Simplified dispatcher-assisted pediatric CPR instructions improves bystander chest compression quality

Background: Dispatcher-assisted bystander cardiopulmonary resuscitation (CPR) improves survival outcomes after out-of-hospital cardiac arrest. Our objective was to evaluate the effectiveness of simplified CPR instructions to improve the chest compression (CC) depth provided by bystander rescuers during simulated pediatric cardiac arrest in public places. Methods: Prospective, randomized, simulation-based study. With IRB approval, healthy adults bystanders were recruited in public places and randomized to receive one of two recorded / scripted dispatcher CC instructions: 1) “Push as hard as you can” (PUSH HARD group) or 2) “Push approximately 2 inches” (2 INCHES group). Randomization was stratified by gender and CPR experience. An identical 2-minute simulated pediatric CPR manikin scenario was conducted. A CPR recording defibrillator (Philips MRx) was used for CC data collection. The primary outcome was average CC depth, and secondary outcomes included CC rate (target: 90-120) and leaning force (target: <2.5kg). Analysis by two-sided unpaired t-test and Chi-square test, as appropriate. Results: 128 out of 140 providers approached for screening met inclusion/exclusion criteria and consented to participate. There were no demographic differences between the groups (n= 64 for both PUSH hard and 2 INCHES). The PUSH HARD group achieved significantly deeper CC compared to 2 INCHES group (43±1mm vs. 36±1mm, p<0.01). Compression rates trended higher in PUSH HARD (93 ±4 vs. 82 ± 4 CC/min, p=0.06). Leaning was not different between groups (p<0.09). Conclusion: Simplified dispatcher assisted pediatric CPR instructions: “Push as hard as you can” was associated with significantly deeper CCs provided by bystander rescuers, without detrimental effects on CC rate or chest recoil. A simplified dispatcher instruction to “Push as hard as you can” appears feasible and effective.