Clinical trial NCT02007499: Pre-arrival Instructions Effect on Bystander Cardiopulmonary Resuscitation (CPR).
Official title: The Effect of Pre-arrival Instructions on the Rate of Bystander Cardiopulmonary Resuscitation (CPR) for Patients in "Out of Hospital Cardiac Arrest (OHCA)".
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Heart Arrest
Cardiac Arrest
Cardiopulmonary Arrest
Out of Hospital Cardiac Arrest
Sudden Cardiac Death
Keywords: Prehospital emergency care
Out of hospital cardiac arrest
Cardiopulmonary resuscitation
CPR
Heart arrest
Outcome
Bystander
Lead sponsor: Medical College of Wisconsin
Sponsor class: OTHER
First posted: 2013-12-10
Enrollment: 4000
Sex: ALL
Minimum age (years): 21
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: ECOLOGIC_OR_COMMUNITY
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: The population of this study will be all patients with OHCA (absence of a detectable pulse, unresponsiveness, and apnea) occurring in the select communities, from January 1, 2009, to December 31, 2013 (five years).

Brief summary: The investigators hypothesized that pre-arrival instructions would increase the likelihood of bystanders performing Cardiopulmonary Resuscitation (CPR).

Detailed description: The City of Milwaukee and surrounding communities combine to form Milwaukee County covering 241 square miles and serving approximately 959,521 people. Milwaukee County includes 19 separate municipalities. Community demographics and other characteristics have remained largely stable for the past decade.

The study will take place in Milwaukee County from 2009 - 2013 in the communities providing Cardiopulmonary Resuscitation (CPR) pre-arrival instructions: West Allis and Oak Creek.

In Milwaukee County Basic Live Support (BLS) shall be started on all patients in cardiac arrest with the exception of victims with: decapitation; rigor mortis; evidence of tissue decomposition; dependent lividity; presence of a valid Do-Not-Resuscitate (DNR) or Physician Orders for Life-Sustaining Treatment (POLST); fire victim with full thickness burns to 90% or greater body surface area; hypothermic patients with signs of frozen tissue, rigid airway, ice formation in mouth, or chest noncompliant for Cardiopulmonary Resuscitation (CPR). The system standard is: Cardiopulmonary Resuscitation (CPR) will be provided whenever patient is pulseless; compressions at least 100/minute; hands on chest more than 75% of time; minimum compression depth of 2 inches in adults 75% of the time.

Therefore, the investigators will analyze data to assess how Cardiopulmonary Resuscitation (CPR) pre-arrival instructions may have affected the probability of receiving bystander Cardiopulmonary Resuscitation (CPR).

Eligibility criteria: Inclusion Criteria:

* Patients 21 years old or older
* Presumed cardiac origin as indicated on the Milwaukee County Emergency Medical Services (MCEMS) report
* Non-Emergency Medical Services (EMS) witnessed arrest

Exclusion Criteria:

* Patients younger than 21 years old
* Patients who are "obviously dead" (decomposition, rigor mortis, decapitation, or other)
* Trauma victims, including hanging and burns
* 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
* Patients determined to be a do-not-resuscitate (DNR) upon arrival of Emergency Medical Services (EMS) providers
* Cardiopulmonary Resuscitation (CPR) by someone other than Emergency Medical Services (EMS) who is a trained first responder or health care provider with a predetermined duty to provide care.

Primary outcomes:
measure: Incidence of bystander Cardiopulmonary Resuscitation (CPR) in Out of Hospital Cardiac Arrest (OHCA)
timeFrame: January, 01 2009 - December, 31 2013
Secondary outcomes:
measure: Survival to hospital discharge or to December, 31 2013 whichever comes first
timeFrame: January, 01 2009 - December, 31 2013
Other outcomes:
Locations:
city: Milwaukee
country: United States
facility: Medical College of Wisconsin
state: Wisconsin
Study officials:
affiliation: Medical College of Wisconsin
name: Khalid A. Ateyyah, MD, SBEM
role: PRINCIPAL_INVESTIGATOR
References:
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citation: Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, Rea T, Lowe R, Brown T, Dreyer J, Davis D, Idris A, Stiell I; Resuscitation Outcomes Consortium Investigators. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA. 2008 Sep 24;300(12):1423-31. doi: 10.1001/jama.300.12.1423.
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citation: Sasson C, Magid DJ, Chan P, Root ED, McNally BF, Kellermann AL, Haukoos JS; CARES Surveillance Group. Association of neighborhood characteristics with bystander-initiated CPR. N Engl J Med. 2012 Oct 25;367(17):1607-15. doi: 10.1056/NEJMoa1110700.
citation: Abella BS, Aufderheide TP, Eigel B, Hickey RW, Longstreth WT Jr, Nadkarni V, Nichol G, Sayre MR, Sommargren CE, Hazinski MF; American Heart Association. Reducing barriers for implementation of bystander-initiated cardiopulmonary resuscitation: a scientific statement from the American Heart Association for healthcare providers, policymakers, and community leaders regarding the effectiveness of cardiopulmonary resuscitation. Circulation. 2008 Feb 5;117(5):704-9. doi: 10.1161/CIRCULATIONAHA.107.188486. Epub 2008 Jan 14. No abstract available.
citation: Billittier AJ 4th, Lerner EB, Tucker W, Lee J. The lay public's expectations of prearrival instructions when dialing 9-1-1. Prehosp Emerg Care. 2000 Jul-Sep;4(3):234-7. doi: 10.1080/10903120090941254.
citation: Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett P, Becker L, Bossaert L, Delooz H, Dick W, Eisenberg M, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. Task Force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Ann Emerg Med. 1991 Aug;20(8):861-74. No abstract available.
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