A statewide telephone-assisted pre-arrival CPR program in Arizona increased survival rates for out-of-hospital cardiac arrest patients, according to a study presented Saturday at the Resuscitation Science Symposium.

The program, which includes bystander-administered CPR before emergency medical services arrive, also decreased time to first chest compression and increased bystander CPR participation and demonstrated favorable neurologic outcomes for patients.

Based on American Heart Association recommendations, the program involves training telecommunicators at 9-1-1 centers throughout Arizona to recognize calls from out-of-hospital cardiac arrest patients and deliver instructions to bystanders to provide CPR. Telecommunicators were trained in live sessions or on the web.

Researchers reviewed data from audio recordings of telecommunicators interacting with 9-1-1 callers using a standardized “time stamp” methodology that involved recognizing cardiac arrest, when CPR instructions were initiated and when first chest compressions were delivered. They also listened to 9-1-1 audio recordings before the program was implemented.

More than 3,600 OHCA patients were identified. When compared to pre-implementation cases, post-implementation cases results included:

  • Survival increased from 8.3 percent to 11 percent.
  • Telephone-assisted bystander CPR increased from 47 percent to 55 percent.
  • Time to telephone-assisted CPR instructions decreased from 148 seconds to 130 seconds.
  • Time to first chest compression decreased from 183 seconds to 156 seconds.

“This CPR protocol was a tremendous change in culture and philosophy on how telecommunicator-assisted CPR can get early bystander involvement,” said Bentley J. Bobrow, MD, FAHA, medical director of the Bureau of EMS and Trauma System in the Arizona Department of Health Services and professor of emergency medicine at the University of Arizona College of Medicine in Phoenix.


“With this technique, by working with a few hundred telecommunicators, we can reach the entire population in the state,” he added. “How assertive, confident and quickly telecommunicators can give the instructions can significantly change outcomes for OHCA patients by getting bystanders involved early.”