An Educational Program to Improve Cardiac Arrest Diagnostic Accuracy of Ambulance Telecommunicators

Multi-Center Implementation of an Educational Program to Improve the Cardiac Arrest Diagnostic Accuracy of Ambulance Telecommunicators and Survival Outcomes for Sudden Cardiac Arrest Victims

Cardiac arrest is the number one cause of death in Canada. It is often the first symptom of cardiac disease for the victims. Eighty-five percent of victims collapse in their own home. Fifty percent collapse in the presence of a family member. Bystander cardiopulmonary resuscitation (CPR) can improve the chance to survive a cardiac arrest by three to four times, but needs to be started quickly. In most communities, less than 30% of victims receive CPR before the ambulance arrives. Currently, only 8% of cardiac arrest victims can leave the hospital alive.

Many things have been tried to improve the number of times people do CPR. So far, the only thing that really increased the number of times that someone did CPR is when 9-1-1 attendants started to give CPR instructions to callers over the phone. The only problem is that about 25% of cardiac arrest victims gasp for air in the first few minutes. This can fool the 9-1-1 callers and attendants into thinking that the victim is still alive.

The investigators have looked at all the studies on how to help 9-1-1 attendants to recognize abnormal breathing over the phone. The investigators have also learned what should be taught after finishing a large survey with 9-1-1 attendants from across Canada. This survey was done with the help of psychologists and other education experts. It measured the impact of attitudes, social pressures, and 9-1-1 attendants' perceived control over their ability to recognize abnormal breathing and cardiac arrest. Then the investigators developed a teaching tool which helped Ottawa 9-1-1 attendants recognize abnormal breathing. When they could do that, they could also recognize more cardiac arrest.

The main goal of this project is to use the tool developed in Ottawa in more centres to help 9-1-1 attendants save the lives of even more cardiac arrest victims across Canada.

Study Overview

• Status: Active, not recruiting
• Conditions: Heart Arrest; Cardiac Arrest; Heart Arrest, Out-Of-Hospital; Death, Sudden, Cardiac; Cardiac Arrest, Sudden; Cardiopulmonary Arrest
• Intervention / Treatment: Other: Educational Intervention

• Study Type: Observational
• Enrollment (Actual): 12224

Contacts and Locations

Study Locations

• Canada
  • Nova Scotia
    • Dartmouth, Nova Scotia, Canada, B3B 2B2
      • Emergency Medical Care Inc.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

All patients with prehospital cardiac arrest (absence of a detectable pulse, unresponsiveness, and apnea) occurring in the catchment area of any participating site during the active study period.

Description

Inclusion Criteria:

We will enroll ALL patients with prehospital cardiac arrest (absence of a detectable pulse, unresponsiveness, and apnea):

• That are of presumed cardiac origin;
• That occur in the catchment area of our participating sites; and
• For which resuscitation is attempted by a bystander and/or the emergency responders.

Exclusion Criteria:

• Cardiac arrest witnessed by paramedics after their arrival (no opportunity for bystander intervention);
• Patients younger than 16 years of age (cardiac arrest usually respiratory and rare in this population);
• Patients who are "obviously dead";
• Trauma victims, including hanging and burns; or
• Patients with cardiac arrest clearly of other non-cardiac origin including drug overdose, carbon monoxide poisoning, drowning, exsanguination, electrocution, asphyxia, hypoxia related to respiratory disease, cerebrovascular accident and documented terminal illness.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Retrospective; Consecutive cases of out-of-hospital cardiac arrest occurring at participating sites, meeting the study eligibility criteria over a 12-month period preceding the implementation of the educational intervention for ambulance telecommunicators.
Prospective; Consecutive cases of out-of-hospital cardiac arrest occurring at participating sites, meeting the study eligibility criteria over a 12-month period following the implementation of the educational intervention for ambulance telecommunicators.	Other: Educational Intervention; Additional training provided to ambulance telecommunicators in participating sites to help increase recognition of agonal breathing in the presence of out-of-hospital cardiac arrest.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Survival	Accessing hospital medical records or coroner's reports, assess survival of cardiac arrest victim as being discharged alive from hospital.	Change between 12 month period before and after delivery of additional education to ambulance telecommunicators

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Community Bystander Cardiopulmonary Resuscitation Rate	The first member of the emergency response team to arrive at the scene will document whether or not chest compressions have been initiated by someone prior to the arrival of the emergency team.	Change between 12 month period before and after delivery of additional education to ambulance telecommunicators
Telecommunication-assisted CPR instructions rate	By reviewing audio recordings, determine the cases where telecommunicator assistance led to delivery of chest compressions	Change between 12 month period before and after delivery of additional education to ambulance telecommunicators
Presence of agonal breathing	Document the presence or absence of agonal breathing through review of audio recording.	Change between 12 month period before and after delivery of additional education to ambulance telecommunicators
Cardiac arrest recognition rate		at time of event
Time intervals	call receipt to recognition of cardiac arrest, time to CPR instructions initiated	Change between 12 month period before and after delivery of additional education to ambulance telecommunicators

Collaborators and Investigators

• Sponsor: Ottawa Hospital Research Institute
• Collaborators: Alberta Health services; Ontario Ministry of Health and Long Term Care; BC Emergency Health Services; Medacom Atlantic; Emergency Health Services Nova Scotia; Health PEI; Providence Health Care, British Columbia
• Investigators: Principal Investigator: Christian Vaillancourt, MD, MSc, Ottawa Hospital Research Institute

Publications and helpful links

General Publications

• Vaillancourt C, Charette M, Naidoo S, Taljaard M, Church M, Hodges S, Leduc S, Christenson J, Cheskes S, Dainty K, Feldman M, Goldstein J, Tallon J, Helmer J, Sibley A, Spidel M, Blanchard I, Garland J, Cyr K, Brehaut J, Dorian P, Lacroix C, Zambon S, Thiruganasambandamoorthy V. Multi-centre implementation of an Educational program to improve the Cardiac Arrest diagnostic accuracy of ambulance Telecommunicators and survival outcomes for sudden cardiac arrest victims: the EduCATe study design and methodology. BMC Emerg Med. 2021 Mar 4;21(1):26. doi: 10.1186/s12873-021-00416-4.

Study record dates

Study Major Dates

• Study Start (Actual): December 14, 2020
• Primary Completion (Estimated): December 31, 2025
• Study Completion (Estimated): December 31, 2025

Study Registration Dates

• First Submitted: March 19, 2019
• First Submitted That Met QC Criteria: March 26, 2019
• First Posted (Actual): March 28, 2019

Study Record Updates

• Last Update Posted (Actual): April 3, 2024
• Last Update Submitted That Met QC Criteria: April 2, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: cardiac arrest; bystander cardiopulmonary resuscitation CPR; dispatch-assisted CPR instructions; agonal breathing
• Additional Relevant MeSH Terms: Pathologic Processes; Heart Diseases; Cardiovascular Diseases; Death; Heart Arrest; Out-of-Hospital Cardiac Arrest; Death, Sudden, Cardiac; Death, Sudden
• Other Study ID Numbers: CRRF 1298

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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