Cardiac Arrest (CA)
Conditions
Keywords
cardiac arrest, automated external defibrillator, dispatcher-assisted cardiopulmonary resuscitation, no-flow time, chest compression fraction
Brief summary
Out-of-hospital cardiac arrest (OHCA) remains a leading cause of mortality worldwide, with survival highly dependent on the immediate initiation of bystander cardiopulmonary resuscitation (CPR). Early recognition, prompt chest compressions, and rapid defibrillation are critical components of the chain of survival. Telephone-assisted CPR (T-CPR) provided by emergency dispatchers has been shown to significantly increase bystander intervention rates and improve outcomes. While the availability and use of automated external defibrillators (AEDs) further enhance survival, the optimal integration of AED use into dispatcher-guided, single-rescuer scenarios remains insufficiently studied. This prospective, randomized, controlled simulation study aims to evaluate the effect of modified telephone cardiopulmonary resuscitation (T-CPR) instructions optimized for automated external defibrillator (AED) use on no-flow time and chest compression fraction (CCF) during single-rescuer resuscitation. Participants are randomized to receive either standard T-CPR instructions or enhanced instructions focusing on minimizing interruptions in chest compressions and reducing time to first compression during AED use.
Detailed description
Out-of-hospital cardiac arrest (OHCA) is a major public health problem associated with low survival rates despite advances in emergency care systems. Survival is critically dependent on early recognition, immediate initiation of high-quality chest compressions, and timely defibrillation. Bystander intervention plays a pivotal role in this process, and telephone-assisted cardiopulmonary resuscitation (T-CPR) has been demonstrated to substantially increase the likelihood of CPR initiation prior to the arrival of emergency medical services. The increasing availability of automated external defibrillators (AEDs) in public spaces has further strengthened the chain of survival. Early defibrillation is a key determinant of favorable outcomes, particularly in shockable rhythms. However, the integration of AED use into dispatcher-assisted scenarios - especially when only a single rescuer is present - poses practical challenges. In such situations, the rescuer must balance multiple tasks, including chest compressions, AED retrieval, device preparation, and adherence to voice prompts, all of which may introduce interruptions in compressions and increase no-flow time. While the benefits of T-CPR and AED use independently are well established, there is limited evidence on how dispatcher instructions can optimally coordinate these interventions in single-rescuer scenarios. In particular, it remains unclear whether modified, AED-optimized T-CPR instructions can reduce no-flow time and improve chest compression fraction (CCF) by minimizing unnecessary interruptions and optimizing task sequencing. This prospective, randomized, controlled simulation study aims to evaluate the effect of modified telephone cardiopulmonary resuscitation (T-CPR) instructions optimized for automated external defibrillator (AED) use on no-flow time and chest compression fraction (CCF) during single-rescuer resuscitation. Participants are randomized to receive either standard T-CPR instructions or enhanced instructions focusing on minimizing interruptions in chest compressions and reducing time to first compression during AED use.
Interventions
BEHAVIORALT-CPR
Participants receive structured telephone CPR instructions reflecting current national practice. AED retrieval is instructed early; however, no additional guidance is provided to optimize timing or minimize interruptions during AED use.
BEHAVIORALAED-optimized T-CPR
Participants receive standard T-CPR instructions supplemented with specific guidance aimed at: * minimizing interruptions in chest compressions, * reducing time to first chest compression, * optimizing AED use workflow. Key elements include: * immediate activation of the AED upon retrieval, * initiation of chest compressions even if AED voice prompts have not yet reached relevant steps, * continuation of compressions during AED preparation and charging (when appropriate), * minimization of pauses before and after shock delivery.
Sponsors
University of Pecs
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
Participants will be informed about their group assignment post-randomization but will be blinded to the study's aims. The dispatcher will be briefed on their specific tasks but will remain blinded to the study hypotheses and outcomes.
Eligibility
Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Adolescents and adults (≥16 years) * Healthcare professionals or laypersons * Voluntary participation
Exclusion criteria
* pregnant women * people with cardio-pulmonary and musculoskeletal diseases or any other impairment that would risk harm for the volunteer while performing CPR * physical and/or psychological disabilities * technical issue during data collection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| No-flow time | During procedure. | Time without chest compressions measured from entry into the simulation (collapse recognition) until termination of the scenario (giving the third shock). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to first chest compression | During procedure. | The time (in seconds) until the first chest compression (measured from entering the scenario). |
| Time to first shock | During procedure | The time to the first shock by the AED (in seconds, from the time of entering the scenario). |
| Chest compression fraction | During procedure. | Proportion of time during which chest compressions are performed (until giving the third shock), calculated from the first chest compression until scenario termination. |
| Peri-shock pause | During procedure | The time without chest compression (in seconds) before and after giving the shock. |
Countries
Hungary
Outcome results
None listed