Improving cardiac arrest survival: First-responder airway and compression study

Questions and answers about the study

• What is cardiac arrest?

  A cardiac arrest is a condition where a person experiences cardiovascular collapse. The heart suddenly stops beating so that there is no longer blood flow. Normal breathing stops so that oxygen delivery to the body quickly ceases. A person who experiences cardiac arrest quickly becomes unconscious and will die in minutes unless there are emergency resuscitation actions. These actions include calling 9-1-1, providing CPR, and using a defibrillator to deliver a shock (when appropriate), and advanced treatments.

  When you activate 9-1-1, the fire department immediately activates fire fighter emergency medical technicians (EMTs). These fire fighters are professional first responders who are trained to be expert in providing CPR that includes chest compressions and rescue breathing.

• What will be studied?

  The study will compare rescue breathing using a bag mask to deliver breaths versus an airway designed to deliver breaths more directly to the lungs. The conventional approach uses a mask that goes over the mouth and nose and delivers air into the mouth and ultimately the lungs when an external bag is squeezed. The study will be comparing this conventional approach with a curved plastic tube which is inserted into the patient’s mouth. With this device, air from a squeezed bag is delivered more directly to the lungs. Both treatments are standard of care for first responders, though there is not clear understanding whether one may provide additional lifesaving benefit.

  The second intervention involves chest compressions provided by first responders when they arrive on scene. The current recommendation is to provide these compressions at a rate of 100-120 per minute. However, we now understand that this compression rate range can produce different dynamic conditions related to blood flow. We are not sure which rate 100 vs 110 vs 120 is best. The chest compression rate will be supported by a metronome set to the assigned rate for the first responder to follow.

• How will we study the treatments?

  The firefighter emergency responders will use a standard of care approach for several months (i.e., rescue breathing with the curved plastic tube and compression rate of 120) and then alternate to a different approach (rescue breathing with bag mask and compression rate of 110). The EMTs will receive refresher training prior to each transition so that they are well-practiced in each technique. Researchers will review notes of each rescue attempt to determine that the first responders applied the assigned study treatment.

• How will people consent to participate in the study?

  In cardiac arrest, care must be delivered quickly for survival. Importantly, since people in this life-threatening circumstance are unconscious and unable to give informed consent to be involved, the UW Medicine researchers leading the trial have acquired a federal exception that allows people to be enrolled without their consent. Patients who are rescued will be notified of their study enrollment when they are awake and alert. The approach has been used previously by UW Medicine investigators working with EMS professionals to address other important clinical questions about cardiac arrest.

  People may opt out of the study in advance or withdraw consent after they recover. Please contact FACTstudy@kingcounty.gov if you have more questions or choose to opt-out or the study.