Quantifying patient movement delays during telecommunicator cardiopulmonary resuscitation

Guidelines advise bystanders move victims in out-of-hospital cardiac arrest (OHCA) to a firm surface prior to performing chest compressions in telecommunicator cardiopulmonary resuscitation (T-CPR). The objective of this study was to quantify delays associated with patient movement.

We conducted a retrospective cohort study of OHCA encounters in two North Carolina counties from 01/01/2021 to 12/31/2021. We reviewed audio recordings to determine if movement was indicated or not during T-CPR and reported frequency and percentage. We abstracted the time cardiac arrest was recognized by the telecommunicator, the time the first compression was started by the bystander, and whether movement was indicated. The primary outcome was the time to first compression, described with median and interquartile range (IQR) overall and by whether patient movement was indicated. We quantified the unadjusted median difference in time to first compression using Hodges-Lehmann estimator and the adjusted median difference using quantile regression.

Of the 329 calls analyzed, patient movement was indicated in 39.8% (131/329). Median time to first compression was 187 s (IQR 141-239 s) when movement was indicated and 145 s (IQR 103-201) when movement was not indicated. The median delay in time to first compression when movement was indicated, compared to when it was not, was 32 s (95% CI 14-52 s, p = 0.0014) after adjustment.

Patient movement to a firm surface was associated with a statistically significant delay in time to first compression during T-CPR. Future studies are needed to determine clinical significance and evaluate the impact on patient-centered outcomes.