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Cardiac arrest (CA) early recognition is essential in order to rapidly activate emergency services and for bystanders to begin cardiopulmonary resuscitation (CPR).
As soon as a call is received, EMS dispatchers should try to identify CA. This may be difficult, in a context of stress and distress of the person calling. Yet, it is vital for bystanders to initiate CPR. Survival can be multiplied by 2 to 4 if the bystanders initiate a CPR before the arrival of the emergency medical services.
This work aim to assess a multifaceted intervention combining 3 elements to improve the initial phone recognition of CA and raise the number of patients benefiting from CPR before EMS arrival on scene.
The first element is a dispatcher training to the early phone recognition of CA. This training will be based on the concept of active teaching, favouring the interactive work of learners in particular by listening to real dispatch recordings. It will be completed by continuing education with a distance teaching platform including the systematic listening of recorded CA calls.
The second element is based on the deployment of a software aiming to notify CA thanks to mobile phones. This system interfaced to a control software enables to request the participation of CPR-trained volunteers automatically. The volunteers have to be located in the patient's surroundings. The deployment of this mobile application will rely on first-aid volunteers, health personal and any trained volunteers willing to participate. A randomized control study in one city area proved the efficiency of a similar software to improve the proportion of CPR by bystanders.
The third element consists in a motivational feedback. A weekly overview of the management and the outcomes of patients who suffered CA will be broadcast to all the responders and volunteers in the mobile application.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control Group | No Intervention | Usual management of patients according to international guidelines. Protocols of call acceptance, phone advice and sending of emergency services are not modified | |
| Test Group | Other | Multifaceted intervention
|
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Multifaceted intervention including 3 components | Other | Multifaceted intervention including Dispatcher training to improve cardiac phone recognition, mobile application to send bystanders on cardiac arrest location before first professionals rescuers and motivational support for volunteer bystanders |
| Measure | Description | Time Frame |
|---|---|---|
| CPR initiated by bystanders before the arrival of first professionals rescuers | Proportion of patients who's received CPR initiated by bystander before EMS arrival. | Day 0 |
| Measure | Description | Time Frame |
|---|---|---|
| Survival at 72h after out-of-hospital cardiac arrest | survival at 72h | 72 hours |
| Return of Spontaneous Circulation | Proportion of patients who's recovered a spontaneous circulation after CPR |
| Measure | Description | Time Frame |
|---|---|---|
| Bystander's CPR quality | Evaluation of CPR quality performed by bystanders on a 4 points scale. CPR quality will be assessed by first professional rescuers on scene. | Day 0 |
| Confirmation of cardiac arrest |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Monique Sorentino | CHU Grenoble Alpes | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| SAMU 80 - CHU Amiens Picardie | Amiens | 80054 | France | |||
| SAMU 74 - CH Annecy Genevois |
Study protocol will be submitted for publication. IPD will be shared with other researcher.
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A Stepped Wedge Cluster Randomized Controlled Trial
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|
| Day 0 |
| Survival to hospital admission | Vital status at hospital admission | Day 0 |
| Survival to hospital discharge | Vital status at hospital discharge | up to 30 days |
| Survival at 30 days | Vital status at 30 days | 30 days |
| Neurological functional status CPC | As measured by Cerebral Performance Category (CPC) at hospital discharge and at 30 days Score less or equal to 2 will be considered as favorable neurological outcome | up to 30 days |
| Neurological functional status mRS | As measured by modified Rankin Scale (mRS) at hospital discharge and at 30 days: modified Rankin Scale (mRS): 0 - No symptoms.
| 30 days |
| First recorded rhythm | First recorded cardiac rhythm by EMS | 30 min |
The dispatcher CA's recognition will be confirmed by EMS on scene
| Days 0 |
| Automated External Defibrillator initiated before EMS arrival | Proportion of patients who's benefit to a automated external defibrillator before the EMS arrivals | Day 0 |
| CPR initiation by witness without dispatcher Telephone-CPR | Evaluation of the proportion of patients with CPR initiated before EMS arrival without dispatcher Telephone-CPR | Day 0 |
| CPR initiation by witness with Telephone-CPR | Evaluation of CPR initiated before EMS arrival following Telephone-CPR | Day 0 |
| CPR initiation by app-activated bystanders | Evaluation of CPR initiated by bystanders, who are activated by the geo-localization application | Day 0 |
| Proportion of cardiac arrest correctly identified after dispatch | Assessment of the evolution in CA recognition after the e-learning training | 24 months |
| Annecy |
| 74370 |
| France |
| SAMU 33 - CHU Hôpital Pellegrin | Bordeaux | 33076 | France |
| SAMU 01 - CH Fleyriat | Bourg-en-Bresse | 01012 | France |
| SAMU 29 - CHRU La Cavale Blanche | Brest | 29609 | France |
| SAMU 73 - Centre Hospitalier Métropôle Savoie | Chambéry | 73011 | France |
| SAMU 21 - CHU Dijon | Dijon | 21000 | France |
| SAMU 38 - CHU Grenoble Alpes | Grenoble | 38043 | France |
| Samu 85 - Chd Les Oudairies | La Roche-sur-Yon | 85025 | France |
| SAMU 54 - CHU Nancy | Nancy | 54000 | France |
| SAMU 44 - Hôtel Dieu | Nantes | France |
| SAMU 06 - CHU de Nice | Nice | 06001 | France |
| SAMU 42 -CHU Saint-Etienne | Saint-Etienne | 42270 | France |
| SAMU 31 - CHU Toulouse | Toulouse | 31000 | France |
| SAMU 26 - CH de Valence | Valence | 26953 | France |
| ID | Term |
|---|---|
| D006323 | Heart Arrest |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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