Current practices of dispatcher-assisted CPR in Italian emergency medical communication centers: A national survey

Aim: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is widely recognized as a critical intervention that significantly improves survival rates in out-of-hospital cardiac arrests (OHCA). This study evaluates current practices of DA-CPR in Italian emergency medical communication centers (EMCCs) and identifies areas for improvement. Methods: A cross-sectional survey using a validated questionnaire was conducted between April and May 2024 among 61 out of 67 EMCCsinItaly, achievinga 91%responserateandcovering91.6%of the population. Data were collected on the availability of DA-CPR, additional medical instructions provided, use of standardized proto cols, integration into dispatch software, availability of video-call systems and follow-up programs. Results: All responding EMCCs provide DA-CPR, with 75% (46/61) initiating these protocols over five years ago. In cardiac arrest cases, 59% (36/61) provide instructions for chest compressions only. Standardized DA-CPR protocols are used in 62% of EMCCs, and 51% have these protocols integrated into their dispatch software. Additionally, 87% provide dispatcher-assisted instructions for other medicalconditions, includingpediatric CPR (80%),neonatal CPR(67%), foreign body airway obstruction (84%), labor (64%), and massive bleeding (52%). Dedicated training programs exist in 64% of EMCCs, with41%conductingperiodicretrainings.Moreover, 34%utilizevideo call systems to support dispatcher-assisted instructions. Data on DA CPR are collected by 41% of EMCCs, primarily on relevant cases, but only 21%have afollow-up path for patients. Furthermore, 38% provide debriefing for bystanders who performed CPR under dispatcher guidance. Conclusions: The study reveals comprehensive implementation of DA-CPR across Italian EMCCs, with significant use of standardized protocols andtrainingprograms.However,variabilityexistsinthetype of instructions provided and the use of support tools. Enhancing training programs and standardizing protocols could improve DA-CPR effectiveness and patient outcomes. Future initiatives should focus on integrating advanced support tools like video-calls, expanding retraining programs, and establishing follow-up and debriefing procedures