Out-of- H ospital cardiac arrest & Smartphon E R esp O nd E r S trial (HEROES Trial): Methodology and study protocol of a pre-post-design trial of the effect of implementing a smartphone alerting system on survival in out-of-hospital cardiac arrest

Affiliations

¹ Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josefs Hospital, Freiburg, Germany.
² Department of Anaesthesiology and Critical Care, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
³ Department of Emergency Medicine, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁴ Department of Cardiovascular Surgery, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁵ Institute of Medical Biometry and Statistics (IMBI), Faculty of Medicine - University Medical Center Freiburg, Freiburg, Germany.
⁶ Department of Anaesthesiology and Intensive Care Medicine, Barmherzige Brüder Hospital St. Barbara, Schwandorf, Germany.
⁷ Department of Anaesthesiology and Intensive Care, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
⁸ Charite Universitätsmedizin Berlin, Corporate Member of Freie Unversität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
⁹ Department of Internal Medicine III, Intensive Care, University of Heidelberg Heidelberg, Germany.
¹⁰ Department of Anesthesiology, Heidelberg University, Medical Faculty Heidelberg, Heidelberg, Germany.
¹¹ Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany.
¹² University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany.

PMID: 38328746
PMCID: PMC10847368
DOI: 10.1016/j.resplu.2024.100564

Out-of- H ospital cardiac arrest & Smartphon E R esp O nd E r S trial (HEROES Trial): Methodology and study protocol of a pre-post-design trial of the effect of implementing a smartphone alerting system on survival in out-of-hospital cardiac arrest

Michael P Müller et al. Resusc Plus. 2024.

. 2024 Feb 1:17:100564.

doi: 10.1016/j.resplu.2024.100564. eCollection 2024 Mar.

Authors

Affiliations

¹ Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josefs Hospital, Freiburg, Germany.
² Department of Anaesthesiology and Critical Care, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
³ Department of Emergency Medicine, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁴ Department of Cardiovascular Surgery, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
⁵ Institute of Medical Biometry and Statistics (IMBI), Faculty of Medicine - University Medical Center Freiburg, Freiburg, Germany.
⁶ Department of Anaesthesiology and Intensive Care Medicine, Barmherzige Brüder Hospital St. Barbara, Schwandorf, Germany.
⁷ Department of Anaesthesiology and Intensive Care, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
⁸ Charite Universitätsmedizin Berlin, Corporate Member of Freie Unversität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
⁹ Department of Internal Medicine III, Intensive Care, University of Heidelberg Heidelberg, Germany.
¹⁰ Department of Anesthesiology, Heidelberg University, Medical Faculty Heidelberg, Heidelberg, Germany.
¹¹ Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany.
¹² University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany.

PMID: 38328746
PMCID: PMC10847368
DOI: 10.1016/j.resplu.2024.100564

Abstract

Background: Since 2021, international guidelines for cardiopulmonary resuscitation recommend the implementation of so-called "life-saving systems". These systems include smartphone alerting systems (SAS), which enable dispatch centres to alert first responders via smartphone applications, who are in proximity of a suspected out-of-hospital cardiac arrest (OHCA). However, the effect of SAS on survival remains unknown.

Aim: The aim is to assess the rate of survival to hospital discharge in adult patients with OHCA not witnessed by emergency medical services (EMS): before and after SAS implementation.

Design: Multicentre, prospective, observational, intention-to-treat, pre-post design clinical trial.

Population: Adults (aged ≥ 18 years), OHCA not witnessed by EMS, no traumatic cause for cardiac arrest, cardiopulmonary resuscitation initiated or continued by EMS.

Setting: Dispatch-centre-based.

Outcomes: Primary: survival to hospital discharge. Secondary: time to first compression, rate of basic life support measures before EMS arrival, rate of patients with shockable rhythm at EMS arrival, Cerebral Performance Category at hospital discharge, and duration of hospital stay.

Sample size: Assuming an absolute difference in survival rates to hospital discharge of 4% in the two groups (11% before implementation of the SAS versus 15% after) and 80% power, and a type 1 error rate of 0.05, the required sample size is N = 1,109 patients per group (at least N = 2,218 evaluated patients in total).

Conclusions: The HEROES trial will investigate the effects of a SAS on the survival rate after OHCA.

Trial registration: German Clinical Trials Register (DRKS, ID: DRKS00032920).

Keywords: Cardiopulmonary resuscitation; First responder system; Out-of-hospital cardiac arrest; Smartphone alerting system.

PubMed Disclaimer

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘MPM is chair of Region der Lebensretter e.V. (non-profit organisation), member of the executive committee of the German Resuscitation Council (GRC), shareholder of SmartResQ ApS, Denmark, and received speaker honoraria by Stryker. JG is board member of Region der Lebensretter e.V. HJB is vice chair of Region der Lebensretter e.V. GT is board member of Region der Lebensretter e.V., secretary of the GRC, and shareholder of Resuscitec GmbH, Freiburg, Germany. JSP is member of Region der Lebensretter e.V. and member of the executive committee of the GRC. All other authors have no conflicts of interest to declare’.

Figures

**Fig. 1**
Smartphone Application “Region of Lifesavers”. From left to right: Home screen without active alarm and display of all time-limited AEDs (yellow) and all AEDs available 24/7 (green). Alarm screen with approximate location. The selected means of transportation must be chosen by the first responder. The first responder is asked whether he is already carrying an AED.

**Fig. 2**
Schematic representation of the study programme in three phases.

See this image and copyright information in PMC

References

1. Qualitätsbericht – Todesursachenstatistik. Statistisches Bundesamt. n.d. https://www.destatis.de/DE/Methoden/Qualitaet/Qualitaetsberichte/Gesundh... (accessed December 10, 2023).
1. Fischer M. Jahresbericht des Deutschen Reanimationsregisters: Außerklinische Reanimation im Notarzt- und Rettungsdienst 2022. Fischer M, Wnent J, Gräsner J-T, Seewald S, Brenner S, Bein B et al: Jahresbericht des Deutschen Reanimationsregisters: Außerklinische Reanimation im Notarzt- und Rettungsdienst 2022 2023:V161–9. 10.19224/ai2023.v161. - DOI
1. Semeraro F., Greif R., Böttiger B.W., et al. European Resuscitation Council Guidelines 2021: Systems saving lives. Resuscitation. 2021;161:80–97. doi: 10.1016/j.resuscitation.2021.02.008. - DOI - PubMed
1. Ringh M., Rosenqvist M., Hollenberg J., et al. Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest. N Engl J Med. 2015;372:2316–2325. doi: 10.1056/NEJMoa1406038. - DOI - PubMed
1. Caputo M.L., Muschietti S., Burkart R., et al. Lay persons alerted by mobile application system initiate earlier cardio-pulmonary resuscitation: A comparison with SMS-based system notification. Resuscitation. 2017;114:73–78. doi: 10.1016/j.resuscitation.2017.03.003. - DOI - PubMed

LinkOut - more resources

Full Text Sources

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Out-of- H ospital cardiac arrest & Smartphon E R esp O nd E r S trial (HEROES Trial): Methodology and study protocol of a pre-post-design trial of the effect of implementing a smartphone alerting system on survival in out-of-hospital cardiac arrest

Affiliations

Out-of- H ospital cardiac arrest & Smartphon E R esp O nd E r S trial (HEROES Trial): Methodology and study protocol of a pre-post-design trial of the effect of implementing a smartphone alerting system on survival in out-of-hospital cardiac arrest

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources