Telemedicine-Assisted vs Conventional Telephone Instruction in Cardiopulmonary Resuscitation (TACTIC)

April 16, 2026 updated by: Sattha Riyapan, Siriraj Hospital

Out-of-hospital cardiac arrest (OHCA) is a life-threatening emergency where early cardiopulmonary resuscitation (CPR) by bystanders can significantly improve survival. Emergency dispatchers often guide bystanders to perform CPR over the phone, a method known as dispatcher-assisted CPR (DA-CPR). While this approach has increased bystander CPR rates worldwide, it relies on voice communication only, which may limit the dispatcher's ability to assess the situation and guide CPR effectively.

With advances in telecommunication technology, video-based communication has become more widely available. Telemedicine-assisted CPR (TA-CPR) allows dispatchers or emergency medical providers to see the patient and the rescuer through a live video call, potentially improving CPR performance by providing real-time visual feedback. However, evidence on whether this approach improves outcomes in real-world emergency medical service (EMS) systems is still limited.

This study aims to compare the effectiveness of TA-CPR with conventional DA-CPR in adult patients with suspected non-traumatic OHCA. The study is designed as a pragmatic cluster-randomized controlled trial conducted within a hospital-based EMS system in Bangkok, Thailand. Instead of randomizing individual patients, the CPR instruction protocol is assigned by month (cluster randomization). During each month, all eligible patients receive either the TA-CPR protocol or the DA-CPR protocol.

In both groups, CPR instructions are first provided through voice communication to avoid delaying the start of chest compressions. In the TA-CPR group, responders may switch to video communication if it is feasible, depending on factors such as the caller's device capability and the availability of another person to hold the camera. In the DA-CPR group, only voice communication is used throughout.

The study includes adult patients (aged 18 years or older) with suspected non-traumatic cardiac arrest who are managed by the participating EMS unit. Patients are excluded if resuscitation is declined, if the location is unsafe, if the cardiac arrest is witnessed by EMS personnel, or if communication barriers prevent CPR instructions.

The primary outcome of the study is the proportion of patients who receive bystander CPR before EMS arrival. Secondary outcomes include whether bystanders continue chest compressions until EMS arrives, how well responders follow the assigned protocol, and selected patient outcomes such as return of spontaneous circulation and survival.

Data are collected from an EMS cardiac arrest registry and hospital medical records. Audio recordings of dispatcher and responder communications are reviewed to assess adherence to the study protocols. The results of this study will help determine whether adding video communication to dispatcher-assisted CPR provides additional benefit in real-world EMS settings and inform future implementation of telemedicine in emergency care systems.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

108

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Thailand
    • Bangkok
      • Bangkok Noi, Bangkok, Thailand, 10700
        • Faculty of Medicine Siriraj Hospital, Mahidol University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adult patients aged ≥18 years
  • Suspected non-traumatic out-of-hospital cardiac arrest
  • Managed by the participating advanced life support (ALS) EMS unit

Exclusion Criteria:

  • Resuscitation declined by patient's relatives
  • Cardiac arrest occurring in unsafe or inappropriate locations for EMS intervention
  • EMS-witnessed cardiac arrest
  • Inability of bystander to communicate in Thai
  • Cases where ALS unit is not directly dispatched to the scene

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Telemedicine-Assisted CPR (TA-CPR)
Participants receive prearrival cardiopulmonary resuscitation (CPR) instructions provided by emergency medical service (EMS) personnel using a telemedicine-assisted approach. CPR instructions are initiated using audio (telephone) communication to avoid delays in chest compression initiation. Following initial instruction, EMS personnel assess the feasibility of establishing real-time video communication based on device capability, internet connectivity, and the availability of an additional bystander to assist with video transmission. When feasible, CPR guidance is continued with live video support to provide real-time visual feedback. If video communication cannot be established, CPR instructions continue via audio only.
Behavioral: Telemedicine-Assisted CPR (TA-CPR)
Participants receive dispatcher or EMS-guided cardiopulmonary resuscitation (CPR) with an initial audio-based instruction followed by real-time video communication when feasible. Video guidance is implemented based on device capability, connectivity, and availability of an additional bystander to assist with video transmission. If video is not feasible, CPR instructions continue via audio.
Active Comparator: Dispatcher-Assisted CPR (DA-CPR)
Participants receive conventional prearrival cardiopulmonary resuscitation (CPR) instructions provided by emergency medical service (EMS) personnel using audio-only (telephone) communication. CPR guidance is delivered continuously via voice without the use of video communication throughout the prehospital period.
Behavioral: Dispatcher-Assisted CPR (DA-CPR)
Participants receive conventional dispatcher-assisted CPR instructions delivered exclusively via audio (telephone communication) without the use of video support.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Bystander CPR rate
Time Frame: From enrollment to the end of resuscitation at 1 day
Proportion of patients with suspected out-of-hospital cardiac arrest who receive cardiopulmonary resuscitation from a bystander prior to EMS arrival
From enrollment to the end of resuscitation at 1 day

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Ongoing bystander CPR at EMS arrival
Time Frame: From enrollment to the end of resuscitation at 1 day
Proportion of patients receiving continuous chest compressions by bystanders at the time EMS arrives
From enrollment to the end of resuscitation at 1 day
Protocol compliance
Time Frame: From enrollment to the audit protocol at 4 weeks
Proportion of cases in which EMS personnel adhere to all required steps of the assigned CPR instruction protocol (including successful video use in TA-CPR when applicable)
From enrollment to the audit protocol at 4 weeks
Return of spontaneous circulation (ROSC) at emergency department
Time Frame: From enrollment to the end of resuscitation at 1 day
Return of spontaneous circulation (ROSC) at emergency department
From enrollment to the end of resuscitation at 1 day
Survival to hospital admission
Time Frame: During hospitalization (assessed up to 5 days)
During hospitalization (assessed up to 5 days)
Survival to hospital discharge
Time Frame: During hospitalization (assessed up to 24 weeks)
During hospitalization (assessed up to 24 weeks)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Siriraj Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 1, 2025

Primary Completion (Actual)

September 30, 2025

Study Completion (Actual)

December 31, 2025

Study Registration Dates

First Submitted

April 11, 2026

First Submitted That Met QC Criteria

April 16, 2026

First Posted (Actual)

April 22, 2026

Study Record Updates

Last Update Posted (Actual)

April 22, 2026

Last Update Submitted That Met QC Criteria

April 16, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • SI821/2024

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

De-identified individual participant data (IPD) underlying the results reported in this study, including demographic characteristics, prehospital variables, and clinical outcomes, will be made available to qualified researchers upon reasonable request. Data will be shared after removal of all personally identifiable information in accordance with applicable data protection regulations.

IPD Sharing Time Frame

Data will be available beginning 6 months after publication of the primary results and will remain available for up to 5 years.

IPD Sharing Access Criteria

Data available upon reasonable request and subject to approval by the study investigators and institutional review board, with a formal data use agreement.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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