RACE-CARS - RAndomized Cluster Evaluation of Cardiac ARrest Systems

Not Applicable

Interventions: Other: Rapid cardiac arrest recognition that triggers immediate priority EMS/first responder dispatch by 911 operators
Other: Systematic bystander resuscitation instruction by 911 operators
Other: Comprehensive community training of lay people in CPR and AED use.
Other: Optimized first responder performance including earlier use of AEDs.

Brief Summary: RACE-CARS is a real-world cluster-randomized trial designed to evaluate a multifaceted community and health systems intervention aimed to improve outcomes of out-of-hospital cardiac arrest. RACE-CARS will enroll 50 counties in North Carolina that are estimated to have a total of approximately 20,000 patients with cardiac arrest over a 4-year intervention period. County "clusters" will be randomized in a 1:1 ratio to intervention versus usual care. The trial duration is 7 years, which includes a 6-month start-up (including recruitment and randomization) period, a 12-month intervention training phase, a 4-year intervention period, a 12-month follow-up for to assess quality of life in survivors of OHCA, and a 6-month close-out and data analysis period.

Recruitment & Eligibility

Inclusion Criteria

OHCA of non-traumatic etiology
Patients who are pulseless on arrival of a first responder; or patients who become pulseless in the presence of a first responder; OR patients who have a pulse on arrival of EMS, where a successful defibrillation was previously administered by a bystander or first responder.

Exclusion Criteria

Untreated cardiac arrests, including arrests in which resuscitation efforts are not initiated or are terminated immediately upon arrival of EMS because the patient is not a viable candidate for resuscitation due to:
1. injuries incompatible with life,
2. the presence of rigor mortis or lividity,
3. signs of decomposition, or
4. the presence of a valid DNR.
Private EMS transport that did not involve 911 dispatch (example: interfacility transport between nursing home and hospital).
Arrest of clear and obvious traumatic etiology
Bystander suspected cardiac arrest, where ROSC was achieved without the need for defibrillation or first responder CPR

Arm && Interventions

Group	Intervention	Description
Intervention (Enhanced Standard of Care)	Optimized first responder performance including earlier use of AEDs.	Mass community CPR/AED training, optimize 911 medical dispatch, improve first responder performance
Intervention (Enhanced Standard of Care)	Systematic bystander resuscitation instruction by 911 operators	Mass community CPR/AED training, optimize 911 medical dispatch, improve first responder performance
Intervention (Enhanced Standard of Care)	Comprehensive community training of lay people in CPR and AED use.	Mass community CPR/AED training, optimize 911 medical dispatch, improve first responder performance
Intervention (Enhanced Standard of Care)	Rapid cardiac arrest recognition that triggers immediate priority EMS/first responder dispatch by 911 operators	Mass community CPR/AED training, optimize 911 medical dispatch, improve first responder performance

Primary Outcome Measures

Name	Time	Method
Survival with good neurologic outcomes as measured by a CPC score of 1 or 2 at discharge	up to 12months	Cerebral Performance Category (CPC)

Secondary Outcome Measures

Name	Time	Method
Rate of Defibrillation before paramedics arrive as measured by bystander interview	Baseline
Percent of patients who receive CPR from a bystander as measured by EMS report	Baseline

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