The Lancet. Public health
A multifaceted intervention to increase bystander CPR rates after out-of-hospital cardiac arrest in France: a stepped-wedge, cluster-randomised, controlled trial
By Debaty G, Ribes S, Ray P and 19 others.
Abstract
Background
Bystander cardiopulmonary resuscitation (CPR) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA), but rates remain suboptimal worldwide. We evaluated whether a multifaceted intervention targeting emergency dispatch systems and community response could increase bystander-initiated CPR before emergency medical service (EMS) arrival.
Methods
We conducted a stepped-wedge, cluster-randomised trial in 15 French EMS agencies. The intervention combined dispatcher training for early recognition of cardiac arrest and telephone-assisted CPR, activation of trained volunteers through a geolocation smartphone application, and structured audit and feedback provided to EMS agencies. Consecutive adults (≥18 years) with non-traumatic OHCA were included. Randomisation was stratified by tercile of OHCA volume managed by each EMS in 2015. The intervention was implemented during a 1-month transition period before the intervention period at each EMS centre. A dedicated protocol guided dispatchers to identify cardiac arrest from unresponsiveness and abnormal breathing, then gave scripted compression-only instructions and activated volunteers, targeting recognition within 60 s of call pick-up and first compression within a further 60 s. The primary outcome was bystander-initiated CPR before EMS arrival. The trial was prospectively registered on ClinicalTrials.gov (NCT03633370) and is completed.