Sudden Cardiac Death
Cardiac arrest is the number one cause of death in Canada. It is often the first symptom of cardiac disease for the victims. Eighty-five percent of victims collapse in their own home. Fifty percent collapse in the presence of a family member. Bystander cardiopulmonary resuscitation (CPR) can improve the chance to survive a cardiac arrest by three to four times but needs to be started quickly. In most communities, less than 30% of victims receive CPR before the ambulance arrives. Currently, only 8% of cardiac arrest victims can leave the hospital alive.
Many things have been tried to improve the number of times people do CPR. So far, the only thing that really increased the number of times that someone did CPR is when 9-1-1 attendants started to give CPR instructions to callers over the phone. The only problem is that about 25% of cardiac arrest victims gasp for air in the first few minutes. This can fool the 9-1-1 callers and attendants into thinking that the victim is still alive.
We have looked at all the studies on how to help 9-1-1 attendants to recognize abnormal breathing over the phone. We have also learned what we should be teaching them after we finished a large survey with 9-1-1 attendants from across Canada. This survey was done with the help of psychologists and other education experts. It measured the impact of attitudes, social pressures, and 9-1-1 attendants’ perceived control over their ability to recognize abnormal breathing and cardiac arrest. Then we developed a teaching tool which helped Ottawa 9-1-1 attendants recognize abnormal breathing. When they could do that, they could also recognize more cardiac arrest. The teaching tool had four components. 1) Information about the significance of abnormal breathing. 2) Demonstration on how to recognize it. 3) Practice of skills required to recognize abnormal breathing. 4) Ongoing monitoring and feedback on performance.
The main goal of this project is to help 9-1-1 attendants save the lives of even more cardiac arrest victims across Canada.
There are three specific objectives for this project.
First, we want to see if 9-1-1 attendants can get better at recognizing abnormal breathing.
Second, we want to see how often 9-1-1 attendants can give CPR instructions.
Third, we want to see if our teaching tool will increase bystander CPR and the number of victims leaving the hospital alive.
At the moment, 9-1-1 attendants only get a small amount of training on abnormal breathing and cardiac arrest. We now have developed an innovative teaching tool that worked well with Ottawa 9-1-1 attendants. That pilot data suggests the impact of this larger multi-centre project will be to increase cardiac arrest recognition and bystander CPR rates by at least 10%, and cardiac arrest survival by 5% or more.
Dr. Christian Vaillancourt MD, MSc, FRCPC, CSPQ
Director of Heart Rhythm Department
The Ottawa Hospital Research Institute
Dr. Vaillancourt’s current research program focusses on pre-hospital care, specifically improving care and survival for cardiac arrest and trauma victims.
In cardiac arrest research, Dr. Vaillancourt’s contributions include the publication of the first national statistics on cardiac arrest and EMS services in Canada, the completion of a national survey on cardiac arrest surveillance, and participation in the last three updates of the guidelines for the International Liaison Committee on Resuscitation for emergency cardiovascular care. He promotes bystander CPR, improvement of dispatch-assisted CPR instructions for out-of-hospital events as well as CPR quality and timeliness in-hospital.
Dr. Vaillancourt is the lead investigator in the pre-hospital evaluation of a clinical decision rule assessing the need for spinal immobilization in low-risk trauma patients. The rule is called the Canadian C-spine Rule, was developed at the OHRI for use by emergency physicians, then triage nurses and finally paramedics. Dr. Vaillancourt has been the lead investigator for the prehospital validation as well as the single centre implementation study.