Bystander CPR Improved by Guideline-Based Telephone Protocols

HealthDay News –  Implementation of a guideline-based telephone cardiopulmonary resuscitation (CPR) bundle increased survival to hospital discharge and functional outcomes, according to a prospective, observational study published in JAMA Cardiology

The American Heart Association emphasizes the importance of telecommunicators, including 911 dispatchers, in assisting bystanders in CPR to improve survival. 

Bentley Bobrow, MD, of the Arizona Department of Health Services in Phoenix, and colleagues examined data from 2,334 out-of-hospital cardiac arrests that occurred in Phoenix before and after a telephone-directed CPR program was implemented.

After introduction of the program, telephone-directed CPR rates rose from 43.5% to 52.8%, the researchers found. In addition, the time in which a patient received a first chest compression from a bystander fell from 256 to 212 seconds. Patient survival rose from 9.1% to 12.0%, while “favorable patient outcomes” rose from 5.6% to 8.3%. 

The team noted that fewer than half of Americans who suffer cardiac arrest in public places receive CPR from bystanders, and survival rates are very low.

Summary and Clinical Applicability

“After implementation of a guideline-based, comprehensive, system-wide [telephone CPR] bundle of care, we observed an increase in telecommunicator CPR, a reduction in the time to first chest compression, and improved survival and functional outcome in patients with out-of-hospital cardiac arrest”,  the authors concluded.

Limitations and Disclosures

A randomized clinical trial would more strongly prove that the changes in outcomes were due to the implemented telephone protocols, however the study authors note that this type of trial may not be ethical since prior studies have shown positive outcomes from telephone interventions.  Applicability of this data may only apply to the type of community setting in which the data was derived, as emergency medical service systems vary widely between states and systems. 


Bobrow BJ, Spaite BW, Vadeboncoeur TF, et al. Implementation of a regional telephone cardiopulmonary resuscitation program and outcomes after out-of-hospital cardiac arrestJAMA Cardiol. Published online ahead of print May 04, 2016. doi:10.1001/jamacardio.2016.0251