Cardiac ArrestCILICA-HSNCT03817892
Compression Is Life In Cardiac Arrest - Human Study (CILICA-HS).
A study testing Guidance of the External Chest Compression and Rhythm of a relay 4 minutes in people with Cardiac Arrest and Cardiopulmonary Resuscitation, run by University Hospital, Caen at 11 sites in France.
Trial summary
The management of out-of-hospital cardiac arrest is complex and multifactorial. With an incidence between 5 and 15 per 10,000 (46,000 patients per year in France) and a survival rate of only 5% to 15%, the room for improvement remains significant even today and is based on fast and optimal care. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Cardiac Arrest, Cardiopulmonary Resuscitation
- What is being tested?
- Guidance of the External Chest Compression and Rhythm of a relay 4 minutes
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 51 participants
- Where
- 11 sitesFrance
- Study dates
- 1 Dec 2019to 1 Aug 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Major person
- Victim of a cardiorespiratory arrest
- Eligible for inclusion procedure in immediate life emergency
- Affiliated to the social security system
Who cannot join
- Minor person.
- Pregnant woman over 6 months old or breastfeeding.
- Known incurable disease.
- Palliative care in progress.
- Decision not to resuscitate from the patient (anticipated directives) or from the medical team.
- Traumatic cardiac arrest.
- Impossibility or contraindication to the use of the External Chest Compression guidance system.
Trial locations and contacts
11 sites in 1 country.
11 sites in 1 country
France11 sites
University Hospital of Amiens
Amiens, 80080
University Hospital of Caen
Caen, Normandy, 14033
Hospital of Cherbourg - Louis Pasteur
Cherbourg, 50100
Hospital of Elbeuf Louviers Val de Reuil
Elbeuf, 76503
Hospital Eure-Seine Evreux
Évreux, 27015
Hospital of Le Havre -
Le Havre, 76290
University Hospital of Lille
Lille, 59000
Hospital of Lisieux - Robert Bisson
Lisieux, 14100
University Hospital of Lyon
Lyon, 69003
University Hospital of Rouen
Rouen, 76000
Hospital of Valenciennes
Valenciennes, 59300
About this study
Official title: Assessment of the Impact of Relay Timing and CPRmeter Guidance on the Quality of External Chest Compression: Compression Is Life In Cardiac Arrest - Human Study (CILICA-HS).
The management of out-of-hospital cardiac arrest is complex and multifactorial. With an incidence between 5 and 15 per 10,000 (46,000 patients per year in France) and a survival rate of only 5% to 15%, the room for improvement remains significant even today and is based on fast and optimal care. Thus French and international recommendations insist on the central element of external chest compression (ECC) and especially its quality (Monsieurs KG and Al. Resuscitation 2015; 95: 1-80). Improving the chest compression fraction (CCF) by limiting time without cardiac massage (No-Flow) is a second major point of the recommendations (Vaillancourt C and Al. Resuscitation 2011; 82: 1501-7). The survival of cardiac arrest victims is closely related on this No-Flow time. The principle of the chain of survival (early warning - ECC - defibrillation - resuscitation) implies that the deterioration of a single link threaten the whole of the care. To meet these qualitative needs, ECC guidance devices have been developed. They make possible to improve the quality of the ECC achieved (Hostler D and Al. BMJ 2011; 342d512). Their use is one of the areas of improvement mentioned in the recommendations. Our team studied in simulation the prolonged effects of guidance on the quality of the ECC during a prolonged resuscitation, with encouraging results (Buléon C and Al. Am J Emerg Med 2016; 34: 1754-60). The investigators propose a study evaluating the efficiency of the guidance of the ECC and the impact of the time of relay on the CCF. The investigators formulate two hypotheses that they wish to test simultaneously using a 2x2 factorial design, in a multicenter randomized trial. The first assumption is that a 4-minute relay rate improves the CCF (by reducing the No-Flow time) compared to the currently recommended 2-minute relay rate. The second hypothesis is that a guiding device improves the quality of the ECC.
This study should, over a period of 2 years, include 500 patients with cardiac arrest for whom specialized resuscitation is undertaken. The investigators hope by this study to improve the knowledge on the optimal rhythm of the ECC and to validate "in vivo" the interest for the guidance found on manikin. This study should make it possible to clarify the recommendations with a high level of evidence in this field and thus contribute to improving the prognosis of the victims of an out-of-hospital cardiac arrest.
Read the detailed description
The management of out-of-hospital cardiac arrest is complex and multifactorial. With an incidence between 5 and 15 per 10,000 (46,000 patients per year in France) and a survival rate of only 5% to 15%, the room for improvement remains significant even today and is based on fast and optimal care. Thus French and international recommendations insist on the central element of external chest compression (ECC) and especially its quality (Monsieurs KG and Al. Resuscitation 2015; 95: 1-80). Improving the chest compression fraction (CCF) by limiting time without cardiac massage (No-Flow) is a second major point of the recommendations (Vaillancourt C and Al. Resuscitation 2011; 82: 1501-7). The survival of cardiac arrest victims is closely related on this No-Flow time. The principle of the chain of survival (early warning - ECC - defibrillation - resuscitation) implies that the deterioration of a single link threaten the whole of the care. To meet these qualitative needs, ECC guidance devices have been developed. They make possible to improve the quality of the ECC achieved (Hostler D and Al. BMJ 2011; 342d512). Their use is one of the areas of improvement mentioned in the recommendations. Our team studied in simulation the prolonged effects of guidance on the quality of the ECC during a prolonged resuscitation, with encouraging results (Buléon C and Al. Am J Emerg Med 2016; 34: 1754-60). The investigators propose a study evaluating the efficiency of the guidance of the ECC and the impact of the time of relay on the CCF. The investigators formulate two hypotheses that they wish to test simultaneously using a 2x2 factorial design, in a multicenter randomized trial. The first assumption is that a 4-minute relay rate improves the CCF (by reducing the No-Flow time) compared to the currently recommended 2-minute relay rate. The second hypothesis is that a guiding device improves the quality of the ECC.
This study should, over a period of 2 years, include 500 patients with cardiac arrest for whom specialized resuscitation is undertaken. The investigators hope by this study to improve the knowledge on the optimal rhythm of the ECC and to validate "in vivo" the interest for the guidance found on manikin. This study should make it possible to clarify the recommendations with a high level of evidence in this field and thus contribute to improving the prognosis of the victims of an out-of-hospital cardiac arrest.
Cardiac arrest (CA) remains a challenge for pre-hospital care. With an incidence of between 5 and 15 per 10,000 (46,000 patients per year in France) and a survival rate of only 5% to 15%, there is yet room for improvement in treatment to reduce morbi-mortality of these patients. The quality of cardiopulmonary resuscitation (CPR) is at the heart of the last three five-year recommendations. (1-3) The latest recommendations emphasize the importance for professionals to work at the highest quality of CPR and External Chest Compression (ECC) possible. (3) The ratio of the time during which the ECC is performed (Low-Flow) to the total time of the resuscitation is referred to as the Chest Compression Fraction (CCF). During CPR, it is essential for the patient's survival to minimize ECC disruption times and therefore to increase the CCF, as this is an independent element in CA survival's improvement. (4,5) ECC interruptions are deleterious to at least two titles. First, they are a source of direct stop in cerebral and coronary perfusions potentially altering the neurological prognosis and the probability of Return of Spontaneous Circulation. (6) Secondly, the quality of the cardiac output generated by the ECC at the time of resuming of the ECC after an interruption is less good for more than 30 seconds: time need for that several chest compressions can restore the best flow possible. (6,7) Reducing these interruptions and improving the ECC is therefore a major goal of improving CPR. The guidelines are that CCF must be greater than 60% and some experts estimate that a CCF of 80% is possible. (8,9) The outcome of patients with pre-hospital CA is significantly, positively and independently correlated with the consistency to different CCF targets, ECC frequency, ECC depth, and brief pre-external electric shock pause (<10 seconds). (10) There is evidence that ECC's guidance improves adequacy to guidelines and allows to be closer with the ECC frequency, depth and release objectives. (11) The investigators have proved in simulation that the guidance of the ECC delays the deterioration of the overall quality of the ECC and its components (frequency, depth and relaxation) related to fatigue during a prolonged ECC beyond the 2 ECC relay minutes currently recommended. (12) Strategies to get closer with the guidelines regarding the quality of the ECC associated with an improvement in CCF should add or even enhance their beneficial effects for the management of CA victims. Achieving high quality CPR requires the measurement of quality of CPR (ECC and CCF). (13,14) This idea of a support strategy enhanced by "bundles" of concepts is developing in the literature. Thus Cheskes S et al. Describe a "high quality CPR" such as the association of a CCF greater than 70% and achievement of the objectives of the recommendations for the frequency and depth of the ECC. (15) The place of devices for guiding the quality of the ECC needs to be specified. Indeed, studies of their use in real-life situations are criticized for their methodological qualities and their size. (16) The use of a real-time guidance device is proposed as a possibility in the latest guidelines without being an indispensable element due to the lack of current evidence. (3) Its use or non-use does not imply any obvious loss of chance for patients. Evidence as to its usefulness therefore remains to be sought.
For this reason, the investigators wish, through an original, randomized, multi-center study, to provide some answers to the questions about the possibility of an improvement in CCF by the lengthening of the time between two ECC relays and the effect of guidance on the quality of the ECC. The design of the study will also allow to approach a possible combined effect of ECC relays rhythm and guidance. The currently recommended duration of a two-minute ECC cycle between two relays does not have a consistent evidence based and corresponds to a duration for which the ECC effort can be maintained in principle with efficiency. (3) Objective measures have shown that the quality of the ECC can be maintained beyond 2 minutes. Extending the duration of an ECC cycle could reduce the number of ECC interruptions and thus improve the CCF.
The investigators therefore formulate two hypotheses that they wish to test simultaneously using a 2x2 factorial design, in a multicenter randomized trial. The first assumption is that a 4-minutes relay rhythm improves the CCF (by reducing the No-Flow time) compared to the currently recommended 2-minutes relay rhythm. The second hypothesis is that a guiding device improves the quality of the ECC.
The CPRmeter® (guidance device used in this study) will record data on the ECC and its quality (depth, frequency, relaxation, CPRmeter® use time, No-Flow time and Low-Flow time) as well as ECC guidance for the group which will benefit from it (the other group will have the screen masked by a screen cap).
This study should, over a period of 2 years, include 500 major patients presenting a non-traumatic CA for whom a specialized CPR is undertaken. The investigators hope by this study to improve the knowledge on the optimal rhythm of the CEE and to validate "in vivo" the interest for the guidance found on manikin. This study should clarify the guidelines with a high level of evidence in this area and thus contribute to improving the prognosis of victims of out-hospital CA.
- Conditions
- Cardiac Arrest, Cardiopulmonary Resuscitation
- Being tested
- Guidance of the External Chest Compression, Rhythm of a relay 4 minutes
- Keywords
- No-Flow, Chest Compression Fraction, Out Hospital, External Chest Compression Relay, External Chest Compression Guidance, External Chest Compression Quality, Correct Compression Score
- Medical subject headings
- Heart Arrest
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Guidance of the External Chest CompressionOther
Also called CPRmeter's feedback
The CPRmeter® device is positioned on the patient's chest with a disposable adhesive. In the situation of guidance of the External Chest Compression the rescuers have access in real time on the screen to visual feedback on the quality of the External Chest Compression performed and indications of possible corrections to improve the quality of the External Chest Compression . In the case of non-guidance of the External Chest Compression , a mask is position on the screen in order to hide the feedback information.
Rhythm of a relay 4 minutesOther
The duration or rhythm of a relay is the time during which a rescuer performs External Chest Compression before being relayed by another rescuer. This time is 2 minutes in non intervention group according to the current guidelines and 4 minutes in experimental group.
| Study group | Role | What they receive |
|---|---|---|
| Unguided 2 minutes (U2) | No intervention | The External Chest Compression are performed without guidance of the CPRmeter device (according to the current guidelines). The duration or rhythm of a relay during which a rescuer performs External Chest Compression before being relayed by another rescuer is 2 minutes according to the current guidelines. |
| Unguided 4 minutes (U4) | Experimental | The External Chest Compression are performed without guidance of the CPRmeter device (according to the current guidelines).
The duration or rhythm of a relay during which a rescuer performs External Chest Compression before being relayed by another rescuer is 4 minutes. (Rhythm of a relay 4 minutes) Receives: Other: Rhythm of a relay 4 minutes |
| Guided 2 minutes (G2) | Experimental | The External Chest Compression are performed with guidance of the CPRmeter device. (Guidance of the External Chest Compression) The duration or rhythm of a relay during which a rescuer performs External Chest Compression before being relayed by another rescuer is 2 minutes according to the current guidelines. Receives: Other: Guidance of the External Chest Compression |
| Guided 4 minutes (G4) | Experimental | The External Chest Compression are performed with guidance of the CPRmeter device. (Guidance of the External Chest Compression) The duration or rhythm of a relay during which a rescuer performs External Chest Compression before being relayed by another rescuer is 4 minutes. (Rhythm of a relay 4 minutes) Receives: Other: Guidance of the External Chest Compression; Other: Rhythm of a relay 4 minutes |
What is being measured
The primary outcome is the main question the study is designed to answer.
Chest Compression Fraction
The Chest Compression Fraction (in percentage) corresponds to the resuscitation time during which a External Chest Compression is performed (Low Flow) related to the patient's management time by the prehospital rescue team.
Measured: 1 day
Correct Compression Score
The correct compression score (in percentage) corresponds to a External Chest Compression for which simultaneously the depth is correct (50 to 60 mm), the frequency is correct (100 to 120 / min) and the relaxation is correct (<2500 g) .
Measured: 1 day
Secondary outcomes (11)
Depth of External Chest Compression
The depth of External Chest Compression (in millimeters) continuously recorded by the guidance system (average and percentage correct).
Measured: 1 day
Frequency of External Chest Compression
The frequency of External Chest Compression (in number of compression per minute) recorded continuously by the guidance system (average and percentage correct)....
Measured: 1 day
Relaxation of External Chest Compression
The relaxation of External Chest Compression corresponds to the residual force (in grams) recorded continuously by the guidance system (average and percentage correct)
Measured: 1 day
Subjective rescuers' fatigue
The subjective fatigue assessed by rescuers who performed External Chest Compression using the Borg scale (average of the Borg Scale values of rescuers)
Measured: 1 day
The delays and durations of care
The delays and durations of care (in minutes and seconds) based on the following events: cardiac arrest time, start time of the External Chest Compression, start time of resuscitation by the prehospital rescue team, end time of resuscitation (ROSC or death of the patient).
Measured: 1 day
No-Flow and Low-Flow times
The times (in minutes and seconds) of No-Flow (time during which no External Chest Compression is performed) and Low-Flow (time during which External Chest Compression is performed, generating a minimum flow rate of organs).
Measured: 1 day
Recuperation of Spontaneous Circulation
The rate of Recuperation of Spontaneous Circulation (percentage).
Measured: 1 day
survival at hospital arrival
The rate of survival at hospital arrival
Measured: 1 day
Neuron Specific Enolase
The serum Neuron Specific Enolase level (ng/mL)
Measured: Day 1 and day 3
Survival
The survival rate.
Measured: Day 2 and one month.
Cerebral Performance Category Score
Cerebral Performance Category Score as discribe in Wijdicks EFM et al. Neurology 2006;67:203-10.
Measured: up to one month.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Jan 2019
- Study start1 Dec 2019
- Primary completion16 Aug 2024
- Study completion1 Aug 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (17)Papers the sponsor has linked to this study.
- Other trials for Cardiac ArrestStudies of the same condition, open and under way.
- More trials run by University Hospital, CaenThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Factorial
- Model description
- This is a randomized, multicenter, open-label study using a 2x2 factorial design comparing (i) the rhythm of External Chest Compression relays every 4 minutes versus every 2 minutes on the Chest Compression Fraction; (ii) the use of real-time guidance of the External Chest Compression via a feedback device (CPRmeter®) versus no guidance on the quality of the External Chest Compression (correct compression score).
- Masking
- None (open label)
- Enrolment
- 51 participants (actual)
Sponsor and investigators
- Lead sponsor
- University Hospital, Caen
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Clément BULEON, MD, Principal investigator, University Hospital of CaenPierre-Yves GUEUGNIAUD, MD, PhD, Study chair, University Hospital of LyonEric ROUPIE, MD, PhD, Study chair, University Hospital of Caen
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03817892
- Sponsor's protocol ID
- 2018-A02000-55
- Other IDs
- 17-248
- Acronym
- CILICA-HS
- Status last verified
- Jun 2026
- First submitted
- 24 Jan 2019
- Last updated
- 25 Jun 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Publications
International Liaison Committee on Resuscitation. 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 4: Advanced life support. Resuscitation. 2005 Nov-Dec;67(2-3):213-47. doi: 10.1016/j.resuscitation.2005.09.018. No abstract available.
PubMed 16324990Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, Koster RW, Wyllie J, Bottiger B; ERC Guidelines Writing Group. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation. 2010 Oct;81(10):1219-76. doi: 10.1016/j.resuscitation.2010.08.021. No abstract available.
PubMed 20956052Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlar A, Wyllie J, Zideman DA; ERC Guidelines 2015 Writing Group. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015 Oct;95:1-80. doi: 10.1016/j.resuscitation.2015.07.038. Epub 2015 Oct 15. No abstract available.
PubMed 26477410Christenson J, Andrusiek D, Everson-Stewart S, Kudenchuk P, Hostler D, Powell J, Callaway CW, Bishop D, Vaillancourt C, Davis D, Aufderheide TP, Idris A, Stouffer JA, Stiell I, Berg R; Resuscitation Outcomes Consortium Investigators. Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation. 2009 Sep 29;120(13):1241-7. doi: 10.1161/CIRCULATIONAHA.109.852202. Epub 2009 Sep 14.
PubMed 19752324Wik L, Olsen JA, Persse D, Sterz F, Lozano M Jr, Brouwer MA, Westfall M, Souders CM, Travis DT, Herken UR, Lerner EB. Why do some studies find that CPR fraction is not a predictor of survival? Resuscitation. 2016 Jul;104:59-62. doi: 10.1016/j.resuscitation.2016.04.013. Epub 2016 May 4.
PubMed 27155547Berg RA, Sanders AB, Kern KB, Hilwig RW, Heidenreich JW, Porter ME, Ewy GA. Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. Circulation. 2001 Nov 13;104(20):2465-70. doi: 10.1161/hc4501.098926.
PubMed 11705826Cunningham LM, Mattu A, O'Connor RE, Brady WJ. Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation. Am J Emerg Med. 2012 Oct;30(8):1630-8. doi: 10.1016/j.ajem.2012.02.015. Epub 2012 May 23.
PubMed 22633716Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, Gazmuri RJ, Travers AH, Rea T. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015 Nov 3;132(18 Suppl 2):S414-35. doi: 10.1161/CIR.0000000000000259. No abstract available.
PubMed 26472993Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, Bossaert LL, Brett SJ, Chamberlain D, de Caen AR, Deakin CD, Finn JC, Grasner JT, Hazinski MF, Iwami T, Koster RW, Lim SH, Ma MH, McNally BF, Morley PT, Morrison LJ, Monsieurs KG, Montgomery W, Nichol G, Okada K, Ong ME, Travers AH, Nolan JP; Utstein Collaborators. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation. 2015 Nov;96:328-40. doi: 10.1016/j.resuscitation.2014.11.002. Epub 2014 Nov 11.
PubMed 25438254Cheskes S, Schmicker RH, Rea T, Morrison LJ, Grunau B, Drennan IR, Leroux B, Vaillancourt C, Schmidt TA, Koller AC, Kudenchuk P, Aufderheide TP, Herren H, Flickinger KH, Charleston M, Straight R, Christenson J; ROC investigators. The association between AHA CPR quality guideline compliance and clinical outcomes from out-of-hospital cardiac arrest. Resuscitation. 2017 Jul;116:39-45. doi: 10.1016/j.resuscitation.2017.05.003. Epub 2017 May 2.
PubMed 28476474Hostler D, Everson-Stewart S, Rea TD, Stiell IG, Callaway CW, Kudenchuk PJ, Sears GK, Emerson SS, Nichol G; Resuscitation Outcomes Consortium Investigators. Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster-randomised trial. BMJ. 2011 Feb 4;342:d512. doi: 10.1136/bmj.d512.
PubMed 21296838Buleon C, Delaunay J, Parienti JJ, Halbout L, Arrot X, Gerard JL, Hanouz JL. Impact of a feedback device on chest compression quality during extended manikin CPR: a randomized crossover study. Am J Emerg Med. 2016 Sep;34(9):1754-60. doi: 10.1016/j.ajem.2016.05.077. Epub 2016 May 28.
PubMed 27349359Goodloe JM, Idris AH. Metrics save lives: value and hurdles faced. Curr Opin Crit Care. 2017 Jun;23(3):204-208. doi: 10.1097/MCC.0000000000000408.
PubMed 28379867Lin S, Scales DC. Cardiopulmonary resuscitation quality and beyond: the need to improve real-time feedback and physiologic monitoring. Crit Care. 2016 Jun 28;20(1):182. doi: 10.1186/s13054-016-1371-9.
PubMed 27349642Cheskes S, Byers A, Zhan C, Verbeek PR, Ko D, Drennan IR, Buick JE, Brooks SC, Lin S, Taher A, Morrison LJ; Rescu Epistry Investigators. CPR quality during out-of-hospital cardiac arrest transport. Resuscitation. 2017 May;114:34-39. doi: 10.1016/j.resuscitation.2017.02.016. Epub 2017 Feb 24.
PubMed 28242210
Study at a glance
From the registry record, last updated by the sponsor on 25 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Assessment of the Impact of Relay Timing and CPRmeter Guidance on the Quality of External Chest Compression: Compression Is Life In Cardiac Arrest - Human Study (CILICA-HS).
- ClinicalTrials.gov ID
- NCT03817892
- Acronym / sponsor ID
- CILICA-HS / 2018-A02000-55
- Conditions
- Cardiac Arrest, Cardiopulmonary Resuscitation
- Keywords
- No-Flow, Chest Compression Fraction, Out Hospital, External Chest Compression Relay, External Chest Compression Guidance, External Chest Compression Quality, Correct Compression Score
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 51 participants (actual)
- Lead sponsor
- University Hospital, CaenUniversity, hospital or other
- Study start
- 1 Dec 2019 (actual)
- Primary completion
- 16 Aug 2024 (actual)
- Study completion
- 1 Aug 2025 (actual)
- First posted
- 28 Jan 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The management of out-of-hospital cardiac arrest is complex and multifactorial. With an incidence between 5 and 15 per 10,000 (46,000 patients per year in France) and a survival rate of only 5% to 15%, the room for improvement remains significant even today and is based on fast and optimal care. Thus French and international recommendations insist on the central element of external chest compression (ECC) and especially its quality (Monsieurs KG and Al. Resuscitation 2015; 95: 1-80). Improving the chest compression fraction (CCF) by limiting time without cardiac massage (No-Flow) is a second major point of the recommendations (Vaillancourt C and Al. Resuscitation 2011; 82: 1501-7). The survival of cardiac arrest victims is closely related on this No-Flow time. The principle of the chain of survival (early warning - ECC - defibrillation - resuscitation) implies that the deterioration of a single link threaten the whole of the care. To meet these qualitative needs, ECC guidance devices have been developed. They make possible to improve the quality of the ECC achieved (Hostler D and Al. BMJ 2011; 342d512). Their use is one of the areas of improvement mentioned in the recommendations. Our team studied in simulation the prolonged effects of guidance on the quality of the ECC during a prolonged resuscitation, with encouraging results (Buléon C and Al. Am J Emerg Med 2016; 34: 1754-60). The investigators propose a study evaluating the efficiency of the guidance of the ECC and the impact of the time of relay on the CCF. The investigators formulate two hypotheses that they wish to test simultaneously using a 2x2 factorial design, in a multicenter randomized trial. The first assumption is that a 4-minute relay rate improves the CCF (by reducing the No-Flow time) compared to the currently recommended 2-minute relay rate. The second hypothesis is that a guiding device improves the quality of the ECC.
This study should, over a period of 2 years, include 500 patients with cardiac arrest for whom specialized resuscitation is undertaken. The investigators hope by this study to improve the knowledge on the optimal rhythm of the ECC and to validate "in vivo" the interest for the guidance found on manikin. This study should make it possible to clarify the recommendations with a high level of evidence in this field and thus contribute to improving the prognosis of the victims of an out-of-hospital cardiac arrest.
Detailed description
The management of out-of-hospital cardiac arrest is complex and multifactorial. With an incidence between 5 and 15 per 10,000 (46,000 patients per year in France) and a survival rate of only 5% to 15%, the room for improvement remains significant even today and is based on fast and optimal care. Thus French and international recommendations insist on the central element of external chest compression (ECC) and especially its quality (Monsieurs KG and Al. Resuscitation 2015; 95: 1-80). Improving the chest compression fraction (CCF) by limiting time without cardiac massage (No-Flow) is a second major point of the recommendations (Vaillancourt C and Al. Resuscitation 2011; 82: 1501-7). The survival of cardiac arrest victims is closely related on this No-Flow time. The principle of the chain of survival (early warning - ECC - defibrillation - resuscitation) implies that the deterioration of a single link threaten the whole of the care. To meet these qualitative needs, ECC guidance devices have been developed. They make possible to improve the quality of the ECC achieved (Hostler D and Al. BMJ 2011; 342d512). Their use is one of the areas of improvement mentioned in the recommendations. Our team studied in simulation the prolonged effects of guidance on the quality of the ECC during a prolonged resuscitation, with encouraging results (Buléon C and Al. Am J Emerg Med 2016; 34: 1754-60). The investigators propose a study evaluating the efficiency of the guidance of the ECC and the impact of the time of relay on the CCF. The investigators formulate two hypotheses that they wish to test simultaneously using a 2x2 factorial design, in a multicenter randomized trial. The first assumption is that a 4-minute relay rate improves the CCF (by reducing the No-Flow time) compared to the currently recommended 2-minute relay rate. The second hypothesis is that a guiding device improves the quality of the ECC.
This study should, over a period of 2 years, include 500 patients with cardiac arrest for whom specialized resuscitation is undertaken. The investigators hope by this study to improve the knowledge on the optimal rhythm of the ECC and to validate "in vivo" the interest for the guidance found on manikin. This study should make it possible to clarify the recommendations with a high level of evidence in this field and thus contribute to improving the prognosis of the victims of an out-of-hospital cardiac arrest.
Cardiac arrest (CA) remains a challenge for pre-hospital care. With an incidence of between 5 and 15 per 10,000 (46,000 patients per year in France) and a survival rate of only 5% to 15%, there is yet room for improvement in treatment to reduce morbi-mortality of these patients. The quality of cardiopulmonary resuscitation (CPR) is at the heart of the last three five-year recommendations. (1-3) The latest recommendations emphasize the importance for professionals to work at the highest quality of CPR and External Chest Compression (ECC) possible. (3) The ratio of the time during which the ECC is performed (Low-Flow) to the total time of the resuscitation is referred to as the Chest Compression Fraction (CCF). During CPR, it is essential for the patient's survival to minimize ECC disruption times and therefore to increase the CCF, as this is an independent element in CA survival's improvement. (4,5) ECC interruptions are deleterious to at least two titles. First, they are a source of direct stop in cerebral and coronary perfusions potentially altering the neurological prognosis and the probability of Return of Spontaneous Circulation. (6) Secondly, the quality of the cardiac output generated by the ECC at the time of resuming of the ECC after an interruption is less good for more than 30 seconds: time need for that several chest compressions can restore the best flow possible. (6,7) Reducing these interruptions and improving the ECC is therefore a major goal of improving CPR. The guidelines are that CCF must be greater than 60% and some experts estimate that a CCF of 80% is possible. (8,9) The outcome of patients with pre-hospital CA is significantly, positively and independently correlated with the consistency to different CCF targets, ECC frequency, ECC depth, and brief pre-external electric shock pause (<10 seconds). (10) There is evidence that ECC's guidance improves adequacy to guidelines and allows to be closer with the ECC frequency, depth and release objectives. (11) The investigators have proved in simulation that the guidance of the ECC delays the deterioration of the overall quality of the ECC and its components (frequency, depth and relaxation) related to fatigue during a prolonged ECC beyond the 2 ECC relay minutes currently recommended. (12) Strategies to get closer with the guidelines regarding the quality of the ECC associated with an improvement in CCF should add or even enhance their beneficial effects for the management of CA victims. Achieving high quality CPR requires the measurement of quality of CPR (ECC and CCF). (13,14) This idea of a support strategy enhanced by "bundles" of concepts is developing in the literature. Thus Cheskes S et al. Describe a "high quality CPR" such as the association of a CCF greater than 70% and achievement of the objectives of the recommendations for the frequency and depth of the ECC. (15) The place of devices for guiding the quality of the ECC needs to be specified. Indeed, studies of their use in real-life situations are criticized for their methodological qualities and their size. (16) The use of a real-time guidance device is proposed as a possibility in the latest guidelines without being an indispensable element due to the lack of current evidence. (3) Its use or non-use does not imply any obvious loss of chance for patients. Evidence as to its usefulness therefore remains to be sought.
For this reason, the investigators wish, through an original, randomized, multi-center study, to provide some answers to the questions about the possibility of an improvement in CCF by the lengthening of the time between two ECC relays and the effect of guidance on the quality of the ECC. The design of the study will also allow to approach a possible combined effect of ECC relays rhythm and guidance. The currently recommended duration of a two-minute ECC cycle between two relays does not have a consistent evidence based and corresponds to a duration for which the ECC effort can be maintained in principle with efficiency. (3) Objective measures have shown that the quality of the ECC can be maintained beyond 2 minutes. Extending the duration of an ECC cycle could reduce the number of ECC interruptions and thus improve the CCF.
The investigators therefore formulate two hypotheses that they wish to test simultaneously using a 2x2 factorial design, in a multicenter randomized trial. The first assumption is that a 4-minutes relay rhythm improves the CCF (by reducing the No-Flow time) compared to the currently recommended 2-minutes relay rhythm. The second hypothesis is that a guiding device improves the quality of the ECC.
The CPRmeter® (guidance device used in this study) will record data on the ECC and its quality (depth, frequency, relaxation, CPRmeter® use time, No-Flow time and Low-Flow time) as well as ECC guidance for the group which will benefit from it (the other group will have the screen masked by a screen cap).
This study should, over a period of 2 years, include 500 major patients presenting a non-traumatic CA for whom a specialized CPR is undertaken. The investigators hope by this study to improve the knowledge on the optimal rhythm of the CEE and to validate "in vivo" the interest for the guidance found on manikin. This study should clarify the guidelines with a high level of evidence in this area and thus contribute to improving the prognosis of victims of out-hospital CA.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Factorial
- Masking
- None (open label)
- Number of arms
- 4
- Model description
- This is a randomized, multicenter, open-label study using a 2x2 factorial design comparing (i) the rhythm of External Chest Compression relays every 4 minutes versus every 2 minutes on the Chest Compression Fraction; (ii) the use of real-time guidance of the External Chest Compression via a feedback device (CPRmeter®) versus no guidance on the quality of the External Chest Compression (correct compression score).
| Arm | Type | Receives |
|---|---|---|
| Unguided 2 minutes (U2) | No intervention | –The External Chest Compression are performed without guidance of the CPRmeter device (according to the current guidelines). The duration or rhythm of a relay during which a rescuer performs External Chest Compression before being relayed by another rescuer is 2 minutes according to the current guidelines. |
| Unguided 4 minutes (U4) | Experimental | Other: Rhythm of a relay 4 minutesThe External Chest Compression are performed without guidance of the CPRmeter device (according to the current guidelines). The duration or rhythm of a relay during which a rescuer performs External Chest Compression before being relayed by another rescuer is 4 minutes. (Rhythm of a relay 4 minutes) |
| Guided 2 minutes (G2) | Experimental | Other: Guidance of the External Chest CompressionThe External Chest Compression are performed with guidance of the CPRmeter device. (Guidance of the External Chest Compression) The duration or rhythm of a relay during which a rescuer performs External Chest Compression before being relayed by another rescuer is 2 minutes according to the current guidelines. |
| Guided 4 minutes (G4) | Experimental | Other: Guidance of the External Chest Compression, Other: Rhythm of a relay 4 minutesThe External Chest Compression are performed with guidance of the CPRmeter device. (Guidance of the External Chest Compression) The duration or rhythm of a relay during which a rescuer performs External Chest Compression before being relayed by another rescuer is 4 minutes. (Rhythm of a relay 4 minutes) |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Major person
- Victim of a cardiorespiratory arrest
- Eligible for inclusion procedure in immediate life emergency
- Affiliated to the social security system
Key exclusion criteria (7 listed)
- Minor person.
- Pregnant woman over 6 months old or breastfeeding.
- Known incurable disease.
- Palliative care in progress.
- Decision not to resuscitate from the patient (anticipated directives) or from the medical team.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Guidance of the External Chest CompressionAlso: CPRmeter's feedbackThe CPRmeter® device is positioned on the patient's chest with a disposable adhesive. In the situation of guidance of the External Chest Compression the rescuers have access in real time on the screen to visual feedback on the quality of the External Chest Compression performed and indications of possible corrections to improve the quality of the External Chest Compression . In the case of non-guidance of the External Chest Compression , a mask is position on the screen in order to hide the feedback information. | Other | Guided 2 minutes (G2), Guided 4 minutes (G4) |
| Rhythm of a relay 4 minutesThe duration or rhythm of a relay is the time during which a rescuer performs External Chest Compression before being relayed by another rescuer. This time is 2 minutes in non intervention group according to the current guidelines and 4 minutes in experimental group. | Other | Guided 4 minutes (G4), Unguided 4 minutes (U4) |
Primary outcome
Chest Compression Fraction
Time frame: 1 day
The Chest Compression Fraction (in percentage) corresponds to the resuscitation time during which a External Chest Compression is performed (Low Flow) related to the patient's management time by the prehospital rescue team.
Correct Compression Score
Time frame: 1 day
The correct compression score (in percentage) corresponds to a External Chest Compression for which simultaneously the depth is correct (50 to 60 mm), the frequency is correct (100 to 120 / min) and the relaxation is correct (<2500 g) .
11 secondary outcomes
Depth of External Chest Compression
Time frame: 1 day
Frequency of External Chest Compression
Time frame: 1 day
Relaxation of External Chest Compression
Time frame: 1 day
Subjective rescuers' fatigue
Time frame: 1 day
The delays and durations of care
Time frame: 1 day
No-Flow and Low-Flow times
Time frame: 1 day
Recuperation of Spontaneous Circulation
Time frame: 1 day
survival at hospital arrival
Time frame: 1 day
Neuron Specific Enolase
Time frame: Day 1 and day 3
Survival
Time frame: Day 2 and one month.
Cerebral Performance Category Score
Time frame: up to one month.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 25 Jun 2026.
- Background: PubMed 16324990International Liaison Committee on Resuscitation. 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 4: Advanced life support. Resuscitation. 2005 Nov-Dec;67(2-3):213-47. doi: 10.1016/j.resuscitation.2005.09.018. No abstract available.
- Background: PubMed 20956052Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, Koster RW, Wyllie J, Bottiger B; ERC Guidelines Writing Group. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation. 2010 Oct;81(10):1219-76. doi: 10.1016/j.resuscitation.2010.08.021. No abstract available.
- Background: PubMed 26477410Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlar A, Wyllie J, Zideman DA; ERC Guidelines 2015 Writing Group. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015 Oct;95:1-80. doi: 10.1016/j.resuscitation.2015.07.038. Epub 2015 Oct 15. No abstract available.
- Background: PubMed 19752324Christenson J, Andrusiek D, Everson-Stewart S, Kudenchuk P, Hostler D, Powell J, Callaway CW, Bishop D, Vaillancourt C, Davis D, Aufderheide TP, Idris A, Stouffer JA, Stiell I, Berg R; Resuscitation Outcomes Consortium Investigators. Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation. 2009 Sep 29;120(13):1241-7. doi: 10.1161/CIRCULATIONAHA.109.852202. Epub 2009 Sep 14.
- Background: PubMed 27155547Wik L, Olsen JA, Persse D, Sterz F, Lozano M Jr, Brouwer MA, Westfall M, Souders CM, Travis DT, Herken UR, Lerner EB. Why do some studies find that CPR fraction is not a predictor of survival? Resuscitation. 2016 Jul;104:59-62. doi: 10.1016/j.resuscitation.2016.04.013. Epub 2016 May 4.
- Background: PubMed 11705826Berg RA, Sanders AB, Kern KB, Hilwig RW, Heidenreich JW, Porter ME, Ewy GA. Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. Circulation. 2001 Nov 13;104(20):2465-70. doi: 10.1161/hc4501.098926.
- Background: PubMed 22633716Cunningham LM, Mattu A, O'Connor RE, Brady WJ. Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation. Am J Emerg Med. 2012 Oct;30(8):1630-8. doi: 10.1016/j.ajem.2012.02.015. Epub 2012 May 23.
- Background: PubMed 26472993Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, Gazmuri RJ, Travers AH, Rea T. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015 Nov 3;132(18 Suppl 2):S414-35. doi: 10.1161/CIR.0000000000000259. No abstract available.
- Background: PubMed 25438254Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, Bossaert LL, Brett SJ, Chamberlain D, de Caen AR, Deakin CD, Finn JC, Grasner JT, Hazinski MF, Iwami T, Koster RW, Lim SH, Ma MH, McNally BF, Morley PT, Morrison LJ, Monsieurs KG, Montgomery W, Nichol G, Okada K, Ong ME, Travers AH, Nolan JP; Utstein Collaborators. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation. 2015 Nov;96:328-40. doi: 10.1016/j.resuscitation.2014.11.002. Epub 2014 Nov 11.
- Background: PubMed 28476474Cheskes S, Schmicker RH, Rea T, Morrison LJ, Grunau B, Drennan IR, Leroux B, Vaillancourt C, Schmidt TA, Koller AC, Kudenchuk P, Aufderheide TP, Herren H, Flickinger KH, Charleston M, Straight R, Christenson J; ROC investigators. The association between AHA CPR quality guideline compliance and clinical outcomes from out-of-hospital cardiac arrest. Resuscitation. 2017 Jul;116:39-45. doi: 10.1016/j.resuscitation.2017.05.003. Epub 2017 May 2.
- Background: PubMed 21296838Hostler D, Everson-Stewart S, Rea TD, Stiell IG, Callaway CW, Kudenchuk PJ, Sears GK, Emerson SS, Nichol G; Resuscitation Outcomes Consortium Investigators. Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster-randomised trial. BMJ. 2011 Feb 4;342:d512. doi: 10.1136/bmj.d512.
- Background: PubMed 27349359Buleon C, Delaunay J, Parienti JJ, Halbout L, Arrot X, Gerard JL, Hanouz JL. Impact of a feedback device on chest compression quality during extended manikin CPR: a randomized crossover study. Am J Emerg Med. 2016 Sep;34(9):1754-60. doi: 10.1016/j.ajem.2016.05.077. Epub 2016 May 28.
- Individual participant dataSharing planned: Undecided
Related trials for Cardiac Arrest
Not yet recruitingObservational study
CAROTID DOPPLER AND CEREBRAL OXIMERY IN POST CARDIAC ARREST ICU PATIENTS
Cardiac Arrest (CA), Carotid Doppler
Active, not recruitingPhase 3
The Danish Out-of-Hospital Cardiac Arrest Study
Out-Of-Hospital Cardiac Arrest, Post-Cardiac Arrest Syndrome
RecruitingObservational study
Evaluation of Acid-base Disorders and Ventilation Settings in Cardiogenic Shock and Post-cardiac Arrest Patients: Comparison With VentilO Algorithm
Cardiac Arrest (CA), Cardiogenic Shock
RecruitingObservational study
Comparison of Scores for Early Brain Damage Assessment at Intensive Care Unit Admission After Cardiac Arrest
Cardiac Arrest
RecruitingObservational study
Smartphone Enabled Detection of Cognitive Motor Dissociation in the ICU
Traumatic Brain Injury (TBI) Patients, Intracerebral Hemorrhage
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Clément BULEON, MD principal investigator
University Hospital of Caen
Pierre-Yves GUEUGNIAUD, MD, PhD study chair
University Hospital of Lyon
Eric ROUPIE, MD, PhD study chair
University Hospital of Caen
11 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Guidance of the External Chest Compression and Rhythm of a relay 4 minutes in people with Cardiac Arrest and Cardiopulmonary Resuscitation, run by University Hospital, Caen at 11 sites in France.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 25 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 11 sites in France. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Chest Compression Fraction (time frame: 1 day). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03817892, which also lists 17 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Jun 2026.