Clinical trial NCT00664443: Effectiveness of Dispatch-Assisted Cardiopulmonary Resuscitation (CPR) Instructions
Official title: Effectiveness of Dispatch-Assisted Cardiopulmonary Resuscitation (CPR) Instructions: An Evaluation of 9-1-1 Calls.
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Cardiac Arrest
Keywords: cardiac arrest
CPR
resuscitation
bystander CPR
dispatch-assisted CPR
Lead sponsor: Ottawa Hospital Research Institute
Sponsor class: OTHER
Collaborators: name: Canadian Institutes of Health Research (CIHR)
First posted: 2008-04-23
Enrollment: 2260
Sex: ALL
Minimum age (years): 16
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients with out-of-hospital cardiac arrest

Brief summary: The overall goal of this study is to better understand the factors leading to successful dispatch-assisted CPR instructions and to ultimately save the lives of more cardiac arrest patients. Specific objectives are to: 1) Determine the ability of 9-1-1 dispatchers to make the diagnosis of cardiac arrest over the phone; 2) Quantify the frequency and impact of perceived agonal breathing on cardiac arrest diagnosis; 3) Measure the frequency with which dispatch-assisted CPR instructions can be successfully completed in out-of-hospital cardiac arrest cases; and 4) Measure the impact of dispatch-assisted CPR instructions on bystander CPR and survival rates for out-of-hospital cardiac arrest.

Detailed description: Background: Cardiac arrest is the leading cause of mortality in Canada, and the overall survival rate for out-of-hospital cardiac arrest rarely exceeds 5%. Survivors have a quality of life similar to the general population. While bystander CPR can increase survival for cardiac arrest victims up to four times, bystander CPR rates remain low in Canada (15%). Many Canadian urban communities offer 9-1-1 dispatch-assisted CPR instructions to callers reporting a victim in cardiac arrest. Some evidence suggests that agonal breathing can be misinterpreted as a sign of life by Dispatch Officers, resulting in the inappropriate withholding of dispatch-assisted CPR instructions. Dispatch-assisted CPR instructions are recommended by the International Guidelines on Emergency Cardiovascular Care, but their ability to improve cardiac arrest survival remains unclear according to a systematic review of the literature.

Objectives: The overall goal of this study is to better understand the factors leading to successful dispatch-assisted CPR instructions and to ultimately save more lives of cardiac arrest patients. Specific objectives are to: 1) Determine the ability of 9-1-1 dispatchers to make the diagnosis of cardiac arrest over the phone; 2) Quantify the frequency and impact of perceived agonal breathing on cardiac arrest diagnosis; 3) Measure the frequency with which dispatch-assisted CPR instructions can be successfully completed in out-of-hospital cardiac arrest cases; and 4) Measure the impact of dispatch-assisted CPR instructions on bystander CPR and survival rates for out-of-hospital cardiac arrest.

Methods: We will conduct a before-after, prospective cohort study that evaluates 9-1-1 call reporting for out-of-hospital cardiac arrest victims. The study will take place in 19 urban communities in Ontario providing dispatch-assisted CPR instructions since April 1st 2004. The study population will include all 9-1-1 callers reporting out-of-hospital cardiac arrests for which resuscitation was attempted in patients 16-years or older. The dispatch center protocol consists of establishing the nature of the emergency before initiating the appropriate level of response; this includes asking standardized questions to determine if cardiac arrest is present. The Dispatch Officer then offers CPR instructions over the telephone while emergency response vehicles are on their way to the location. Standardized data collection tools will be used to extract information from: 9-1-1 call recordings, paramedic patient care reports, base hospital records, fire medical records, and hospital medical records. All participating centers already combine information from various sources in a cardiac arrest registry. The following information will be collected: confirmation of cardiac arrest status by the Dispatch Officer, presence of apparent agonal breathing, CPR instructions offered to the 9-1-1 callers, factors influencing the ability of 9-1-1 callers to perform CPR including their proximity to the victim's location and their emotional receptiveness to instructions, the time interval between the call to 9-1-1 and the initiation of CPR by the bystander. Measurements will include the accuracy of cardiac arrest diagnosis, the frequency of perceived agonal breathing during cardiac arrest, 9-1-1 caller's ability to receive instructions and initiate CPR, bystander CPR rates, and survival to hospital discharge. Data analysis for Objective #1 will include sensitivity, specificity and receiver operating characteristic curve; Objectives #2 and #3 will be analyzed using descriptive statistics; and for Objective #4 univariate, stepwise logistic regression, and time series analysis will be performed to control for trends over time and variables otherwise associated with bystander CPR and survival rates in 6000 arrest victims.

Eligibility criteria: Inclusion Criteria:

All patients with out-of-hospital cardiac arrest (absence of a detectable pulse, unresponsiveness, and apnea) that are:

* Of presumed cardiac origin;
* Occurring in our study communities; and
* For which resuscitation is attempted by a bystander and/or the emergency responders; or for which dispatch-assisted CPR instructions are being provided.

Exclusion Criteria:

The following patients will be excluded:

* Patients younger than 16 years;
* 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; or
* Patients with cardiac arrests clearly of other 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: Sensitivity
timeFrame: At time of 9-1-1 call
Secondary outcomes:
Other outcomes:
measure: Specificity
timeFrame: At time of 9-1-1 call
Locations:
city: Ottawa
country: Canada
facility: Ottawa Hospital Research Institute
state: Ontario
Study officials:
affiliation: OHRI
name: Christian Vaillancourt, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Vaillancourt C, Charette M, Kasaboski A, Hoad M, Larocque V, Crete D, Logan S, Lamoureux P, McBride J, Cheskes S, Wells GA, Stiell IG. Cardiac arrest diagnostic accuracy of 9-1-1 dispatchers: a prospective multi-center study. Resuscitation. 2015 May;90:116-20. doi: 10.1016/j.resuscitation.2015.02.027. Epub 2015 Mar 9.
citation: Vaillancourt C, Charette ML, Stiell IG, Wells GA. An evaluation of 9-1-1 calls to assess the effectiveness of dispatch-assisted cardiopulmonary resuscitation (CPR) instructions: design and methodology. BMC Emerg Med. 2008 Nov 5;8:12. doi: 10.1186/1471-227X-8-12.