Incidence and risk stratification of caller noncompliance with dispatcher instructions for cardiopulmonary resuscitation

Aim

This study aimed to describe the incidence of, identify risk factors for, and develop a simple risk-scoring model for cases where callers fail to follow dispatcher instructions regarding cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest.

Methods

Using the Tokyo Fire Department's database, cases of out-of-hospital cardiac arrest in adults where callers received dispatcher instructions regarding CPR between 1 January 2018 and 31 December 2022 were identified. Factors associated with noncompliance with CPR instructions were determined using multivariable logistic regression analysis. A simple scoring model was developed to stratify the caller noncompliance probability.

Results

Overall, 19,525 cases were included. Bystander CPR was not provided in 11,443 (58.6%) of these cases; the 1-month favorable neurological outcome rate was significantly lower in this group (1.1% vs. 2.2%, p < 0.001). Regression analysis revealed that patient age, male patient sex, emergency call at night, cardiac arrest in the bathroom, and a familial relationship between the caller and the patient were significantly associated with noncompliance. The scoring model assigned 1 point for each of the following criteria: patient aged ≥65 years, familial relationship between the caller and the patient, and cardiac arrest in the bathroom. It also stratified caller noncompliance probability, with scores of 0, 1, 2, and 3 corresponding to probabilities of 48.0%, 50.8%, 61.3%, and 70.5%, respectively.

Conclusion

We found that callers frequently did not follow dispatcher CPR instructions and identified risk factors for caller noncompliance. Furthermore, the simple scoring model developed effectively stratified the probability of caller noncompliance associated with dispatcher instructions.