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Dispatcher Identification of Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival: A Retrospective Cohort Study

Published online by Cambridge University Press:  29 November 2019

Julian G. Mapp Open the ORCID record for Julian G. Mapp [Opens in a new window] ,
Anthony M. Darrington ,
Stephen A. Harper ,
Chetan U. Kharod ,
David A. Miramontes ,
David A. Wampler  and
Prehospital Research and Innovation in Military and Expeditionary Environments (PRIME) Research Group
Julian G. Mapp*
Affiliation:
San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam Houston, TexasUSA Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TexasUSA
Anthony M. Darrington
Affiliation:
San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam Houston, TexasUSA
Stephen A. Harper
Affiliation:
San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam Houston, TexasUSA Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TexasUSA
Chetan U. Kharod
Affiliation:
San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam Houston, TexasUSA Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TexasUSA
David A. Miramontes
Affiliation:
Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TexasUSA
David A. Wampler
Affiliation:
Department of Emergency Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TexasUSA
*
Julian G. Mapp, MD, MPH Department of Emergency Health Sciences University of Texas Health Science Center at San Antonio San Antonio, Texas 78229 USA E-mail: [email protected]
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Abstract

Introduction:

To date, there are no published data on the association of patient-centered outcomes and accurate public-safety answering point (PSAP) dispatch in an American population. The goal of this study is to determine if PSAP dispatcher recognition of out-of-hospital cardiac arrest (OHCA) is associated with neurologically intact survival to hospital discharge.

Methods:

This retrospective cohort study is an analysis of prospectively collected Quality Assurance/Quality Improvement (QA/QI) data from the San Antonio Fire Department (SAFD; San Antonio, Texas USA) OHCA registry from January 2013 through December 2015. Exclusion criteria were: Emergency Medical Services (EMS)-witnessed arrest, traumatic arrest, age <18 years old, no dispatch type recorded, and missing outcome data. The primary exposure was dispatcher recognition of cardiac arrest. The primary outcome was neurologically intact survival (defined as Cerebral Performance Category [CPC] 1 or 2) to hospital discharge. The secondary outcomes were: bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and prehospital return of spontaneous return of circulation (ROSC).

Results:

Of 3,469 consecutive OHCA cases, 2,569 cases were included in this analysis. The PSAP dispatched 1,964/2,569 (76.4%) of confirmed OHCA cases correctly. The PSAP dispatched 605/2,569 (23.6%) of confirmed OHCA cases as another chief complaint. Neurologically intact survival to hospital discharge occurred in 99/1,964 (5.0%) of the recognized cardiac arrest group and 28/605 (4.6%) of the unrecognized cardiac arrest group (OR = 1.09; 95% CI, 0.71–1.70). Bystander CPR occurred in 975/1,964 (49.6%) of the recognized cardiac arrest group versus 138/605 (22.8%) of the unrecognized cardiac arrest group (OR = 3.34; 95% CI, 2.70–4.11).

Conclusion:

This study found no association between PSAP dispatcher identification of OHCA and neurologically intact survival to hospital discharge. Dispatcher identification of OHCA remains an important, but not singularly decisive link in the OHCA chain of survival.

Keywords

emergency medical dispatchingEmergency Medical Servicesout-of-hospital cardiac arrestrecognition
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 1 , February 2020 , pp. 17 - 23
Copyright
© World Association for Disaster and Emergency Medicine 2019

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