Dispatcher assisted cardiopulmonary resuscitation implementation in Kuwait: A before and after study examining the impact on outcomes of out of hospital cardiac arrest victims

Abstract

Dispatcher assisted cardiopulmonary resuscitation (DACPR) by Emergency medical services has been shown to improve rates of early out of hospital cardiac arrest (OHCA) recognition and early cardiopulmonary resuscitation (CPR) for OHCA. This study measures the impact of introducing DACPR on OHCA recognition, CPR rates and on patient outcomes in a pilot region in Kuwait. EMS treated OHCA data over 10 months period (February 21–December 31, 2017) before and after the intervention was prospectively collected and analyzed. Comprehensive DACPR in the form of: a standardized dispatch protocol, 1-day training package and quality assurance and improvement measures were applied to Kuwait EMS central Dispatch unit only for pilot region. Primary outcomes: OHCA recognition rate, CPR instruction rate, and Bystander CPR rate. Secondary outcome: survival to hospital discharge. A total of 332 OHCA cases from the EMS archived data were extracted and after exclusion 176 total OHCA cases remain. After DACPR implementation OHCA recognition rate increased from 2% to 12.9% (P = .037), CPR instruction rate increased from 0% to 10.4% (P = .022); however, no significant change was noted for bystander CPR rates or prehospital return of spontaneous circulation. Also, survival to hospital discharge rate did not change significantly (0% before, and 0.8% after, P = .53) In summary, DACPR implementation had positive impacts on Kuwait EMS system operational outcomes; early OHCA recognition and CPR instruction rates in a pilot region of Kuwait. Expanding this initiative to other regions in Kuwait and coupling it with other OHCA system of care interventions are needed to improve OHCA survival rates.