The First Responder Shock Trial (FIRST): Can We Improve Cardiac Arrest Survival by Providing Community Responders With Ultraportable Automated External Defibrillators?

Abstract

Out-of-hospital cardiac arrest (OHCA) is the ultimate prehospital emergency. Early CPR and defibrillation are key to survival. During an emergency call, algorithms are applied to detect OHCA to dispatch emergency medical services (EMS). Simultaneously, nearby community responders who are confident in cardiopulmonary resuscitation and using an automated external defibrillator (AED) are alerted via the GoodSAM app. GoodSAM responders are provided with the patient location and the nearest AED (if available). Despite this, AED use before EMS arrival is 5%. The FIRST trial examines whether equipping community responders with an ultraportable defibrillator (CellAED) can increase survival to 30 days in OHCA. FIRST is a multicentre trial co-led by St John NZ and Ambulance Victoria. High-frequency GoodSAM responders (≥0.5 accepted alerts/year) were invited to participate. Participants were cluster randomised to the control or the CellAED intervention arm, stratified by region. Participants are instructed to carry the device as much as practical. Inclusion criteria are all OHCA patients assessed by EMS and activation of an eligible GoodSAM responder where the responder accepts the alert and arrives on scene before EMS. The primary outcome is survival at 30 days. The trial aims to detect a 7% improvement in the proportion of 30-day survivors (16% vs 9%). The FIRST trial has recruited 1,805 participants, with 903 community responders allocated a CellAED. Participants have been successfully trained in CellAED use online. To date, 1,788 alerts have been sent to CellAED participants, with 104 responders arriving before EMS. The world-first FIRST trial aims to improve prehospital defibrillation and patient survival in OHCA.