Clinical trial NCT01872325: Improving Cardiac Arrest Diagnostic Accuracy of Emergency Medical Dispatchers
Official title: Improving the Cardiac Arrest Diagnostic Accuracy of 9-1-1 Emergency Medical Dispatchers
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Cardiac Arrest
Keywords: cardiac arrest
bystander cardiopulmonary resuscitation CPR
dispatch-assisted CPR instructions
agonal breathing
Lead sponsor: Ottawa Hospital Research Institute
Sponsor class: OTHER
First posted: 2013-06-07
Enrollment: 1076
Sex: ALL
Minimum age (years): 16
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: All patients with out-of-hospital cardiac arrest

Brief summary: The main goal of this project is to help 9-1-1 emergency medical dispatchers save the lives of more cardiac arrest victims. The investigators will develop teaching tools to help the dispatchers recognize abnormal breathing that may indicate a victim as having a cardiac arrest. After training sessions, the investigators will see if dispatchers can get better at recognizing abnormal breathing, how often they give CPR instructions, and if use of the teaching tool will increase bystander CPR and the number of victims leaving the hospital alive.

Detailed description: Cardiac arrest is a leading cause of death in Canada; it is defined as the sudden cessation of cardiac mechanical activity. It is uniformly fatal if not treated within minutes. More than 85% of out-of-hospital cardiac arrest (OOHCA) occur in residential locations so public access to automatic external defibrillators, to restart the heart, are not helpful. The overall rate of survival for OOHCA rarely exceeds 8%.

Bystander cardiopulmonary resuscitation (CPR) is chest compression and ventilations provided by someone not on the emergency response team. A victim or cardiac arrest is almost 4 times more likely to survive when receiving bystander CPR. However, despite various attempts to improve bystander rates they have remained low, not exceeding 15% in Ontario. It has been shown that since the ambulance dispatch centres in Ontario implemented dispatch-assisted CPR instructions (given to callers while emergency vehicles were on the way), there was a significant increase in use.

Emergency medical dispatchers can identify about 70% of OOHCA cases over the phone. Agonal breathing (laboured breathing preceding death) may be misinterpreted as a sign of life, and is responsible for as much as 50% of missed diagnoses. There is no specific training on the significance of this sign, and minimal information about recognizing cardiac arrest. An educational intervention designed to better understand the significance of agonal breathing and to clarify the existing CPR instruction protocol will most likely increase the frequency of CPR instructions, bystander CPR rates, and potentially survival of victims of cardiac arrest.

Eligibility criteria: Inclusion Criteria:

* presumed cardiac origin
* event occurs in the catchment area of Training or Control Site
* resuscitation is attempted by a bystander and/or the emergency responders

Exclusion Criteria:

* patients younger than 16 years old
* patients who are "obviously dead" as defined by the Ambulance Act of Ontario (decomposition, rigor mortis, decapitation, or other)
* trauma victims including hanging and burns
* cardiac arrest of non-cardiac origin including drug overdose, carbon monoxide poisoning, drowning, exsanguination, electrocution, asphyxia, hypoxia related to respiratory disease, cerebrovascular accident, and documented terminal illness

Primary outcomes:
measure: Number of Participants With Agonal Breathing
timeFrame: At the time of the cardiac arrest event
Secondary outcomes:
measure: Number of Cases Where Cardiac Arrest Was Recognized by the Ambulance Dispatcher
timeFrame: At the time of the cardiac arrest event
Other outcomes:
measure: Number of Participants Who Received Bystander CPR
timeFrame: At the time of the cardiac arrest event
measure: Number of Participants Surviving to Hospital Discharge
timeFrame: At the time of the cardiac arrest event to discharge alive from hospital (varies, depending on length of hospital stay)
Locations:
city: Ottawa
country: Canada
facility: Ottawa Hospital Research Institute
state: Ontario
Study officials:
affiliation: The Ottawa Hospital Research Institute and University of Ottawa
name: Christian Vaillancourt, MD,MSc,FRCPC
role: PRINCIPAL_INVESTIGATOR
References: