Pre-recorded instructional audio vs. dispatchers’ conversational assistance in telephone cardiopulmonary resuscitation: A randomized controlled simulation study

doi:10.5847/wjem.j.1920-8642.2018.03.001

Abstract

Abstract:

BACKGROUND: To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation (CPR) guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation.
METHODS: It was a prospective, blind, randomised controlled study involving 109 medical students without previous CPR training. In a standardized mannequin scenario, after the step of dispatcher-assisted cardiac arrest recognition, the participants performed compression-only resuscitation guided over the telephone by either: (1) the pre-recorded instructional audio (n=57); or (2) verbal dispatcher assistance (n=52). The simulation video records were reviewed to assess the CPR performance using a 13-item checklist. The interval from call reception to the first compression, total number and rate of compressions, total number and duration of pauses after the first compression were also recorded.
RESULTS: There were no significant differences between the recording-assisted and dispatcher-assisted groups based on the overall performance score (5.6±2.2 vs. 5.1±1.9, P>0.05) or individual criteria of the CPR performance checklist. The recording-assisted group demonstrated significantly shorter time interval from call receipt to the first compression (86.0±14.3 vs. 91.2±14.2 s, P<0.05), higher compression rate (94.9±26.4 vs. 89.1±32.8 min^-1) and number of compressions provided (170.2±48.0 vs. 156.2±60.7).
CONCLUSION: When provided by untrained persons in the simulated settings, the compression-only resuscitation guided by the pre-recorded instructional audio is no less efficient than dispatcher-assisted CPR. Future studies are warranted to further assess feasibility of using instructional audio aid as a potential alternative to dispatcher assistance.

Key words: Cardiopulmonary resuscitation, Cardiac arrest, Dispatcher, Telephone CPR, Audio instructions, Instructional aid

Alexei Birkun, Maksim Glotov, Herman Franklin Ndjamen, Esther Alaiye, Temidara Adeleke, Sergey Samarin. Pre-recorded instructional audio vs. dispatchers’ conversational assistance in telephone cardiopulmonary resuscitation: A randomized controlled simulation study[J]. World Journal of Emergency Medicine, 2018, 9(3): 165-171.

Figures/Tables 4

Table 1

Table 2

Comparison for participants’ performance of CPR, n (%)

Parameters	Recording-assisted group (n=57)	Dispatcher-assisted group (n=52)	P value
CPR performance criterion
1. Shakes victim’s shoulders	25 (43.9)	22 (42.3)	>0.05
2. Shouts to the victim	34 (59.6)	29 (55.8)	>0.05
3. Kneels by the side of the victim	41 (71.9)	40 (76.9)	>0.05
4. Places first hand on the lower half of the sternum along the midline	18 (31.6)	11 (21.2)	>0.05
5. Places other hand on top of the first with fingers interlocked	26 (45.6)	20 (38.5)	>0.05
6. Positions himself vertically above the victim’s chest	16 (28.1)	7 (13.5)	>0.05
7. Compresses to a depth of 5-6 cm	23 (40.4)	17 (32.7)	>0.05
8. Compresses with a rate of 100-120 per minute	26 (45.6)	16 (30.8)	>0.05
9. Applies pressure with a heel only	12 (21.1)	10 (19.2)	>0.05
10. Keeps arms straight with no flexion in elbows	19 (33.3)	13 (25.0)	>0.05
11. Allows for complete chest recoil after every compression	24 (42.1)	26 (50.0)	>0.05
12. Keeps hands in contact with the chest between compressions	54 (94.7)	48 (92.3)	>0.05
13. Counts compressions aloud	3 (5.3)	5 (9.6)	>0.05
Overall performance score (0-13) (mean±SD)	5.6±2.2	5.1±1.9	>0.05
Time interval from call receipt to the 1st compression (seconds) (mean±SD)	86.0±14.3	91.2±14.2	<0.05
Total number of compressions (mean±SD)	170.2±48.0	156.2±60.7	<0.05
Total number of compressions (mean±SD) - corrected for outliers	176.9±39.3 (n=54)	151.1±42.9 (n=49)	<0.05
Mean compression rate (min^-1) (mean±SD)	94.9±26.4	89.1±32.8	<0.05
Mean compression rate (min^-1) (mean±SD) - corrected for outliers	98.6±21.4 (n=54)	86.4±22.8 (n=49)	<0.05
Total number of pauses after the 1st compression (mean±SD)	1.3±3.0	1.8±2.4	<0.05
Total number of pauses after the 1st compression (mean±SD) - corrected for outliers	0.9±1.1 (n=56)	1.6±1.5 (n=51)	<0.05
Total duration of pauses after the 1st compression (seconds) (mean±SD)	8.5±14.4	11.3±16.1	>0.05
Total duration of pauses after the 1st compression (seconds) (mean±SD) - corrected for outliers	6.8±7.6 (n=56)	9.3±8.1 (n=51)	>0.05

Table 2

Figure 1.

Figure 2.

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Telephone CPR Protocol
1. Emergency medical service, what are you reporting?
2. Is the environment safe?
3. Ok. Shake the shoulders of the victim and shout loudly. Any response?
4. Is the victim breathing normally?
5. Dispatcher-assisted group: Ok. Emergency help is on the way. In the meantime, listen carefully, I will tell you what to do.	5. Recording-assisted group: Ok. Emergency help is on the way. In the meantime, carefully follow an automatic instructional record.
CPR instructions phase
1. Put the victim on his back on the floor.
2. Kneel by the side of the victim.
3. Put the heel of your hand at the center of the victim's chest.
4. Put your other hand on top of that hand with your fingers interlocked with each other.
5. Push down with the heel of your hand as hard as you can.
6. Keep your arms straight and don’t allow your elbows to be bent.
7. Push as hard as you can, following the rhythm of the timer and counting loudly in pairs of ten.
Metronome starts
Encouragements (alternating every 15 seconds):
a) Push, push, push hard… You are doing great.
b) Come on, come on… Keep it up, help is almost there.