Compression Only CPR Versus Standard CPR in Out-Of-Hospital Cardiac Arrest - A Randomized Survival Study

Summary

Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of mortality in the industrialized world. Bystander CPR before arrival of the Emergency Medical Service (EMS) is associated with an increased chance of survival.

During the last decade, the best form of bystander CPR has been debated. Chest Compression Only CPR (CO-CPR) has been advocated as a preferable method in situations where the bystander has no previous knowledge in CPR, both because its believed to be equally efficient but also a simplified form of CPR that could lead to a higher incidence of bystander-CPR.

In an initiative to increase CPR rates the American Heart Association has launched public campaigns such as the "hands-only CPR" promoting CO-CPR as an option to S-CPR for adult non-asphyxic cardiac arrest. In the 2015 updates of the European resuscitation council guidelines it states that the confidence in the equivalence between the two methods is not sufficient to change current practice.

Whether CO-CPR leads to a survival rate no worse than, or even superior to standard CPR in situations where the bystander has previous CPR training remains unclear. This clinical question remains unanswered while millions of people are trained in CPR worldwide each year.

To investigate whether CO-CPR is non-inferior to standard CPR (S-CPR) when performed by a bystander with previous CPR training in witnessed, non-asphyxic cases of OHCA. Superiority testing will also be performed for the purpose of demonstrating a possible increase in survival with CO-CPR.

Conditions

• Out-Of-Hospital Cardiac Arrest
• Cardiac Arrest
• Cardiopulmonary Resuscitation

Interventions

OTHER

Chest Compression Only CPR (CO-CPR) performed by trained bystanders after instructions from dispatchers

Instructions by dispatcher to bystander to provide CPR with chest-compressions only The instructions from the dispatcher in interventional arm include: * An ambulance is dispatched and is on it´s way to you * Do CPR with chest compressions only * Push hard on the chest with a pace of 100/minute without interruptions for rescue breathing.

OTHER

Standard CPR (S-CPR) performed by trained bystanders after instructions from dispatchers

Instructions by dispatcher to bystander to provide CPR with chest-compressions and rescue breaths in a ration of 30:2 The Instructions from the dispatcher in the control arm include: * An ambulance is dispatched and is on it´s way to you * Do CPR with chest compressions and rescue breathing * Push hard on the chest 30 times and give 2 rescue breaths. The pace of the compressions should be 100/minute.

Sponsors & Collaborators

• Swedish Heart Lung Foundation

  collaborator OTHER

• SOS Alarm

  collaborator UNKNOWN

• Azienda Regionale Emergenza Urgenza - AREU Lombardia

  collaborator OTHER

• The Swedish Research Council

  collaborator OTHER_GOV

• Karolinska Institutet

  lead OTHER

Principal Investigators

• Jacob Hollenberg, MD, PhD · Karolinska Institutet

• Giuseppe Ristagno, MD, PhD · University of Milan

• Gabril Riva, MD, PhD · Karolinska Institutet

• Martin Jonsson, McS, PhD · Karolinska Institutet

• Mattias Ringh, MD, PhD · Karolinska Institutet

• Per Nordberg, MD, PhD · Karolinska Institutet

• Annette Nord, RN, PhD · Karolinska Institutet

• Andreas Claesson, RN, PhD · Karolinska Institutet

• Marcus Skrifvars, MD, PhD · University of Helsinki

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2017-01-01

Primary Completion

2027-12-31

Completion

2028-12-31

Countries

• Italy
• Sweden

Study Locations