Abstract
BackgroundWith 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.MethodsUsing 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.DiscussionThis 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 registrationClinicalTrials.gov, NCT03817892. Registered on 28 January 2019
Highlights
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
This study will contribute to assessing the impact of real-time feedback on chest compressions (CC) quality in practical conditions of OHCA resuscitation
We have demonstrated in simulation that the guidance of the CC delays the deterioration of the overall quality of the CC and its components related to fatigue during an extended CC beyond the 2-min CC relay currently recommended [21]
Summary
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. It is essential to minimize CC interruptions, and increase the chest compression fraction (CCF), as this is an independent factor for survival. During CPR, minimizing CC interruptions, and increasing the CCF, is essential, as this is an independent factor of cardiac arrest (CA) survival [10, 11]. CC interruptions automatically decrease the CC rate per minute, and difficulty in reaching the upper target of the guidelines’ CC rate has been linked to a significantly higher ratio of ROSC [14]. Reducing these interruptions and improving CC is a major goal of improving CPR. The recommendations state that the CCF must be greater than 60%, and some experts estimate that a CCF of 80% is possible [15, 16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
