Dispatcher-assisted cardiopulmonary resuscitation:Patient outcomes following out of hospital cardiac arrest in a pilot region of Kuwait.

Abstract

Background:
The goal of this study is to measure the impact of dispatcher assisted cardiopulmonary resuscitation on out of hospital cardiac arrest (OHCA) patients’ outcomes in a pilot region of Kuwait.
Methods:
This is a before and after study with a control group of adults with OHCA who activated the Kuwaiti emergency medical services (EMS) in three time periods (1st anuary 31st October 2016, 21st February 31st May 2017 and 1st une 31st December 2017). Patients’ data were collected from Kuwaiti EMS archived data. Dispatcher assisted cardiopulmonary resuscitation (DACPR) was then implemented in an intervention region. Meanwhile, OHCA patients in the control region received standard Kuwaiti EMS protocol for OHCA incidences. Primary outcome: survival to 30 days. Secondary outcomes: OHCA recognition rate, CPR instruction rate, bystander CPR rate and return of spontaneous circulation. Multivariate logistic regression analysis was used to compare outcomes between groups before, during and after DACPR implementation in the intervention region. Binary logistic regression was used to compare outcomes between intervention and control groups during two study periods: during and after DACPR implementation.
Results:
A total of 664 OHCA cases from the Kuwaiti EMS archived data were extracted. Of these, 377 OHCA cases met the inclusion criteria and fell within the proposed study periods. There were 80 cases in the pre intervention group, 78 in the intervention group and 219 in the post intervention group. DACPR was found to be a complex intervention, requiring a cycle of implementation evaluation feasibility and development to ensure its implementation in the Kuwaiti EMS during the post intervention period. The comparison between groups in the pilot region for before, during and after DACPR implementation found that the survival to 30 days rate was 29.2% before, 2.1% during and .8% after (p =0.001). OHCA recognition rates were 20.8% before, 2.1% during and 12.9% after, with p = 0.037. CPR instruction for the recognised OHCA cases was 60% before, 0% during and 80% following the implementation of DACPR. The comparison between the pilot and control regions during 2017 was documented` survival to 30 days rates of 1.1% for the pilot region and 1.7% for the control region were found (p =.954, OR=.93). The CPR instruction rate was 7.5% for the pilot region and 2.5% for the control region (p=.007,OR=13.26). The bystander CPR rate was12.7% for the pilot region and 4.1% for the control region (p = 0.05,OR=3.40).
Conclusion:
DACPR is a complex intervention` however, it was implemented in a pilot region of the Kuwaiti EMS. The DACPR intervention resulted in positive impacts on the Kuwaiti EMS system operational outcomes, CPR instruction rates and bystander CPR rates in the pilot region in Kuwait. This caused the activation of the early OHCA survival links, early OHCA recognition and early CPR.

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ORCID for Eloise Monger: orcid.org/0000-0003-2799-0596

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