Multifaceted Intervention for Increasing Performance of CPR by Laypersons in Out-of-hospital Cardiac Arrest (DISPATCH)

Multifaceted Intervention for Increasing Performance of Cardiopulmonary Resuscitation by Laypersons in Out-of-hospital Cardiac Arrest. A Stepped Wedge Cluster Randomized Controlled Trial

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.

Study Overview

• Status: Completed
• Conditions: Cardiac Arrest
• Intervention / Treatment: Other: Multifaceted intervention including 3 components

• Study Type: Interventional
• Enrollment (Actual): 2481
• Phase: Not Applicable

Contacts and Locations

Study Locations

• France
  • Amiens, France, 80054
    • SAMU 80 - CHU Amiens Picardie
  • Annecy, France, 74370
    • SAMU 74 - CH Annecy Genevois
  • Bordeaux, France, 33076
    • SAMU 33 - CHU Hôpital Pellegrin
  • Bourg en bresse, France, 01012
    • SAMU 01 - CH Fleyriat
  • Brest, France, 29609
    • SAMU 29 - CHRU La Cavale Blanche
  • Chambéry, France, 73011
    • SAMU 73 - Centre Hospitalier Métropôle Savoie
  • Dijon, France, 21000
    • SAMU 21 - CHU Dijon
  • Grenoble, France, 38043
    • SAMU 38 - CHU Grenoble Alpes
  • La Roche-sur-Yon, France, 85025
    • Samu 85 - Chd Les Oudairies
  • Nancy, France, 54000
    • SAMU 54 - CHU Nancy
  • Nantes, France
    • SAMU 44 - Hôtel Dieu
  • Nice, France, 06001
    • SAMU 06 - CHU de Nice
  • Saint-Étienne, France, 42270
    • SAMU 42 -CHU Saint-Etienne
  • Toulouse, France, 31000
    • SAMU 31 - CHU Toulouse
  • Valence, France, 26953
    • SAMU 26 - CH de Valence

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• All adults with nontraumatic, out-of-hospital cardiac arrest diagnosed during the emergency medical service call
• Cardiac arrest located in urban area

Exclusion Criteria:

• Pregnant or breastfeeding women
• Patients under the law
• Patients deprived of liberty by court ruling or administrative ruling
• Traumatic cardiac arrest
• CA occurring under the eyes of a professional emergency services patrol on duty
• Cardiac arrest for which resuscitation seem unjustified (inevitable death, terminally ill irreversible condition, too long duration of cardiac arrest, non-resuscitation personal directive…)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Sequential Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control Group; Usual management of patients according to international guidelines. Protocols of call acceptance, phone advice and sending of emergency services are not modified
Other: Test Group; Multifaceted intervention; Training using distance learning for medical regulation assistants to recognise cardiac arrest on phone; Activation of the location-software application to send bystanders on cardiac arrest location before the arrival of emergency medical services (EMS); Motivation feed-back Volunteers will received feed-back regarding CPR initiated before EMS arrival and survival	Other: Multifaceted intervention including 3 components; 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

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Survival to hospital discharge	Vital status at hospital discharge	up to 30 days
Survival at 30 days	Vital status at 30 days	30 days
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	Day 0
Survival to hospital admission	Vital status at hospital admission	Day 0
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.; - No significant disability. Able to carry out all usual activities, despite some symptoms.; - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities.; - Moderate disability. Requires some help, but able to walk unassisted.; - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted.; - Severe disability. Requires constant nursing care and attention, bedridden, incontinent.; - Dead Score less or equal to 3 will be considered as favorable neurological outcome	30 days
First recorded rhythm	First recorded cardiac rhythm by EMS	30 min

Other Outcome Measures

Outcome Measure	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	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

Collaborators and Investigators

• Sponsor: University Hospital, Grenoble
• Investigators: Study Director: Monique Sorentino, CHU Grenoble Alpes

Study record dates

Study Major Dates

• Study Start (Actual): August 27, 2018
• Primary Completion (Actual): March 1, 2022
• Study Completion (Actual): March 20, 2022

Study Registration Dates

• First Submitted: July 19, 2018
• First Submitted That Met QC Criteria: August 13, 2018
• First Posted (Actual): August 16, 2018

Study Record Updates

• Last Update Posted (Actual): May 17, 2023
• Last Update Submitted That Met QC Criteria: May 16, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: Cardiac Arrest; Cardiopulmonary Resuscitation; Dispatcher
• Additional Relevant MeSH Terms: Heart Diseases; Cardiovascular Diseases; Heart Arrest; Out-of-Hospital Cardiac Arrest
• Other Study ID Numbers: DISPATCH

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Study protocol will be submitted for publication. IPD will be shared with other researcher.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No