Improving Cardiac Arrest Diagnostic Accuracy of Emergency Medical Dispatchers

• Sponsor: Ottawa Hospital Research Institute (Other)
• Overall Status: Completed
• CT.gov ID: NCT01872325
• Collaborator: (none)
• Enrollment: 1,076
• Location: 1
• Duration (Months): 18
• Patients Per Site Per Month: 59.8

Study Details

Study Description

Brief Summary

The main goal of this project is to help 9-1-1 emergency medical dispatchers save the lives of more cardiac arrest victims. The investigators will develop teaching tools to help the dispatchers recognize abnormal breathing that may indicate a victim as having a cardiac arrest. After training sessions, the investigators will see if dispatchers can get better at recognizing abnormal breathing, how often they give CPR instructions, and if use of the teaching tool will increase bystander CPR and the number of victims leaving the hospital alive.

Condition or Disease	Intervention/Treatment	Phase
Cardiac Arrest	Behavioral: Education

Detailed Description

Cardiac arrest is a leading cause of death in Canada; it is defined as the sudden cessation of cardiac mechanical activity. It is uniformly fatal if not treated within minutes. More than 85% of out-of-hospital cardiac arrest (OOHCA) occur in residential locations so public access to automatic external defibrillators, to restart the heart, are not helpful. The overall rate of survival for OOHCA rarely exceeds 8%.

Bystander cardiopulmonary resuscitation (CPR) is chest compression and ventilations provided by someone not on the emergency response team. A victim or cardiac arrest is almost 4 times more likely to survive when receiving bystander CPR. However, despite various attempts to improve bystander rates they have remained low, not exceeding 15% in Ontario. It has been shown that since the ambulance dispatch centres in Ontario implemented dispatch-assisted CPR instructions (given to callers while emergency vehicles were on the way), there was a significant increase in use.

Emergency medical dispatchers can identify about 70% of OOHCA cases over the phone. Agonal breathing (laboured breathing preceding death) may be misinterpreted as a sign of life, and is responsible for as much as 50% of missed diagnoses. There is no specific training on the significance of this sign, and minimal information about recognizing cardiac arrest. An educational intervention designed to better understand the significance of agonal breathing and to clarify the existing CPR instruction protocol will most likely increase the frequency of CPR instructions, bystander CPR rates, and potentially survival of victims of cardiac arrest.

Study Design

• Study Type: Observational
• Actual Enrollment: 1076 participants
• Observational Model: Cohort
• Time Perspective: Prospective
• Official Title: Improving the Cardiac Arrest Diagnostic Accuracy of 9-1-1 Emergency Medical Dispatchers
• Study Start Date: Jun 1, 2013
• Actual Primary Completion Date: Sep 1, 2014
• Actual Study Completion Date: Dec 1, 2014

Arms and Interventions

Arm	Intervention/Treatment
Training site All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy.	Behavioral: Education; An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback.
Control site All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival

Outcome Measures

Primary Outcome Measures

1. Number of Participants With Agonal Breathing [At the time of the cardiac arrest event]

   By reviewing recordings of all cardiac arrest calls, including missed cases retrieved from a registry, document presence or absence of agonal breathing.

Secondary Outcome Measures

1. Number of Cases Where Cardiac Arrest Was Recognized by the Ambulance Dispatcher [At the time of the cardiac arrest event]

   By reviewing recordings of all cardiac arrest calls, collect information on dispatcher recognition of cardiac arrest to bystander implementation of chest compressions

Other Outcome Measures

1. Number of Participants Who Received Bystander CPR [At the time of the cardiac arrest event]

   The first member of the emergency response team to arrive at scene will document whether or not chest compressions have been initiated by someone prior to the arrival of emergency team

2. Number of Participants Surviving to Hospital Discharge [At the time of the cardiac arrest event to discharge alive from hospital (varies, depending on length of hospital stay)]

   Accessing hospital medical records or coroner's reports, assess survival of cardiac arrest victim as being discharged alive from hospital

Eligibility Criteria

Criteria

• Ages Eligible for Study: 16 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• presumed cardiac origin

• event occurs in the catchment area of Training or Control Site

• resuscitation is attempted by a bystander and/or the emergency responders

Exclusion Criteria:

• patients younger than 16 years old

• patients who are "obviously dead" as defined by the Ambulance Act of Ontario (decomposition, rigor mortis, decapitation, or other)

• trauma victims including hanging and burns

• cardiac arrest of non-cardiac origin including drug overdose, carbon monoxide poisoning, drowning, exsanguination, electrocution, asphyxia, hypoxia related to respiratory disease, cerebrovascular accident, and documented terminal illness

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Ottawa Hospital Research Institute	Ottawa	Ontario	Canada	K1Y 4E9

Sponsors and Collaborators

• Ottawa Hospital Research Institute

Investigators

• Principal Investigator: Christian Vaillancourt, MD,MSc,FRCPC, The Ottawa Hospital Research Institute and University of Ottawa

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Ottawa Hospital Research Institute
• ClinicalTrials.gov Identifier: NCT01872325
• Other Study ID Numbers: 2012-0379-01H
• First Posted: Jun 7, 2013
• Last Update Posted: Mar 17, 2021
• Last Verified: Feb 1, 2021

• Keywords provided by Ottawa Hospital Research Institute: cardiac arrest; bystander cardiopulmonary resuscitation CPR; dispatch-assisted CPR instructions; agonal breathing
• Additional relevant MeSH terms: Heart Arrest; Emergencies

Study Results

Participant Flow

Arm/Group Title	Training Site	Control Site
Arm/Group Description	All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy. Education: An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback.	All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival
Period Title: Overall Study
STARTED	689	387
COMPLETED	689	387
NOT COMPLETED	0	0

Baseline Characteristics

Arm/Group Title	Training Site	Control Site	Total
Arm/Group Description	All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy. Education: An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback.	All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival	Total of all reporting groups
Overall Participants	689	387	1076
Age (years) [Mean (Full Range) ]
Mean (Full Range) [years]	68	68	68
Sex: Female, Male (Count of Participants)
Female	217 31.5%	136 35.1%	353 32.8%
Male	472 68.5%	251 64.9%	723 67.2%
Race and Ethnicity Not Collected (Count of Participants)
Count of Participants [Participants]	0 0%
Region of Enrollment (participants) [Number]
Canada	689 100%	387 100%	1076 100%
Witnessed Status (Count of Participants)
Count of Participants [Participants]	310 45%	162 41.9%	472 43.9%
Initial Cardiac Rhythm Ventricular Fibrillation/Ventricular Tachycardia (Count of Participants)
Count of Participants [Participants]	199 28.9%	87 22.5%	286 26.6%

Outcome Measures

1. Primary Outcome

Title	Number of Participants With Agonal Breathing
Description	By reviewing recordings of all cardiac arrest calls, including missed cases retrieved from a registry, document presence or absence of agonal breathing.
Time Frame	At the time of the cardiac arrest event

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Training Site	Control Site
Arm/Group Description	All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy. Education: An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback.	All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival
Measure Participants	689	387
Count of Participants [Participants]	176 25.5%	87 22.5%

2. Secondary Outcome

Title	Number of Cases Where Cardiac Arrest Was Recognized by the Ambulance Dispatcher
Description	By reviewing recordings of all cardiac arrest calls, collect information on dispatcher recognition of cardiac arrest to bystander implementation of chest compressions
Time Frame	At the time of the cardiac arrest event

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Training Site	Control Site
Arm/Group Description	All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy. Education: An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback.	All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival
Measure Participants	689	387
Count of Participants [Participants]	495 71.8%	287 74.2%

3. Other Pre-specified Outcome

Title	Number of Participants Who Received Bystander CPR
Description	The first member of the emergency response team to arrive at scene will document whether or not chest compressions have been initiated by someone prior to the arrival of emergency team
Time Frame	At the time of the cardiac arrest event

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Training Site	Control Site
Arm/Group Description	All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy. Education: An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback.	All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival
Measure Participants	689	387
Count of Participants [Participants]	247 35.8%	153 39.5%

4. Other Pre-specified Outcome

Title	Number of Participants Surviving to Hospital Discharge
Description	Accessing hospital medical records or coroner's reports, assess survival of cardiac arrest victim as being discharged alive from hospital
Time Frame	At the time of the cardiac arrest event to discharge alive from hospital (varies, depending on length of hospital stay)

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Training Site	Control Site
Arm/Group Description	All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy. Education: An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback.	All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival
Measure Participants	689	387
Count of Participants [Participants]	86 12.5%	27 7%

Adverse Events

Arm/Group Title	Training Site		Control Site
Arm/Group Description	All emergency medical dispatchers at a central ambulance communication centre in Ontario will participate in an educational program designed to improve cardiac arrest diagnostic accuracy. Education: An education program will be developed using behaviour change techniques specifically mapped to address modifiable factors identified in a previous study. These techniques will include: information about the significance of agonal breathing, modeling/demonstration of desired behavioural skills, rehearsal of desired skills, and monitoring/reinforcement and feedback.		All emergency medical dispatchers at a central ambulance communications centre geographically remote from the Training Site and has a similar rate to the Training Site for cardiac arrests, bystander CPR rate, and survival
All Cause Mortality
	Training Site		Control Site
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	/ (NaN)		/ (NaN)
Serious Adverse Events
	Training Site		Control Site
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/689 (0%)		0/387 (0%)
Other (Not Including Serious) Adverse Events
	Training Site		Control Site
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/689 (0%)		0/387 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.