Effect of telephone CPR on the rate of bystander CPR for out-of-hospital cardiac arrest in a typical urban city in Japan

Abstract

Introduction: Today, the emergency medical service (EMS) system has been developing in each country. However, it is not known whether people are willing to perform CPR and whether they are prepared to perform CPR under telephone CPR advice. In this study, we examined how Japanese citizens are interested in the importance of immediate CPR and defibrillation, and how they understand this importance. Methods: Patients with out-of-hospital cardiac arrest due to nontraumatic etiology treated in our center for the past 2 years were enrolled. Cardiac arrest after the scene was excluded. Patients' records from our emergency department were reviewed. In Japan, the ambulance service, dispatch service and emergency life-saving technician (ELST) belong to the fire department. ELSTs perform not only advanced CPR for CPA patients on the job but also education of call takers in the central operation center under medical control about the importance of the recognition of CPA and advice for immediate bystander CPR. Results: A total of 747 patients were enrolled. Telephone CPR advice was performed for bystanders of 336 (45%) patients and 304 bystanders actually performed CPR (90%). Five percent (40) of all 747 cases underwent voluntarily bystander CPR before telephone advice, 40% underwent bystander CPR according to telephone advice, and 4% (32) did not undergo CPR against telephone CPR advice. In 344 patients with bystander CPR, 33% reached ROSC, 11% survived more than 24 hours, and 3% were discharged, and in 391 patients without bystander CPR, 30%, 11%, and 6%, respectively. Restricted in 302 witnessed patients, of 125 with bystander CPR, 52% reached ROSC, 16% survived more than 24 hours, and 3% were discharged, and in 177 without bystander CPR, 44% reached ROSC, 14% survived more than 24 hours, and 1% were discharged, respectively. Conclusions: Most people are willing to perform CPR. Bystanders are prepared to perform CPR with telephone CPR advice to help them. However, bystander CPR is not always adequate, resulting in no distinct effect of CPR on survival rate. We should educate citizens beforehand and guide bystanders with more proper and quick advice by telephone.