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Out-of-hospital cardiac arrest (OHCA) management is a challenge, especially in developing countries. A previous study in Thailand reported that only 16% of OHCA patients received bystander cardiopulmonary resuscitation (CPR), and the survival-to-discharge rate was 4%.
In 2019, we established the community CPR project in the Bangkoknoi District of Bangkok, Thailand, which is a 12-square-kilometer semi-urban and slum community. Much of the area is difficult to access by public transportation, including ambulances. As such, many people living in this area use motorcycle-taxis for transportation. Based on the strengths and weaknesses of this setting, we developed the motorcycle-taxi CPR project to increase the rate of bystander CPR. The deliverables of this project included (1) hand-only CPR training for people and motorcycle-taxi drivers in the community; (2) certification of competent volunteers as community first responders (CFRs); (3) the development and launch of a crowdsourcing mobile application called Siriraj Emergency Responder Application (SiER app) to determine the victim’s location and to dispatch a CFR to the scene; and, (4) an audit of the system by in situ simulation in the community.
During 2019, we organized 10 community CPR courses that taught 355 laypersons, and 39 of those were motorcycle-taxi drivers (11%). We also conducted 6 CPR test sessions to certify our CFRs. Among our cohort, 156 (44%) trainees became certified CFRs. Of those, 10 motorcycle-taxi drivers became CFR certified (3%). We assessed the impact of our intervention by comparing 2018 data from our center’s non-traumatic OHCA registry with 2020 post-intervention data. Our registry collects OHCA data from emergency medical service (EMS) and emergency department records at out center, and this data includes the vast majority of the OHCA cases in Bangkoknoi. There were 127 OHCA cases in 2018, and 187 cases in 2020. Fig. 1 shows a significant increase from 2018 to 2020 for both EMS utilization (52% vs. 76%; p < 0.001) and bystander CPR (27% vs. 44%; p = 0.002). In contrast, 30-day survival was significantly decreased from 12% in 2018 to 2% in 2020 (p < 0.001).
Fig. 1Out-of-hospital cardiac arrest management and 30-day survival compared between pre-community intervention in 2018 and post-community intervention in 2020.
Although our community CPR project focused on motorcycle-taxi drivers, the response rate from our target group was low. This might be due to the low socioeconomic status of these service providers. Our survey of CFR revealed that 50% of our volunteers have an income level lower than the average cost of living in Thailand, so they may not have had enough time to attend the training. We will shorten the training and provide incentives to increase the response rate from our target group in the future. Our CFRs self-reported that 35% of them responded to OHCA scenes. Our community intervention increased the bystander CPR rate by addressing first response roles and by employing mobile technology similar to other studies.
Assessment of community interventions for bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a systematic review and meta-analysis.
Regrettably, the significant increase in bystander CPR did not improve 30-day survival. This may be explained by the fact that our community did not have enough public AED. In conclusion, our motorcycle-taxi CPR project indirectly influenced an increase in the bystander CPR rate in semi-urban and slum community in Thailand.
Funding
This study was funded by a grant from the Bangkoknoi Model Project of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (grant no: BKN 002).
Conflicts of interest
There are no conflicts of interest to declare.
References
Ong M.E.
Shin S.D.
De Souza N.N.
et al.
Outcomes for out-of-hospital cardiac arrests across 7 countries in Asia: The Pan Asian Resuscitation Outcomes Study (PAROS).
Assessment of community interventions for bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a systematic review and meta-analysis.
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