Telephone cardiopulmonary resuscitation after pediatric out-of-hospital cardiac arrest: An analysis of the process measures, outcomes, and barriers to delivery

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Telephone 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.This item is part of the College of Medicine - Phoenix Scholarly Projects 2020 collection. For more information, contact the Phoenix Biomedical Campus Library at pbc-library@email.arizona.edu