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 Emergency Medicine

Jim Garland¹  Matthew Church²  Stephanie Hodges³  Kathryn Cyr⁴  Manya Charette⁴  Sarika Naidoo⁴  Venkatesh Thiruganasambandamoorthy⁵  Christian Vaillancourt⁵  Jamie Brehaut⁶  Monica Taljaard⁶  Ian Blanchard⁷  Aaron Sibley⁸  Jim Christenson⁹  John Tallon^1,10  Katie Dainty^1,11  Judah Goldstein^1,12  Sandra Zambon^1,13  Colette Lacroix^1,14  Matthew Spidel^1,15  Paul Dorian^1,16  Shannon Leduc^1,17  Jennie Helmer^1,18  Michael Feldman^1,19  Sheldon Cheskes^2,20 

[1] Alberta Health Services, Edmonton, Canada;Cardiac Arrest Survivor, Study Patient Partner, Toronto, Canada;Central Ambulance Communications Centre, Ottawa Paramedic Service, Ottawa, Canada;Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Civic Campus, Rm F649, 1053 Carling Ave., K1Y 4E9, Ottawa, Ontario, Canada;Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Civic Campus, Rm F649, 1053 Carling Ave., K1Y 4E9, Ottawa, Ontario, Canada;Department of Emergency Medicine, University of Ottawa, Ottawa, Canada;School of Epidemiology & Public Health-Faculty of Medicine, University of Ottawa, Ottawa, Canada;Clinical Epidemiology Unit, Ottawa Hospital Research Institute, The Ottawa Hospital, Civic Campus, Rm F649, 1053 Carling Ave., K1Y 4E9, Ottawa, Ontario, Canada;School of Epidemiology & Public Health-Faculty of Medicine, University of Ottawa, Ottawa, Canada;Department of Emergency Medical Services, Alberta Health Services, Calgary, Canada;Department of Community Health Sciences-Cumming School of Medicine, University of Calgary, Calgary, Canada;Department of Emergency Medicine, Dalhousie University, Halifax, Canada;Division of Paramedicine, University of Prince Edward Island, Charlottetown, Canada;Department of Emergency Medicine, University of British Columbia, Vancouver, Canada;Provincial Health Services Authority, British Columbia Emergency Health Services, Vancouver, Canada;Center for Health Evaluation and Outcomes Sciences, Providence Health Care Research Institute, Vancouver, Canada;Department of Emergency Medicine, University of British Columbia, Vancouver, Canada;Provincial Health Services Authority, British Columbia Emergency Health Services, Vancouver, Canada;Department of Emergency Medicine, Dalhousie University, Halifax, Canada;Department of Research and Innovation, North York General Hospital, Toronto, Canada;Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada;Division of Emergency Medical Services, Dalhousie University, Halifax, Canada;Emergency Health Services Operations, Nova Scotia, Canada;Heart and Stroke Foundation of Canada, Toronto, Canada;International Business Machines (IBM) Canada, Ottawa, Canada;Island Emergency Medical Services, Prince Edward Island, Charlottetown, Canada;Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada;Division of Cardiology and Division of Clinical Pharmacology, University of Toronto, Toronto, Canada;Ottawa Paramedic Service, Ottawa, Canada;Provincial Health Services Authority, British Columbia Emergency Health Services, Vancouver, Canada;Sunnybrook Centre for Prehospital Medicine, Toronto, Canada;Sunnybrook Centre for Prehospital Medicine, Toronto, Canada;Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada;Department of Family and Community Medicine, University of Toronto, Toronto, Canada;

关键词: Cardiac arrest;    Agonal breathing;    Telecommunicators;    Cardiopulmonary resuscitation;    Resuscitation;    Emergency medical services;   

DOI  :  10.1186/s12873-021-00416-4

来源: Springer

【 摘 要 】

BackgroundSudden 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.MethodsIn 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.DiscussionThe 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 registrationProspectively registered on March 28, 2019 at ClinicalTrials.gov identifier: NCT03894059.

【 授权许可】

CC BY