Telemedicine-Assisted vs Conventional Telephone Instruction in Cardiopulmonary Resuscitation

NCT07546474 | Completed

• 1 other identifier: SI821/2024
• Study Type: interventional
• Target: 108
• Locations: 1 country
• Sites: 1

Brief Summary

Out-of-hospital cardiac arrest (OHCA) is a life-threatening emergency where early cardiopulmonary resuscitation (CPR) by bystanders can significantly improve survival. Emergency dispatchers often guide bystanders to perform CPR over the phone, a method known as dispatcher-assisted CPR (DA-CPR). While this approach has increased bystander CPR rates worldwide, it relies on voice communication only, which may limit the dispatcher's ability to assess the situation and guide CPR effectively. With advances in telecommunication technology, video-based communication has become more widely available. Telemedicine-assisted CPR (TA-CPR) allows dispatchers or emergency medical providers to see the patient and the rescuer through a live video call, potentially improving CPR performance by providing real-time visual feedback. However, evidence on whether this approach improves outcomes in real-world emergency medical service (EMS) systems is still limited. This study aims to compare the effectiveness of TA-CPR with conventional DA-CPR in adult patients with suspected non-traumatic OHCA. The study is designed as a pragmatic cluster-randomized controlled trial conducted within a hospital-based EMS system in Bangkok, Thailand. Instead of randomizing individual patients, the CPR instruction protocol is assigned by month (cluster randomization). During each month, all eligible patients receive either the TA-CPR protocol or the DA-CPR protocol. In both groups, CPR instructions are first provided through voice communication to avoid delaying the start of chest compressions. In the TA-CPR group, responders may switch to video communication if it is feasible, depending on factors such as the caller's device capability and the availability of another person to hold the camera. In the DA-CPR group, only voice communication is used throughout. The study includes adult patients (aged 18 years or older) with suspected non-traumatic cardiac arrest who are managed by the participating EMS unit. Patients are excluded if resuscitation is declined, if the location is unsafe, if the cardiac arrest is witnessed by EMS personnel, or if communication barriers prevent CPR instructions. The primary outcome of the study is the proportion of patients who receive bystander CPR before EMS arrival. Secondary outcomes include whether bystanders continue chest compressions until EMS arrives, how well responders follow the assigned protocol, and selected patient outcomes such as return of spontaneous circulation and survival. Data are collected from an EMS cardiac arrest registry and hospital medical records. Audio recordings of dispatcher and responder communications are reviewed to assess adherence to the study protocols. The results of this study will help determine whether adding video communication to dispatcher-assisted CPR provides additional benefit in real-world EMS settings and inform future implementation of telemedicine in emergency care systems.

Conditions

Out-of-hospital Cardiac Arrest (OHCA); Emergency Medical Services

Keywords

Dispatcher-Assisted CPR; Telemedicine; Video-Assisted CPR; Out-of-Hospital Cardiac Arrest (OHCA); Emergency Medical Services (EMS); Bystander CPR

Outcome Measures

Primary Outcomes (1)

• Bystander CPR rate

  Proportion of patients with suspected out-of-hospital cardiac arrest who receive cardiopulmonary resuscitation from a bystander prior to EMS arrival

  From enrollment to the end of resuscitation at 1 day

Secondary Outcomes (5)

• Ongoing bystander CPR at EMS arrival

  From enrollment to the end of resuscitation at 1 day

• Protocol compliance

  From enrollment to the audit protocol at 4 weeks

• Return of spontaneous circulation (ROSC) at emergency department

  From enrollment to the end of resuscitation at 1 day

• Survival to hospital admission

  During hospitalization (assessed up to 5 days)

• Survival to hospital discharge

  During hospitalization (assessed up to 24 weeks)

Study Arms (2)

Telemedicine-Assisted CPR (TA-CPR)

EXPERIMENTAL

Participants receive prearrival cardiopulmonary resuscitation (CPR) instructions provided by emergency medical service (EMS) personnel using a telemedicine-assisted approach. CPR instructions are initiated using audio (telephone) communication to avoid delays in chest compression initiation. Following initial instruction, EMS personnel assess the feasibility of establishing real-time video communication based on device capability, internet connectivity, and the availability of an additional bystander to assist with video transmission. When feasible, CPR guidance is continued with live video support to provide real-time visual feedback. If video communication cannot be established, CPR instructions continue via audio only.

Behavioral: Telemedicine-Assisted CPR (TA-CPR)

Dispatcher-Assisted CPR (DA-CPR)

ACTIVE COMPARATOR

Participants receive conventional prearrival cardiopulmonary resuscitation (CPR) instructions provided by emergency medical service (EMS) personnel using audio-only (telephone) communication. CPR guidance is delivered continuously via voice without the use of video communication throughout the prehospital period.

Behavioral: Dispatcher-Assisted CPR (DA-CPR)

Interventions

Telemedicine-Assisted CPR (TA-CPR) BEHAVIORAL

Participants receive dispatcher or EMS-guided cardiopulmonary resuscitation (CPR) with an initial audio-based instruction followed by real-time video communication when feasible. Video guidance is implemented based on device capability, connectivity, and availability of an additional bystander to assist with video transmission. If video is not feasible, CPR instructions continue via audio.

Telemedicine-Assisted CPR (TA-CPR)

Dispatcher-Assisted CPR (DA-CPR) BEHAVIORAL

Participants receive conventional dispatcher-assisted CPR instructions delivered exclusively via audio (telephone communication) without the use of video support.

Dispatcher-Assisted CPR (DA-CPR)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adult patients aged ≥18 years
• Suspected non-traumatic out-of-hospital cardiac arrest
• Managed by the participating advanced life support (ALS) EMS unit

You may not qualify if:

• Resuscitation declined by patient's relatives
• Cardiac arrest occurring in unsafe or inappropriate locations for EMS intervention
• EMS-witnessed cardiac arrest
• Inability of bystander to communicate in Thai
• Cases where ALS unit is not directly dispatched to the scene

Sponsors & Collaborators

• Siriraj Hospital: lead

Study Sites (1)

Faculty of Medicine Siriraj Hospital, Mahidol University

Bangkok Noi, Bangkok, 10700, Thailand

Location

Related Publications (3)

• Lee SY, Song KJ, Shin SD, Hong KJ, Kim TH. Comparison of the effects of audio-instructed and video-instructed dispatcher-assisted cardiopulmonary resuscitation on resuscitation outcomes after out-of-hospital cardiac arrest. Resuscitation. 2020 Feb 1;147:12-20. doi: 10.1016/j.resuscitation.2019.12.004. Epub 2019 Dec 13.

  PMID: 31843537 RESULT

• Lin YY, Chiang WC, Hsieh MJ, Sun JT, Chang YC, Ma MH. Quality of audio-assisted versus video-assisted dispatcher-instructed bystander cardiopulmonary resuscitation: A systematic review and meta-analysis. Resuscitation. 2018 Feb;123:77-85. doi: 10.1016/j.resuscitation.2017.12.010. Epub 2017 Dec 12.

  PMID: 29242057 RESULT

• Nikolaou N, Dainty KN, Couper K, Morley P, Tijssen J, Vaillancourt C; International Liaison Committee on Resuscitation's (ILCOR) Basic Life Support and Pediatric Task Forces. A systematic review and meta-analysis of the effect of dispatcher-assisted CPR on outcomes from sudden cardiac arrest in adults and children. Resuscitation. 2019 May;138:82-105. doi: 10.1016/j.resuscitation.2019.02.035. Epub 2019 Mar 8.

  PMID: 30853623 RESULT

MeSH Terms

Conditions

Out-of-Hospital Cardiac Arrest

Condition Hierarchy (Ancestors)

Heart Arrest; Heart Diseases; Cardiovascular Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant professor

Study Record Dates

• First Submitted: April 11, 2026
• First Posted: April 22, 2026
• Study Start: February 1, 2025
• Primary Completion: September 30, 2025
• Study Completion: December 31, 2025
• Last Updated: April 22, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL
• Time Frame: Data will be available beginning 6 months after publication of the primary results and will remain available for up to 5 years.
• Access Criteria: Data available upon reasonable request and subject to approval by the study investigators and institutional review board, with a formal data use agreement.

Locations

TH (1)