title: Implementation of a dispatch-instruction protocol for cardiopulmonary resuscitation according to various abnormal breathing patterns: a population-based study.
abstract: BACKGROUND
  We modified the dispatch protocol for cardiopulmonary resuscitation (CPR) using results of a retrospective analysis that identified descriptions by laypersons of possible patterns of agonal respiration. The purpose of this study was to assess the effectiveness of this modified protocol by comparing the frequency of dispatch instructions for CPR and bystander CPR before and after protocol implementation. We also identified descriptions of abnormal breathing patterns among 'Not in cardiac arrest (CA)' unresponsive cases.
  
  
  METHODS
  This study was conducted prospectively using the population-based registry of out-of-hospital cardiac arrests (OHCAs). For 8 months we implemented this modified protocol in cooperation with 4 fire departments that cover regions with a total population of 840,000.
  
  
  RESULTS
  There were 478 and 427 OHCAs before and after implementation, respectively. Among them, 69 and 71 layperson-witnessed OHCAs for pre- and post-implementation, respectively, were analyzed. Dispatchers provided CPR instructions more frequently after protocol implementation than before (55/71 [77.5 %] vs. 41/69 [59.4 %], p < 0.05). Based on breathing patterns described by emergency callers, dispatchers assessed 143 'Not in CA' unresponsive cases and provided CPR instruction for 45 cases. Sensitivity and specificity of this protocol was 93 % and 50 %, respectively.
  
  
  CONCLUSIONS
  This modified protocol based on abnormal breathing described by laypersons significantly increased CPR instructions. Considering high sensitivity and low specificity for abnormal breathing to identify CA and the low risk of chest compression for 'Not in CA' cases, our study suggested that dispatchers can provide CPR instruction assertively and safely for those unresponsive individuals with various abnormal breathing patterns.
authors.affiliation: Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan. hidetakarina@gmail.com.
authors.forename: Hidetada
authors.initials: H
authors.lastname: Fukushima
authors.affiliation: Nara Saiseikai Gose Hospital, Mimuro, 20, Gose City, Nara, 639-2306, Japan. imachan@fg8.so-net.ne.jp.
authors.forename: Masami
authors.initials: M
authors.lastname: Imanishi
authors.affiliation: Kyoto University Health Service, Yoshida-honmachi, sakyo-ku, Kyoto, 606-8501, Japan. iwami.taku.8w@kyoto-u.ac.jp.
authors.forename: Taku
authors.initials: T
authors.lastname: Iwami
authors.affiliation: Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan. a990013_mini@yahoo.co.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitaoka
authors.affiliation: Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan. akahellchobi@gmail.com.
authors.forename: Hideki
authors.initials: H
authors.lastname: Asai
authors.affiliation: Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan. tseki@naramed-u.ac.jp.
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Seki
authors.affiliation: Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan. k6k6k@naramed-u.ac.jp.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kawai
authors.affiliation: Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan. norimoto@naramed-u.ac.jp.
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Norimoto
authors.affiliation: Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan. uri@naramed-u.ac.jp.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Urisono
authors.affiliation: Department of General Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan. knishio@naramed-u.ac.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Nishio
authors.affiliation: Department of Emergency and Critical Care Medicine, Nara Medical University, Shijo-cho, 840, Kashihara City, Nara, 634-8522, Japan. okucci@naramed-u.ac.jp.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Okuchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012680:Sensitivity and Specificity