Arizona Prehospital CPR Quality Improvement Project

The quality of cardiopulmonary resuscitation (CPR) provided to patients with out-of-hospital cardiac arrest (OHCA) is often suboptimal. There now exist monitors/defibrillators that allow for the measurement and real time feedback of the quality of chest compressions and ventilations. In addition to giving the prehospital provider the benefit of real time CPR quality feedback via voice and visual cues, the CPR quality data acquired using these devices can be utilized as part of an on-going quality assurance/quality improvement program.

The first objective of the proposed project is to quantify the quality of chest compressions and ventilations provided in the state of Arizona to patients with OHCA and to determine whether the quality of CPR is related to patient outcome from OHCA.

A second objective of this project is to determine whether use of audiovisual feedback improves both CPR quality and patient outcome in the pre-hospital setting.

Study Overview

• Status: Completed
• Conditions: Out-of-Hospital Cardiac Arrest
• Intervention / Treatment: Other: Audiovisual Feedback

Detailed Description

Phase I: In the first phase of the project, the EMS systems will utilize the E-series units to treat all patients with OHCA. The audiovisual feedback prompts will be inactivated during this phase. The EMS providers will be instructed to follow the standard CCR protocol, as is currently the practice. Aside from the change in monitor/defibrillator equipment, the treatment of OHCA patients during this phase will be identical to the treatment that is currently performed. The quality of CPR will be measured using the accelerometer-based system. The data will be stored in the defibrillator and will be downloaded upon completion of the call. The first phase will be conducted for approximately 6 months from the time each site initiates the use of the E-series monitor/defibrillators.

Phase 2:In the second phase of the project, the EMS providers will undergo training on how to use the audiovisual feedback prompts. The providers will continue to treat patients according to the CCR protocol but will now receive audio and/or visual feedback on the quality of CPR that they are performing. The providers will select the preferred feedback method(s) - audio, visual or both. As in phase I, the CPR data will be stored in the defibrillator and will be downloaded upon completion of the call.

The total number of EMS personnel who will be trained is approximately 450. In Phase I, there were 219 OHCAs (80% from Mesa Fire Dept, and 20% from Guardian Medical Transport). So far in Phase II, there have been about 100 OHCAs.

• Study Type: Observational
• Enrollment (Actual): 101

Contacts and Locations

Study Locations

• United States
  • Arizona
    • Flagstaff, Arizona, United States, 86001
      • Guardian Medical Transport
    • Mesa, Arizona, United States, 85201
      • Mesa Fire Department

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 24 years to 55 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Emergency medical services providers in 4 different Arizona cities

Description

Inclusion Criteria:

• Emergency Medical Services personnel at 8 fire departments in AZ who treat patients with out of hospital cardiac arrest (OHCA)

Exclusion Criteria:

-

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Audiovisual feedback on CPR; EMS technicians will receive audiovisual feedback from the ZOLL device on depth, frequency, and interruptions to cardiac compressions	Other: Audiovisual Feedback; EMTs will get audiovisual feedback on CPR technique during CPR

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of chest compressions	Depth of chest compressions, rate of chest compressions, and interruptions in chest compressions	Phase I - 6 months; Phase II - 20 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Survival to hospital discharge	Did the patient survive to hospital discharge? (Yes or no--dichotomous measure)	Phase I - 6 months; Phase II - 20 months

Collaborators and Investigators

• Sponsor: Valleywise Health
• Collaborators: Arizona Department of Health Services; Zoll Medical Corporation; Guardian Medical Transport; Mesa Fire Department
• Investigators: Principal Investigator: Bentley J Bobrow, MD, Arizona Department of Health Services, Maricopa Integrated Health System

Publications and helpful links

General Publications

• Bobrow BJ, Clark LL, Ewy GA, Chikani V, Sanders AB, Berg RA, Richman PB, Kern KB. Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest. JAMA. 2008 Mar 12;299(10):1158-65. doi: 10.1001/jama.299.10.1158.
• Handley AJ, Handley SA. Improving CPR performance using an audible feedback system suitable for incorporation into an automated external defibrillator. Resuscitation. 2003 Apr;57(1):57-62. doi: 10.1016/s0300-9572(02)00400-8.

Study record dates

Study Major Dates

• Study Start (Actual): December 7, 2010
• Primary Completion (Actual): February 25, 2015
• Study Completion (Actual): February 25, 2015

Study Registration Dates

• First Submitted: December 9, 2010
• First Submitted That Met QC Criteria: December 9, 2010
• First Posted (Estimate): December 10, 2010

Study Record Updates

• Last Update Posted (Actual): January 25, 2018
• Last Update Submitted That Met QC Criteria: January 22, 2018
• Last Verified: January 1, 2018

More Information

Terms related to this study

• Keywords: Out-of-Hospital Cardiac Arrest, OHCA
• Additional Relevant MeSH Terms: Heart Diseases; Cardiovascular Diseases; Heart Arrest; Out-of-Hospital Cardiac Arrest
• Other Study ID Numbers: 2010-118