Multifaceted Intervention for Increasing Performance of CPR by Laypersons in Out-of-hospital Cardiac Arrest

Study Overview
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Brief Summary
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Cardiac arrest (CA) early recognition is essential in order to rapidly activate emergency services and for bystanders to begin cardiopulmonary resuscitation (CPR). As soon as a call is received, EMS dispatchers should try to identify CA. This may be difficult, in a context of stress and distress of the person calling. Yet, it is vital for bystanders to initiate CPR. Survival can be multiplied by 2 to 4 if the bystanders initiate a CPR before the arrival of the emergency medical services. This work aim to assess a multifaceted intervention combining 3 elements to improve the initial phone recognition of CA and raise the number of patients benefiting from CPR before EMS arrival on scene. The first element is a dispatcher training to the early phone recognition of CA. This training will be based on the concept of active teaching, favouring the interactive work of learners in particular by listening to real dispatch recordings. It will be completed by continuing education with a distance teaching platform including the systematic listening of recorded CA calls. The second element is based on the deployment of a software aiming to notify CA thanks to mobile phones. This system interfaced to a control software enables to request the participation of CPR-trained volunteers automatically. The volunteers have to be located in the patient's surroundings. The deployment of this mobile application will rely on first-aid volunteers, health personal and any trained volunteers willing to participate. A randomized control study in one city area proved the efficiency of a similar software to improve the proportion of CPR by bystanders. The third element consists in a motivational feedback. A weekly overview of the management and the outcomes of patients who suffered CA will be broadcast to all the responders and volunteers in the mobile application.

Official Title
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Multifaceted Intervention for Increasing Performance of Cardiopulmonary Resuscitation by Laypersons in Out-of-hospital Cardiac Arrest. A Stepped Wedge Cluster Randomized Controlled Trial

Conditions
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Cardiac Arrest

Intervention / Treatment
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* Other: Multifaceted intervention including 3 components


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All adults with nontraumatic, out-of-hospital cardiac arrest diagnosed during the emergency medical service call Cardiac arrest located in urban area Exclusion Criteria: Pregnant or breastfeeding women Patients under the law Patients deprived of liberty by court ruling or administrative ruling Traumatic cardiac arrest CA occurring under the eyes of a professional emergency services patrol on duty Cardiac arrest for which resuscitation seem unjustified (inevitable death, terminally ill irreversible condition, too long duration of cardiac arrest, non-resuscitation personal directive…)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Sequential Assignment
Interventional Model Description: A Stepped Wedge Cluster Randomized Controlled Trial
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control Group<br>Usual management of patients according to international guidelines. Protocols of call acceptance, phone advice and sending of emergency services are not modified | |
| Other: Test Group<br>Multifaceted intervention Training using distance learning for medical regulation assistants to recognise cardiac arrest on phone Activation of the location-software application to send bystanders on cardiac arrest location before the arrival of emergency medical services (EMS) Motivation feed-back Volunteers will received feed-back regarding CPR initiated before EMS arrival and survival | Other: Multifaceted intervention including 3 components<br>* Multifaceted intervention including Dispatcher training to improve cardiac phone recognition, mobile application to send bystanders on cardiac arrest location before first professionals rescuers and motivational support for volunteer bystanders<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CPR initiated by bystanders before the arrival of first professionals rescuers | Proportion of patients who's received CPR initiated by bystander before EMS arrival. | Day 0 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Survival at 72h after out-of-hospital cardiac arrest | survival at 72h | 72 hours | 
| Return of Spontaneous Circulation | Proportion of patients who's recovered a spontaneous circulation after CPR | Day 0 | 
| Survival to hospital admission | Vital status at hospital admission | Day 0 | 
| Survival to hospital discharge | Vital status at hospital discharge | up to 30 days | 
| Survival at 30 days | Vital status at 30 days | 30 days | 
| Neurological functional status CPC | As measured by Cerebral Performance Category (CPC) at hospital discharge and at 30 days Score less or equal to 2 will be considered as favorable neurological outcome | up to 30 days | 
| Neurological functional status mRS | As measured by modified Rankin Scale (mRS) at hospital discharge and at 30 days: modified Rankin Scale (mRS): 0 - No symptoms. - No significant disability. Able to carry out all usual activities, despite some symptoms. - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities. - Moderate disability. Requires some help, but able to walk unassisted. - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted. - Severe disability. Requires constant nursing care and attention, bedridden, incontinent. - Dead Score less or equal to 3 will be considered as favorable neurological outcome | 30 days | 
| First recorded rhythm | First recorded cardiac rhythm by EMS | 30 min | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cardiac Arrest, Dispatcher, Cardiopulmonary Resuscitation