Using real-time ventilation feedback during cardiac arrest resuscitation by ambulance clinicians to improve ventilation performance and patient outcomes: a randomised feasibility study

Project title: Using real-time ventilation feedback during cardiac arrest resuscitation by ambulance clinicians to improve ventilation performance and patient outcomes: a randomised feasibility study Background: NHS ambulance services resuscitate around 30,000 out-of-hospital cardiac arrest (OHCA) patients each year in the UK. Ambulance clinician resuscitation of an OHCA patient focusses on high-quality cardiopulmonary resuscitation (CPR), which includes chest compressions and ventilations, and early defibrillation. Historically, collecting data on ventilations during OHCA and providing clinicians with feedback to improve ventilations has been challenging. However, new developments in technology enable ventilation data to be collected and for clinicians to receive real-time, visual feedback on the rate and volume of their ventilations. There has been little research into ventilation during CPR. The research suggests that ambulance clinicians, and other healthcare professionals, struggle to ventilate according to guidelines, although adherence can be improved using real-time visual feedback. The impact of improved adherence with ventilation guidelines and the subsequent impact on patient outcomes remain uncertain. Aim and objectives: This study aims to assess the feasibility of conducting a randomised controlled trial exploring the impact of real-time visual feedback on ventilation rate and volume delivered during CPR by ambulance clinicians. Study objectives are fourfold: assess recruitment of ambulance clinicians to the study; assess collection of ventilation and other relevant clinical data; assess survival rates and whether survivors will consent to the study; and interview participating clinicians and patients to elicit their views on the study. Methods: A randomised controlled feasibility study will be conducted in one division of North East Ambulance Service (NEAS) with 100 ambulance clinicians. The use of defibrillators will be randomised 1:1 to show real-time visual feedback (intervention) or not show feedback (control/standard care). Eligible patients will be adults (≥18 years) who receive CPR from NEAS clinicians in the study area. The target sample size is 80 OHCA patients. Surviving patients will be approached for consent and followed up at 30-days to collect quality of life data. Participating clinicians will be surveyed during the study as part of a process evaluation. In addition, NEAS clinicians and patients, or their representatives, will be interviewed about their views on the study. A prospective cost-effectiveness analysis will be performed. Timelines: 18-month study starting in June 2025. There will be 5-months allocated to setup the study and train NEAS clinicians, with an 8-month recruitment period and 1 month patient follow-up. A 4-month period has been allocated to analysis, writing up and follow-on study development. Anticipated impact and dissemination: Outcomes from OHCA have barely changed in the last decade. Establishing the impact of real-time visual feedback on ventilation quality and how this then impacts patient outcomes is important as part of delivering high quality CPR. This study will demonstrate proof of concept to inform a definitive randomised controlled trial to improve patient survival from OHCA. Study findings will be disseminated to emergency medical service and resuscitation professionals, patient groups and other stakeholders via publications in academic journals, presentations at relevant conferences and other routes such as social media.