;122:S250-

275.

Objective To describe the impact of a comprehensive bundle of

DATCPR on BCPR and survival from OHCA in a horizontal computerized-aided dispatch (CAD) system.

Methods – the setting

Taipei, capital of Taiwan 2.68 million population 272 square kilometres EMS – fired based

computerized assisted dispatch (CAD)

1 centralized dispatch center

40 dispatchers + 5 nurses/4 teams

a horizontal dispatch

< 60 seconds, call to dispatch

< 60 sec

Call taker

Dispatch ambu

CPR instructions

Call taker

Dispatch ambu

CPR instructions

RN

Vertical Horizontal

Methods – the bundle

Multidimensional Bundlesimple

protocol

post-hoc auditing

feedback

modify CAD system

reassuring assessment

leadership

a steering team

Methods – the design

Observational study The data are prospectively collected (web Epistry) The results are retrospectively analysed

Bundle implementation launch (since 2013/01/01)

control group (P0)2012/10/01-2012/12/31

study group (P1)2014/10/01-2014/12/31

2012 2013 2014 2015

P2P1P0

Results

OHCA: 740

Non Trauma: 665

OHCA: 845

Non Trauma: 772

EMS resus: 471 EMS resus: 483

2012 2014

Trauma: 75 Trauma: 73

Non-res: 194 Non-res: 289

Results

Before (N=665) After (N=772) p-value Age (years) Mean: 74.7 (SD:54.0) Mean: 75.2 (SD:37.6) 0.8Sex (Men) % 66 65 0.7Response Time (min) Mean: 5.1 (SD:2.1) Mean: 5.4 (SD:2.7) 0.04*Scene Time (min) Mean: 17.1 (SD: 11.3) Mean: 17.9 (SD: 8.6) 0.1Transport Time (min) Mean: 4.2 (SD: 4.3) Mean: 5.0 (SD: 4.3) <0.01*Witnessed arrest % 21.8 26.2 0.06Bystander CPR % 20.6 35.0 <0.001*

ResultsBefore (N=665) After (N=772) p-value

Bystander CPR % 20.6 35.0 <0.001*Initial shockable rhythm % 12.0 13.3 0.5Laryngeal mask airway % 53.1 52.5 0.9Endotracheal intubation % 6.7 8.8 0.2Epinephrine % 17.4 17.8 0.9ECMO 0.6 0.5 0.7T. Hypothermia % 1.0 1.1 0.6Pre-hospital ROSC % 3.2 4.9 0.1ROSC (upon hospital arrival) 6.6 10.4 <0.04*2-hr sustained ROSC % 20.0 24.4 0.1024-hr ROSC % 15.1 18.9 0.14Survival to discharge % 6.4 8.3 0.3CPC 1or2 % 2.6 5.5 <0.03*

Results After adjusting for witnessed arrest, shockable

rhythms, age, sex, and pre-hospital time intervals, TH, good neurological outcome after the bundle intervention was still significantly higher in our study. (adjusted odds ratios: 2.1 [95% 1.1-4.4])

Conclusion We developed and demonstrated successful

implementation of a multidimensional bundle for dispatcher-assisted CPR in our horizontal dispatch system.

There are significant improvements in the rates of BCPR and good neurologic outcome of OHCA in our study.

Thank You for Your Listening !Appreciations to:

NTUH Emerg. Dept.

Taipei Fire Dept.

Taipei Health Dept.

PAROS

MF Yang

Stacy Chiang

YY Wu

Palm on the Chest, Look and Feel

Human factors and Ergonomics

Is the patient Breathing normally?

Human factors and Ergonomics

Yes No need

2012 2013N % N % p-value

Case 335 309

Recognize yes 198 59.1% 213 68.9% 0.01*

no 137 40.9% 96 31.1%Bystander CPR yes 62 18.5% 94 30.4% <0.01*

no 273 81.5% 215 69.6%

Ko et al, ReSS 2014

P1

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

2012-2015.09 BYSTANDER CPR (ALL OHCA CASES)

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

2012-2015.09 BYSTANDER CPR (TRANSPORT CASES)

P2P1

Methods – the bundle

Multidimensional Bundlesimple

protocol

post-hoc auditing

feedback

modify CAD system

reassuring assessment

leadership

a steering team