Out of Hospital Cardiac Arrest
Conditions
Keywords
cardiac arrest, dispatcher-assisted bystander cardiopulmonary resuscitation, survival
Brief summary
Despite aggressive cardiopulmonary resuscitation (CPR) training, the outcome of cardiac arrest is not good. The problem is method of education. So, the investigators want to add the dispatcher-assisted CPR simulation into conventional CPR training. In this study, the study is aimed to investigate the effect of newer CPR training program.
Detailed description
The training program focuses on working in team with dispatcher, performing all steps from recognizing cardiac arrest to performing CPR, together with the dispatcher. The one hours training session is split into four parts: 1. Video self-instruction manikin practice (30 min), including a brief introduction to automated external defibrillator (AED). 2. Practice in pairs (15 min). Practicing the dispatcher and rescuer role in a simulation to enhance learning. 3. Debriefing. Questions, answers and reflection (15 min). 4. Homework. Leaflet with tasks like learn how to activate the speaker function on your own phone. The main difference between dispatcher-assisted basic life support (DA-BLS) and traditional BLS training is that DA-BLS provides the scenes and interactive experiences on calling emergency medical service (EMS) and receiving CPR instruction via telephone speaker function, following up the skill training by scenario simulation training.
Interventions
OTHERBLS CPR program with dispatcher assisted CPR simulation
the training program more focuses on cooperation with a dispatcher, from recognition to perform DA-CPR and hands-on practice.
Sponsors
Seoul National University Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All out-of-hospital cardiac arrest (OHCA) patients with presumed cardiac etiology who are 19 years of age or older and assessed and treated by EMS providers after dispatched by the EMS dispatch center will be included.
Exclusion criteria
* We will exclude patients with non-cardiac etiology, prolonged cardiac arrest with a suspected duration more than 30 minutes, cases such as livor mortis or rigor mortis, and decapitated or decomposed body, and patients who have Do-Not-Resuscitate card documented by doctor.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Surviving to Hospital Discharge | from date of discharge, assessed up to 3 months | The study end points are survival to hospital discharge. Survival to discharge will be measured as proportions of patients who were discharged from a hospital with their spontaneous circulation recovered. This information will be collected from medical record review. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Return of Spontaneous Circulation (ROSC) | from date of cardiac arrest occurred, assessed up to 1 week | The return of spontaneous circulation will be measured as proportion of the patients who were recovered their circulation at emergency department. This information will be collected from the medical review. |
| Number of Participants With Good Neurological Recovery | from date of discharge, assessed up to 3 months | The Cerebral Performance Categories (CPC) score will be used to measure neurological recovery status: CPC 1 (good cerebral performance), CPC 2 (moderate cerebral disability), CPC 3 (severe cerebral disability), CPC 4 (coma or vegetative state), CPC 5 (brain death). We defined the good neurological recovery as CPC 1 or CPC 2. This information will be collected from medical record review. |
Countries
South Korea
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Districts Which Implement New DA-BLS Training Program A one-hour training course that includes a 30-minute video-based self-instruction (VSI) training session, a short role-play, and a debriefing. The video consists of a bystander CPR simulation with dispatcher instructions using the trainee's own phone and practice session following demonstration by a simulated layperson. After watching the video clip, all trainees are divided into two groups and conduct a role-play as dispatchers and laypersons for 15 minutes. Finally, there is a 15-minute debriefing session with several assignments. The HEROS program focuses on cooperation with a dispatcher, from recognition of cardiac arrest to performing DA-CPR, with hands-on practice so that laypersons can provide bystander CPR immediately in a real situation. Moreover, the HEROS program emphasizes practice for providing the correct address of the scene and switching to speakerphone mode, especially for the elderly. | 1,486 |
| Districts Which Keep Current BLS Training Program A one-hour training program that was developed by the Korea CDC and it was based on the AHA guideline (http://www.cdc.go.kr/board.es?mid=a20503050000&bid=0021&tag=&act=view&list\_no=127655). The program consists of a 30-minute VSI, and a 30-minute practice debriefing session. It focuses on detailed techniques for performing high-quality chest compressions including the correct hands and body position of the bystanders. | 8,641 |
| Total | 10,127 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | <19 years old | 49 | 326 |
| Overall Study | CPR not performed | 74 | 473 |
| Overall Study | incomplete data | 1 | 9 |
| Overall Study | non-cardiac etiology | 504 | 3,431 |
| Overall Study | occurred not at home | 298 | 2,474 |
| Overall Study | witnessed by paramedic | 139 | 917 |
Baseline characteristics
| Characteristic | Total | Districts Which Keep Current BLS Training Program | Districts Which Implement New DA-BLS Training Program |
|---|---|---|---|
| Age, Continuous | 74 years | 74 years | 74 years |
| bystander CPR | 6140 Participants | 5281 Participants | 859 Participants |
| DA-CPR | 7856 Participants | 6717 Participants | 1139 Participants |
| level of ED Level 1 | 1098 Participants | 1086 Participants | 12 Participants |
| level of ED Level 2 | 7809 Participants | 6533 Participants | 1276 Participants |
| level of ED Level 3 | 1220 Participants | 1022 Participants | 198 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 10127 Participants | 8641 Participants | 1486 Participants |
| Race (NIH/OMB) White | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Female | 4110 Participants | 3487 Participants | 623 Participants |
| Sex: Female, Male Male | 6017 Participants | 5154 Participants | 863 Participants |
| shockable rhythm | 1267 Participants | 1080 Participants | 187 Participants |
| witnessed by laypersons | 4674 Participants | 3993 Participants | 681 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 1,401 / 1,486 | 8,090 / 8,641 |
| other Total, other adverse events | 0 / 1,486 | 0 / 8,641 |
| serious Total, serious adverse events | 1,401 / 1,486 | 8,090 / 8,641 |
Outcome results
Primary
Number of Participants Surviving to Hospital Discharge
The study end points are survival to hospital discharge. Survival to discharge will be measured as proportions of patients who were discharged from a hospital with their spontaneous circulation recovered. This information will be collected from medical record review.
Time frame: from date of discharge, assessed up to 3 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Districts Which Implement Newer DA-BLS Training Program | Number of Participants Surviving to Hospital Discharge | 85 Participants |
| Districts Which Keep Traditional BLS Training Program | Number of Participants Surviving to Hospital Discharge | 551 Participants |
p-value: 0.34Chi-squared
Secondary
Number of Participants With Good Neurological Recovery
The Cerebral Performance Categories (CPC) score will be used to measure neurological recovery status: CPC 1 (good cerebral performance), CPC 2 (moderate cerebral disability), CPC 3 (severe cerebral disability), CPC 4 (coma or vegetative state), CPC 5 (brain death). We defined the good neurological recovery as CPC 1 or CPC 2. This information will be collected from medical record review.
Time frame: from date of discharge, assessed up to 3 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Districts Which Implement Newer DA-BLS Training Program | Number of Participants With Good Neurological Recovery | 42 Participants |
| Districts Which Keep Traditional BLS Training Program | Number of Participants With Good Neurological Recovery | 316 Participants |
p-value: 0.11Chi-squared
Secondary
Number of Participants With Return of Spontaneous Circulation (ROSC)
The return of spontaneous circulation will be measured as proportion of the patients who were recovered their circulation at emergency department. This information will be collected from the medical review.
Time frame: from date of cardiac arrest occurred, assessed up to 1 week
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Districts Which Implement Newer DA-BLS Training Program | Number of Participants With Return of Spontaneous Circulation (ROSC) | 544 Participants |
| Districts Which Keep Traditional BLS Training Program | Number of Participants With Return of Spontaneous Circulation (ROSC) | 3118 Participants |
p-value: 0.7Chi-squared