Background : The specific components of professional first-responder CPR (chest compressions and ventilations) are associated with clinical outcomes following out-of-hospital cardiac arrest (OHCA). Yet, this understanding about best-practices CPR is largely informed by observational rather than randomized evaluation. The F irst responder A irway and C ompression rate T rial (FACT) will evaluate the survival effects of the professional first responder airway management and three compression rates. Design and Setting . FACT is a factorial, cluster-randomized, cross-over trial conducted in a large metropolitan region in the United States by Emergency Medical Services (EMS). Study interventions are allocated according to EMS agency every 4 months. Study subjects. The study plans to enroll ∼4200 adults with nontraumatic OHCA treated by first responder firefighter emergency medical technicians (EMTs). Interventions. Randomized interventions will include the initial EMT airway (mask or i-gel supraglottic airway) and the professional rescuer compression rate (100 or 110 or 120 compressions per minute). Inspiratory and expiratory ventilation volume will be assessed in a subset of subjects. Compression rates will be directed by metronome and assessed through review of the defibrillator recording. Outcomes . The primary outcome is survival to hospital discharge; secondary outcomes include return of spontaneous circulation at the end of EMS care and survival with favorable neurological status classified as Cerebral Performance Category of 1 or 2 at hospital discharge. Subgroup analyses. Planned subgroup analyses include intervention comparisons according to sex, initial rhythm, and BLS CPR strategy (30:2 and 10:1). Inference. Results of the FACT study may inform fundamental approaches to first responder CPR. Clinical Trial Registration : ClinicalTrials.org (NCT05969028)
Rea et al. (Sun,) studied this question.