Phone CPR and barriers affecting life-saving seconds

Objectives: Phone cardiopulmonary resuscitation (CPR) increases the rate of bystander CPR to patients suffering from an out-of-hospital cardiac arrest (OHCA). This study analyzed the effectiveness of the ALERT protocol for instructing laypeople in bystander CPR. Methods: All 244 phone CPR calls to the emergency medical communication center in Leuven during a one-year period were analyzed. Time to recognition of OHCA and to start of phone CPR was evaluated and compared to the recommendations set up by the American Heart Association (AHA). Barriers that delayed or prevented phone CPR were identified. Results: Time to recognition of OHCA and to start of chest compressions was below the benchmark set by the AHA in 37% and 32% of the calls, respectively. The most common barriers that delayed the start of phone CPR were irrelevant questioning by the dispatcher and difficulties moving the patient. In 52 calls, phone CPR was not initiated. In 54% of these calls, this was due to the bystander's inability to move the patient to the floor or to perform CPR. In 44% the bystander's lack of motivation hindered the start of CPR. Conclusions: The ALERT protocol plays a key role in bystander-CPR. Despite the increased CPR rates and reduced time to start chest compressions since its implementation, further improvement is required. Based on the barriers detected, intensive training of dispatchers is an important next step. Furthermore, adding an alternative track to the protocol for immovable patients might be worth considering.