Dispatcher-assisted cardiopulmonary resuscitation. Validation of efficacy.

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Abstract
Dispatcher-delivered telephone instruction in cardiopulmonry resuscitation (CPR) has been proposed to increase rates of bystander CPR in cases of out-of-hospital cardiac arrest. We tested the efficacy of a previously developed CPR message using a recording mannikin in a high stress, simulated cardiac arrest scenario. Community volunteers were unaware they would perform CPR until immediately before each trial. Performance of volunteers without prior CPR training (group A, n = 65) who received telephone instruction was compared with that of previously trained volunteers (group B, n = 43) who received the same message. Performances of both groups were also compared with a third group (group C, n = 43) composed of previously trained volunteers who did not receive the message. Quality of CPR was graded by three CPR instructors using explicit criteria. Printout strips from the recording mannikins were also analyzed. Evaluators were unaware of the training status of volunteers. The three groups were of comparable sex, race, and educational level, but group C was significantly younger than groups A and B (31.7 vs. 37.7 years, p < 0.001). Because of the time required for telephone instruction, groups A and B started chest compressions a mean of 4.0 minutes after collapse compared with 1.2 minutes for group C (p < 0.0001). We found that the previously untrained volunteers of group A performed CPR of an overall quality comparable to that performed by previously trained members of group C. Group A performed chest compressions significantly better than group C (p < 0.01) but had greater problems performing effective ventilations. The global performance of group B, the group with prior CPR training and telephone instruction, was superior to that achieved by groups A and C (p < 0.005). We conclude that telephone CPR can offer a safe and cost-effective means to increase the rate of bystander CPR in communities where few citizens are trained to perform CPR. Telephone instruction also improves the quality of CPR performed by persons with prior CPR training.