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Published on: December 5, 2025
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First responder airway and compression rate cluster randomized controlled trial: rational and design
Thomas Rea1,2, Jenny Shin2, Jennifer Blackwood2
1University of Washington, Department of Medicine, United States.
Resuscitation Plus
|April 20, 2026
Summary
The First responder Airway and Compression rate Trial (FACT) investigates optimal airway management and compression rates for out-of-hospital cardiac arrest (OHCA) survival. Findings may refine emergency medical services (EMS) protocols for improved patient outcomes.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Trials
Background:
- Chest compressions and ventilations during CPR are linked to survival after out-of-hospital cardiac arrest (OHCA).
- Current understanding relies heavily on observational data, necessitating randomized trials for best-practice determination.
- The First responder Airway and Compression rate Trial (FACT) aims to address this gap.
Purpose of the Study:
- To evaluate the impact of different airway management strategies on survival.
- To determine the effect of varying chest compression rates on patient survival.
- To provide evidence-based recommendations for professional first responder CPR.
Main Methods:
- A factorial, cluster-randomized, cross-over trial design involving Emergency Medical Services (EMS) agencies.
- Enrollment of approximately 4200 adults with non-traumatic OHCA.
- Randomized interventions comparing airway devices (mask vs. i-gel) and compression rates (100, 110, 120/min).
Main Results:
- Primary outcome: survival to hospital discharge.
- Secondary outcomes: return of spontaneous circulation and survival with favorable neurological status (CPC 1-2).
- Subgroup analyses planned for sex, initial rhythm, and basic life support (BLS) CPR strategy.
Conclusions:
- Results from the FACT study are expected to significantly influence fundamental approaches to first responder CPR.
- The trial will provide critical data to optimize interventions for OHCA patients.
- Findings may lead to updated clinical guidelines for EMS providers.
Keywords:
Airway managementCardiopulmonary arrestChest compressionsClinical trialsEmergency medical servicesEmergency medical technicianResuscitationMore Related Videos
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