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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Public access defibrillation by activated community first responders - the randomized HeartRunner trial
Fredrik Folke1,2,3, Linn Andelius1, Annette Kjær Ersbøll4
1Copenhagen University Hospital - Copenhagen Emergency Medical Services, Copenhagen, Denmark.
Insights
Community first responders (CFRs) activated via smartphone app show potential to improve survival rates for out-of-hospital cardiac arrest (OHCA) patients. This randomized clinical trial investigated the impact of dispatched CFRs alongside standard care.
Area of Science:
- Emergency medicine
- Public health interventions
- Cardiovascular research
Background:
- Out-of-hospital cardiac arrest (OHCA) presents a critical public health challenge.
- Rapid response is crucial for improving survival rates in OHCA cases.
- Investigating novel strategies to enhance emergency medical services is essential.
Purpose of the Study:
- To evaluate the effectiveness of community first responders (CFRs) dispatched via a smartphone application in improving survival after OHCA.
- To compare standard care with standard care augmented by dispatched CFRs for OHCA patients.
Main Methods:
- The HeartRunner trial was a randomized clinical controlled trial (RCT) conducted in the Capital Region of Denmark.
- It compared standard care alone versus standard care with the addition of dispatched CFRs.
- Primary outcome was 30-day survival; secondary outcomes included bystander CPR, defibrillation, and neurological outcomes.
Main Results:
- The trial enrolled a significant number of citizens as CFRs and deployed numerous automated external defibrillators.
- Data on 30-day survival, bystander interventions, and neurological outcomes were collected.
- Safety outcomes for activated CFRs were also assessed.
Conclusions:
- The findings will elucidate the impact of a smartphone-based CFR system on OHCA survival.
- This study provides critical insights into optimizing emergency response for cardiac arrest.
- The results will inform future strategies for community-based emergency medical services.
Background:
The HeartRunner trial was an investigator-initiated, randomized clinical controlled trial (RCT) examining whether community first responders (CFRs) activated through a smartphone application can improve survival after out-of-hospital cardiac arrest (OHCA).
Objectives:
The study compared standard care alone versus standard care with the addition of dispatched CFRs for patients with OHCA.
Methods:
The trial was conducted in the Capital Region of Denmark, with a catchment area of approximately 1.9 million inhabitants. By May 2019, 15,401 citizens had registered to serve as CFRs (837/100,000 inhabitants) and roughly 6200 automated external defibrillators (344/100,000 inhabitants) were publicly accessible in the study area (2.4 defibrillators per km2).The primary outcome was 30-day survival. Secondary outcomes included bystander defibrillation, bystander cardiopulmonary resuscitation, return of spontaneous circulation before hospital arrival, favorable neurological outcome at hospital discharge, and 1-year survival. As safety outcomes, the trial examined the potential physical or psychological risk involved for the activated CFR. The trial was expected to randomize 4188 cases of suspected OHCAs over a period of 7 years and was terminated February 28, 2026, when inclusion was completed. The full study protocol is available at www.clinicaltrials.gov (identifier: NCT03835403).
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