Study finds factors impeding bystander CPR

November 26, 2003

A study in the December 2003 issue of Annals of Emergency Medicine identifies specific factors that may impede dispatcher-assisted bystander cardiopulmonary resuscitation (CPR) and could potentially be corrected through dispatcher training, variation in CPR technique, or community education. (Factors Impeding Dispatcher-Assisted Telephone Cardiopulmonary Resuscitation, p. 731)

In this study of 404 sudden cardiac arrest victims, 25 percent received bystander CPR without dispatcher assistance, 33 percent received CPR from a bystander receiving instruction over the phone from a dispatcher; and 41 percent did not receive bystander CPR before Emergency Medical Services (EMS) arrival.

"The fact that one-third of victims received dispatcher-assisted CPR is a rate fairly consistent with studies done in our community and is testimony to the proficient skill of the dispatchers and the community's CPR awareness and training," said Thomas D. Rea, MD, MPH, from the University of Washington School of Medicine in Seattle. "However, our study was looking for what may have impeded bystanders from performing dispatcher-assisted CPR in cases where CPR was not performed."

The study found almost one-half of sudden cardiac arrest victims did not receive CPR before EMS arrival. Among the cases potentially eligible for telephone-assisted CPR, the dispatcher most commonly did not offer instruction because the victim was reported to have signs of life.

"Review of these cases suggests dispatchers should continue to question bystanders about signs of life, with special attention to identifying agonal respiration, which are irregular respirations and are a sign of sudden cardiac arrest, though they may be mistaken for the patient breathing on his own," said Dr. Rea.

Other reasons CPR was not performed included combinations of the bystander's own physical limitation or the victim's location or position (e.g., sitting in a chair), according to the study. Contrary to other investigations, this study found it uncommon for CPR to be impeded because bystanders were emotionally distressed, or were afraid of disease transmission, or potential liability.
Annals of Emergency Medicine is the peer-reviewed journal of the American College of Emergency Physicians, a national medical specialty organization with nearly 23,000 members. The following highlights from the December 2003 issue are not intended to substitute for articles as sources of information. To obtain copies of the studies, contact Colleen Hughes at the phone number above or by e-mail at

American College of Emergency Physicians

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