Pediatric Out‐of‐Hospital Cardiac Arrest: The Role of the Telecommunicator in Recognition of Cardiac Arrest and Delivery of Bystander Cardiopulmonary Resuscitation

Abstract

Background Telecommunicator CPR (T‐CPR), whereby emergency dispatch facilitates cardiac arrest recognition and coaches CPR over the telephone, is an important strategy to increase early recognition and bystander CPR in adult out‐of‐hospital cardiac arrest (OHCA). Little is known about this treatment strategy in the pediatric population. We investigated the role of T‐CPR and related performance among pediatric OHCA. Methods and Results This study was a retrospective cohort investigation of OHCA among individuals <18 years in King County, Washington, from April 1, 2013, to December 31, 2019. We reviewed the 911 audio recordings to determine if and how bystander CPR was delivered (unassisted or T‐CPR), key time intervals in recognition of arrest, and key components of T‐CPR delivery. Of the 185 eligible pediatric OHCAs, 23% (n=43) had bystander CPR initiated unassisted, 59% (n=109) required T‐CPR, and 18% (n=33) did not receive CPR before emergency medical services arrival. Among all cases, cardiac arrest was recognized by the telecommunicator in 89% (n=165). Among those receiving T‐CPR, the median (interquartile range) interval from start of call to OHCA recognition was 59 seconds (38–87) and first CPR intervention was 115 seconds (94–162). When stratified by age (≤8 versus >8), the older age group was less likely to receive CPR before emergency medical services arrival (88% versus 69%, P =0.002). For those receiving T‐CPR, bystanders spent a median of 207 seconds (133–270) performing CPR. The median compression rate was 93 per minute (82–107) among those receiving T‐CPR. Conclusions T‐CPR is an important strategy to increase early recognition and early CPR among pediatric OHCA.