Barriers to dispatcher-assisted CPR are associated with delayed bystander CPR and worse outcomes in out-of-hospital cardiac arrest: A retrospective cohort study.

BACKGROUND: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is associated with increased bystander CPR rates after out-of-hospital cardiac arrest (OHCA). We aimed to quantify barriers to DA-CPR occurring after dispatcher recognition of cardiac arrest and estimate their associations with bystander CPR initiation, return of spontaneous circulation (ROSC), and 30-day survival. METHODS: We conducted a retrospective cohort study of transcribed 112 emergency calls from five OHCA studies, linked to the Swedish Registry for Cardiopulmonary Resuscitation. Calls were included if the dispatcher recognised cardiac arrest and classified as barrier-present if ≥1 barrier occurred after recognition. Barriers included caller not with the patient, left/hang up the phone, language barriers, overly distraught caller, inability to move the patient, and CPR refusal. We analysed cumulative bystander CPR initiation by the number of barriers, used Bayesian modeling to estimate the delay to bystander CPR, and estimated associations between any barrier and ROSC and 30-day survival. RESULTS: Among 3,263 confirmed OHCA, 43.7% had at least one barrier. The most common barrier was the inability to move the patient (55.8% of barrier-present calls). Barrier-free calls had the highest cumulative bystander CPR initiation, reaching 85%, whereas calls with ≥3 barriers remained below 50%. Barrier-present calls were associated with lower ROSC (adjusted RR 0.89, 95% CrI 0.81-0.98) and 30-day survival (adjusted RR 0.57, 95% CrI 0.46-0.71). CONCLUSIONS: Barriers to DA-CPR after dispatcher recognition of cardiac arrest were common and associated with delayed bystander CPR and worse outcomes. Targeting these barriers could improve dispatcher call handling and bystander CPR rates.