Discrepancies in Bystander CPR Documentation: Comparing the Birmingham CARES Data with 9-1-1 Audio Review

OBJECTIVES: To evaluate the agreement between bystander cardiopulmonary resuscitation (B-CPR) documented by emergency medical services (EMS) personnel in the Birmingham Cardiac Arrest Registry to Enhance Survival (CARES) and B-CPR identified through 9-1-1 audio review. METHODS: We conducted a retrospective observational analysis of adult non-traumatic out-of-hospital cardiac arrest (OHCA) cases in Birmingham from January 1 to December 31, 2023. We excluded EMS-witnessed events, those in nursing homes, health care facilities, jails/prisons, or involving patients who were conscious during the 9-1-1 call. The provision of B-CPR was classified as "yes" or "no" in CARES based on EMS documentation and compared to B-CPR status determined through review of the corresponding 9-1-1 audio by a single reviewer. Agreement between sources was assessed using percent agreement, Cohen's kappa, Gwet's AC, and McNemar's test. CONCLUSIONS: The provision of B-CPR differed in nearly 25% of OHCA cases when comparing EMS documentation with 9-1-1 audio review. Most discrepancies resulted from early termination of B-CPR by the caller prior to EMS arrival, while a smaller proportion appeared to reflect EMS misclassification. These findings underscore the importance of sustained telecommunicator CPR instruction through EMS arrival at the patient's side.