Impacts of chest compression cycle length and real-time feedback with a CPRmeter® on chest compression quality in out-of-hospital cardiac arrest: study protocol for a multicenter randomized controlled factorial plan trial

Clément Buléon, Jean-Jacques Parienti, Elodie Morilland-Lecoq, Laurent Halbout, Eric Cesaréo, Pierre-Yves Dubien, Benoit Jardel, Christophe Boyer, Kévin Husson, Florian Andriamirado, Xavier Benet, Emmanuel Morel-Marechal, Antoine Aubrion, Catalin Muntean, Erwan Dupire, Eric Roupie, Hervé Hubert, Christian Vilhelm, Pierre-Yves Gueugniaud, CILICA-HS study group, Clément Buléon, Jean-Jacques Parienti, Elodie Morilland-Lecoq, Laurent Halbout, Eric Cesaréo, Pierre-Yves Dubien, Benoit Jardel, Christophe Boyer, Kévin Husson, Florian Andriamirado, Xavier Benet, Emmanuel Morel-Marechal, Antoine Aubrion, Catalin Muntean, Erwan Dupire, Eric Roupie, Hervé Hubert, Christian Vilhelm, Pierre-Yves Gueugniaud, CILICA-HS study group

Abstract

Background: With a survival rate of 6 to 11%, out-of-hospital cardiac arrest (OHCA) remains a healthcare challenge with room for improvement in morbidity and mortality. The guidelines emphasize the highest possible quality of cardiopulmonary resuscitation (CPR) and chest compressions (CC). It is essential to minimize CC interruptions, and therefore increase the chest compression fraction (CCF), as this is an independent factor for survival. Survival is significantly and positively correlated with the suitability of CCF targets, CC frequency, CC depth, and brief predefibrillation pause. CC guidance improves adherence to recommendations and allows closer alignment with the CC objectives. The possibility of improving CCF by lengthening the time between two CC relays and the effect of real-time feedback on the quality of the CC must be investigated.

Methods: Using a 2 × 2 factorial design in a multicenter randomized trial, two hypotheses will be tested simultaneously: (i) a 4-min relay rhythm improves the CCF (reducing the no-flow time) compared to the currently recommended 2-min relay rate, and (ii) a guiding tool improves the quality of CC. Primary outcomes (i) CCF and (ii) correct compression score will be recorded by a real-time feedback device. Five hundred adult nontraumatic OHCAs will be included over 2 years. Patients will be randomized in a 1:1:1:1 distribution receiving advanced CPR as follows: 2-min blind, 2 min with guidance, 4-min blind, or 4 min with guidance. Secondary outcomes are the depth, frequency, and release of CC; length (care, no-flow, and low-flow); rate of return of spontaneous circulation; characteristics of advanced CPR; survival at hospital admission; survival and neurological state on days 1 and 30 (or intensive care discharge); and dosage of neuron-specific enolase on days 1 and 3.

Discussion: This study will contribute to assessing the impact of real-time feedback on CC quality in practical conditions of OHCA resuscitation. It will also provide insight into the feasibility of extending the relay rhythm between two rescuers from the currently recommended 2 to 4 min.

Trial registration: ClinicalTrials.gov, NCT03817892 . Registered on 28 January 2019.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Chest compression; Chest compression fraction; Guidance; No-flow; Quality.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
Position and use of CPRmeter® during external chest compression
Fig. 3
Fig. 3
CPRmeter® screen display and feedback provided during external chest compression

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