Cardiac Arrest
Conditions
Keywords
cardiac arrest, bystander cardiopulmonary resuscitation CPR, dispatch-assisted CPR instructions, agonal breathing
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.
Interventions
BEHAVIORALEducation
An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback.
Sponsors
Ottawa Hospital Research Institute
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Agonal Breathing | At the time of the cardiac arrest event | By reviewing recordings of all cardiac arrest calls, including missed cases retrieved from a registry, document presence or absence of agonal breathing. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Cases Where Cardiac Arrest Was Recognized by the Ambulance Dispatcher | At the time of the cardiac arrest event | By reviewing recordings of all cardiac arrest calls, collect information on dispatcher recognition of cardiac arrest to bystander implementation of chest compressions |
Other
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Received Bystander CPR | At the time of the cardiac arrest event | The first member of the emergency response team to arrive at scene will document whether or not chest compressions have been initiated by someone prior to the arrival of emergency team |
| Number of Participants Surviving to Hospital Discharge | At the time of the cardiac arrest event to discharge alive from hospital (varies, depending on length of hospital stay) | Accessing hospital medical records or coroner's reports, assess survival of cardiac arrest victim as being discharged alive from hospital |
Countries
Canada
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Training Site All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy.
Education: An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback. | 689 |
| Control Site All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival | 387 |
| Total | 1,076 |
Baseline characteristics
| Characteristic | Training Site | Control Site | Total |
|---|---|---|---|
| Age, Continuous | 68 years | 68 years | 68 years |
| Initial Cardiac Rhythm Ventricular Fibrillation/Ventricular Tachycardia | 199 Participants | 87 Participants | 286 Participants |
| Race and Ethnicity Not Collected | — | — | 0 Participants |
| Region of Enrollment Canada | 689 participants | 387 participants | 1076 participants |
| Sex: Female, Male Female | 217 Participants | 136 Participants | 353 Participants |
| Sex: Female, Male Male | 472 Participants | 251 Participants | 723 Participants |
| Witnessed Status | 310 Participants | 162 Participants | 472 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 689 | 0 / 387 |
| serious Total, serious adverse events | 0 / 689 | 0 / 387 |
Outcome results
Primary
Number of Participants With Agonal Breathing
By reviewing recordings of all cardiac arrest calls, including missed cases retrieved from a registry, document presence or absence of agonal breathing.
Time frame: At the time of the cardiac arrest event
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Training Site | Number of Participants With Agonal Breathing | 176 Participants |
| Control Site | Number of Participants With Agonal Breathing | 87 Participants |
Secondary
Number of Cases Where Cardiac Arrest Was Recognized by the Ambulance Dispatcher
By reviewing recordings of all cardiac arrest calls, collect information on dispatcher recognition of cardiac arrest to bystander implementation of chest compressions
Time frame: At the time of the cardiac arrest event
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Training Site | Number of Cases Where Cardiac Arrest Was Recognized by the Ambulance Dispatcher | 495 Participants |
| Control Site | Number of Cases Where Cardiac Arrest Was Recognized by the Ambulance Dispatcher | 287 Participants |
Other Pre-specified
Number of Participants Surviving to Hospital Discharge
Accessing hospital medical records or coroner's reports, assess survival of cardiac arrest victim as being discharged alive from hospital
Time frame: At the time of the cardiac arrest event to discharge alive from hospital (varies, depending on length of hospital stay)
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Training Site | Number of Participants Surviving to Hospital Discharge | 86 Participants |
| Control Site | Number of Participants Surviving to Hospital Discharge | 27 Participants |
Other Pre-specified
Number of Participants Who Received Bystander CPR
The first member of the emergency response team to arrive at scene will document whether or not chest compressions have been initiated by someone prior to the arrival of emergency team
Time frame: At the time of the cardiac arrest event
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Training Site | Number of Participants Who Received Bystander CPR | 247 Participants |
| Control Site | Number of Participants Who Received Bystander CPR | 153 Participants |