Impact of language barrier during emergency call on out of hospital cardiac arrest treatment and outcomes.

Abstract

In out-of-hospital cardiac arrest (OHCA), a language barrier between a 9-1-1 caller and telecommunicator can challenge communication and OHCA recognition. However, little is known about downstream effects on care. We assessed how a language barrier in the 9-1-1 call influences the chain of survival and clinical outcomes after OHCA. We conducted a cohort investigation of adult OHCA in King County, Washington between 2014-2023. Audio recordings were used to determine language barrier. We applied chi-square, Mann-Whitney-U test, and logistic regression to compare links in the chain of survival and clinical outcomes according to language barrier. Of 6146 eligible OHCA, 204 (3%) involved a language barrier. A language barrier was associated with delays in OHCA recognition (2.0 vs 1.0 min), time to assisted bystander CPR (2.2 vs 1.1 min), lower rates of bystander CPR (75% vs 89%) and early AED application (7% vs 13%) (p < 0.001, for all). EMS and hospital care did not differ between those with versus without a language barrier including field intubation (95% vs 96%), epinephrine administration (88% vs 88%), post-OHCA coronary angiogram (27% vs 33%) and targeted temperature management (54% vs 52%) (p > 0.19 for all). Likewise, outcomes did not differ according to language barrier status including rates of hospital admission (46% vs 41%) and survival to discharge (18% vs 17%) (p > 0.1 for all). Language barrier challenged early CPR and defibrillation but was not associated with differential EMS or hospital care, highlighting the potential for systems to effectively care for OHCA regardless of 9-1-1 language barrier.