Christian Vaillancourt1,2,3, Manya Charette4, Sarika Naidoo4, Monica Taljaard4,5, Matthew Church6, Stephanie Hodges7, Shannon Leduc8, Jim Christenson9,10,11, Sheldon Cheskes12,13,14, Katie Dainty15,16, Michael Feldman12, Judah Goldstein17,18, John Tallon9,10,19, Jennie Helmer10, Aaron Sibley19,20, Matthew Spidel21, Ian Blanchard22,23, Jim Garland24, Kathryn Cyr4, Jamie Brehaut4,5, Paul Dorian13,25, Colette Lacroix26, Sandra Zambon27, Venkatesh Thiruganasambandamoorthy4,28,5. 1. Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Civic Campus, Rm F649, 1053 Carling Ave., Ottawa, Ontario, K1Y 4E9, Canada. cvaillancourt@ohri.ca. 2. Department of Emergency Medicine, University of Ottawa, Ottawa, Canada. cvaillancourt@ohri.ca. 3. School of Epidemiology & Public Health-Faculty of Medicine, University of Ottawa, Ottawa, Canada. cvaillancourt@ohri.ca. 4. Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Civic Campus, Rm F649, 1053 Carling Ave., Ottawa, Ontario, K1Y 4E9, Canada. 5. School of Epidemiology & Public Health-Faculty of Medicine, University of Ottawa, Ottawa, Canada. 6. Cardiac Arrest Survivor, Study Patient Partner, Toronto, Canada. 7. Central Ambulance Communications Centre, Ottawa Paramedic Service, Ottawa, Canada. 8. Ottawa Paramedic Service, Ottawa, Canada. 9. Department of Emergency Medicine, University of British Columbia, Vancouver, Canada. 10. Provincial Health Services Authority, British Columbia Emergency Health Services, Vancouver, Canada. 11. Center for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, Canada. 12. Sunnybrook Centre for Prehospital Medicine, Toronto, Canada. 13. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. 14. Department of Family and Community Medicine, University of Toronto, Toronto, Canada. 15. Department of Research and Innovation, North York General Hospital, Toronto, Canada. 16. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. 17. Division of Emergency Medical Services, Dalhousie University, Halifax, Canada. 18. Emergency Health Services Operations, Nova Scotia, Canada. 19. Department of Emergency Medicine, Dalhousie University, Halifax, Canada. 20. Division of Paramedicine, University of Prince Edward Island, Charlottetown, Canada. 21. Island Emergency Medical Services, Prince Edward Island, Charlottetown, Canada. 22. Department of Emergency Medical Services, Alberta Health Services, Calgary, Canada. 23. Department of Community Health Sciences-Cumming School of Medicine, University of Calgary, Calgary, Canada. 24. Alberta Health Services, Edmonton, Canada. 25. Division of Cardiology and Division of Clinical Pharmacology, University of Toronto, Toronto, Canada. 26. International Business Machines (IBM) Canada, Ottawa, Canada. 27. Heart and Stroke Foundation of Canada, Toronto, Canada. 28. Department of Emergency Medicine, University of Ottawa, Ottawa, Canada.
Abstract
BACKGROUND: Sudden cardiac death remains a leading cause of mortality in Canada, resulting in more than 35,000 deaths annually. Most cardiac arrest victims collapse in their own home (85% of the time) and 50% are witnessed by a family member or bystander. Survivors have a quality of life similar to the general population, but the overall survival rate for out-of-hospital cardiac arrest (OHCA) rarely exceeds 8%. Victims are almost four times more likely to survive when receiving bystander CPR, but bystander CPR rates have remained low in Canada over the past decade, not exceeding 15-25% until recently. Telecommunication-assisted CPR instructions have been shown to significantly increase bystander CPR rates, but agonal breathing may be misinterpreted as a sign of life by 9-1-1 callers and telecommunicators, and is responsible for as much as 50% of missed OHCA diagnoses. We sought to improve the ability and speed with which ambulance telecommunicators can recognize OHCA over the phone, initiate timely CPR instructions, and improve survival. METHODS: In this multi-center national study, we will implement and evaluate an educational program developed for ambulance telecommunicators using a multiple baseline interrupted time-series design. We will compare outcomes 12 months before and after the implementation of a 20-min theory-based educational video addressing barriers to recognition of OHCA while in the presence of agonal breathing. Participating Canadian sites demonstrated prior ability to collect standardized data on OHCA. Data will be collected from eligible 9-1-1 recordings, paramedic documentation and hospital medical records. Eligible cases will include suspected or confirmed OHCA of presumed cardiac origin in patients of any age with attempted resuscitation. DISCUSSION: The ability of telecommunication-assisted CPR instructions to improve bystander CPR and survival rates for OHCA victims is undeniable. The ability of telecommunicators to recognize OHCA over the phone is unequivocally impeded by relative lack of training on agonal breathing, and reluctance to initiate CPR instructions when in doubt. Our pilot data suggests the potential impact of this project will be to increase absolute OHCA recognition and bystander CPR rates by at least 10%, and absolute out-of-hospital cardiac arrest survival by 5% or more. TRIAL REGISTRATION: Prospectively registered on March 28, 2019 at ClinicalTrials.gov identifier: NCT03894059 .
BACKGROUND:Sudden cardiac death remains a leading cause of mortality in Canada, resulting in more than 35,000 deaths annually. Most cardiac arrest victims collapse in their own home (85% of the time) and 50% are witnessed by a family member or bystander. Survivors have a quality of life similar to the general population, but the overall survival rate for out-of-hospital cardiac arrest (OHCA) rarely exceeds 8%. Victims are almost four times more likely to survive when receiving bystander CPR, but bystander CPR rates have remained low in Canada over the past decade, not exceeding 15-25% until recently. Telecommunication-assisted CPR instructions have been shown to significantly increase bystander CPR rates, but agonal breathing may be misinterpreted as a sign of life by 9-1-1 callers and telecommunicators, and is responsible for as much as 50% of missed OHCA diagnoses. We sought to improve the ability and speed with which ambulance telecommunicators can recognize OHCA over the phone, initiate timely CPR instructions, and improve survival. METHODS: In this multi-center national study, we will implement and evaluate an educational program developed for ambulance telecommunicators using a multiple baseline interrupted time-series design. We will compare outcomes 12 months before and after the implementation of a 20-min theory-based educational video addressing barriers to recognition of OHCA while in the presence of agonal breathing. Participating Canadian sites demonstrated prior ability to collect standardized data on OHCA. Data will be collected from eligible 9-1-1 recordings, paramedic documentation and hospital medical records. Eligible cases will include suspected or confirmed OHCA of presumed cardiac origin in patients of any age with attempted resuscitation. DISCUSSION: The ability of telecommunication-assisted CPR instructions to improve bystander CPR and survival rates for OHCA victims is undeniable. The ability of telecommunicators to recognize OHCA over the phone is unequivocally impeded by relative lack of training on agonal breathing, and reluctance to initiate CPR instructions when in doubt. Our pilot data suggests the potential impact of this project will be to increase absolute OHCA recognition and bystander CPR rates by at least 10%, and absolute out-of-hospital cardiac arrest survival by 5% or more. TRIAL REGISTRATION: Prospectively registered on March 28, 2019 at ClinicalTrials.gov identifier: NCT03894059 .
Authors: Jan L Jensen; Christian Vaillancourt; Jessica Tweedle; Ann Kasaboski; Manya Charette; Jeremy Grimshaw; Jamie C Brehaut; Martin H Osmond; George A Wells; Ian G Stiell Journal: Prehosp Emerg Care Date: 2012-06-19 Impact factor: 3.077
Authors: Monica E Kleinman; Erin E Brennan; Zachary D Goldberger; Robert A Swor; Mark Terry; Bentley J Bobrow; Raúl J Gazmuri; Andrew H Travers; Thomas Rea Journal: Circulation Date: 2015-11-03 Impact factor: 29.690
Authors: Laurie J Morrison; Graham Nichol; Thomas D Rea; Jim Christenson; Clifton W Callaway; Shannon Stephens; Ronald G Pirrallo; Dianne L Atkins; Daniel P Davis; Ahamed H Idris; Craig Newgard Journal: Resuscitation Date: 2008-05-13 Impact factor: 5.262
Authors: Christian Vaillancourt; Manya L Charette; Katarina Bohm; James Dunford; Maaret Castrén Journal: Resuscitation Date: 2011-06-24 Impact factor: 5.262
Authors: Ian Jacobs; Vinay Nadkarni; Jan Bahr; Robert A Berg; John E Billi; Leo Bossaert; Pascal Cassan; Ashraf Coovadia; Kate D'Este; Judith Finn; Henry Halperin; Anthony Handley; Johan Herlitz; Robert Hickey; Ahamed Idris; Walter Kloeck; Gregory Luke Larkin; Mary Elizabeth Mancini; Pip Mason; Gregory Mears; Koenraad Monsieurs; William Montgomery; Peter Morley; Graham Nichol; Jerry Nolan; Kazuo Okada; Jeffrey Perlman; Michael Shuster; Petter Andreas Steen; Fritz Sterz; James Tibballs; Sergio Timerman; Tanya Truitt; David Zideman Journal: Circulation Date: 2004-11-23 Impact factor: 29.690
Authors: Samantha R Hauff; Thomas D Rea; Linda L Culley; Frieda Kerry; Linda Becker; Mickey S Eisenberg Journal: Ann Emerg Med Date: 2003-12 Impact factor: 5.721