Enhanced community first responder support system: protocol of a randomized trial to improve bystander cardiopulmonary resuscitation quality for out-of-hospital cardiac arrest patients.

Introduction: The earliest and impactful intervention for out-of-hospital cardiac arrest (OHCA) patients is cardiopulmonary resuscitation (CPR) delivered by a community first responder (CFR). However, the CFRs often fail to meet the established performance targets for compression rate and depth throughout the event, thereby defeating the purpose of instituting the CFR system. While telephone CPR has been shown to help, certain aspects cannot be improved with a voice-only guidance. Therefore, a trial has been designed to evaluate an enhanced CFR support system (eCSS) intervention that comprises (a) audio/video communication between a CFR and dispatcher, in addition to (b) relaying compression depth and rate data to the dispatcher in real time through a battery-operated Bluetooth-enabled motion sensor-mounted CPR card connected to a smart phone through an application over 5G mobile phone network. Both these features of eCSS will allow the dispatchers to better guide the CFR, ensuring high-quality CPR. The control group will have voice-only dispatcher assistance as per the current standard of care. Objective: This protocol paper describes the rationale, methodology, and run-in period recruitment experience of the trial, where all non-pregnant adult suspected OHCA patients will be eligible for the study, on whom CFR provides CPR engaging the eCSS. CFRs will be recruited from a volunteers' registry maintained by the Singapore Civic Defence Force, the largest publicly funded EMS agency. This trial protocol has been registered in the ClinicalTrials.gov registry [ID NCT06530433].