What is T-CPR?

Telephone-assisted cardiopulmonary reanimation or T-CPR is a powerful tool to increase the rate of cardiopulmonary reanimation (CPR) performed by bystanders and to reduce the time without cardiac compressions until the emergency service arrives. It is known that immediate bystander cardiopulmonary reanimation (CPR) increases the outcome after sudden cardiac arrest up to four times.1, 2 Despite out-of-hospital cardiac arrest is witnessed in 60-80%, bystander CPR is delivered in less than 1 in 5 out-of-hospital cardiac arrests.3 However, there where manifold reasons why bystanders not initiate CRP: Bystanders can be  panicky or can be afraid of performing CPR incorrectly or that they potentially harm the patient.4 And even though bystanders were trained in performing CPR, not all trained bystanders initiate CPR. Thus, in the case of witnessed cardiac arrest, T-CPR may be the decisive factor for the initiation of bystander CPR.

How to conduct T-CPR?

The European Resuscitation Council (ERC) Guidelines for Resuscitation 2015 and the guidelines of the American Heart Association (AHA) Guidelines 2015 recommended concordantly the introduction of T-CPR in order to increase the bystander willingness to perform CPR.5,6 In practical terms, in the case a caller reports an adult who is unresponsive and not breathing or not breathing normally (ie, only gasping), the dispatcher at the emergency call centers provide structured information how CPR should be performed via telephone.6 It is now clear, that T-CPR or sometimes called dispatcher-assisted CPR increases the survival after sudden cardiac arrest.5,7 However, when telephone guidance is needed, survival is improved when compression-only CPR is provided as compared with conventional CPR for adult victims of cardiac arrest6,7 and multiple studies have shown no difference in survival when comparing compression-only CPR versus conventional CPR.6
To date, T-CPR is established in many emergency call centers. However, interrogations and protocols for T-CPR vary between emergency call centers.8 Therefore, our aim is to introduce standardized T-CPR in the emergency call centers worldwide. In the video below we show a typical situation, in which cardiac arrest sometimes takes place and how T-CPR is performed. For further information about T-CPR, Maler et al. recently published a readable overview about the current literature regarding T-CPR.8

1.    Holmberg M, Holmberg S, Herlitz J: Effect of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation 2000;47:59–70.
2.    Bottiger BW, van Aken H: Kids save lives--Training school children in cardiopulmonary resuscitation worldwide is now endorsed by the World Health Organization (WHO). Resuscitation 2015;94:A5-7.
3.    Grasner J-T, Bossaert L: Epidemiology and management of cardiac arrest: what registries are revealing. Best practice & research. Clinical anaesthesiology 2013;27:293–306.
4.    Swor R, Khan I, Domeier R, Honeycutt L, Chu K, Compton S: CPR training and CPR performance: do CPR-trained bystanders perform CPR? Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2006;13:596–601.
5.    Perkins GD, Travers AH, Berg RA, Castren M, Considine J, Escalante R, Gazmuri RJ, Koster RW, Lim SH, Nation KJ, Olasveengen TM, Sakamoto T, Sayre MR, Sierra A, Smyth MA, Stanton D, Vaillancourt C: Part 3: Adult basic life support and automated external defibrillation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015;95:e43-69.
6.    Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, Gazmuri RJ, Travers AH, Rea T: Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S414-35.
7.    Hupfl M, Selig HF, Nagele P: Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis. Lancet (London, England) 2010;376:1552–7.
8.    M. Maier, M. Luger, M. Baubin: Telephone-assisted CPR - A literature review. Notfall Rettungsmed 2016.


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