Telemedicine-assisted vs conventional telephone instruction in cardiopulmonary resuscitation: the TACTIC cluster randomized trial.
Resuscitation · 2026-06-26 · Randomised trial
Abstract
INTRODUCTION: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) has been shown to increase bystander CPR rates and improve outcomes after out-of-hospital cardiac arrest (OHCA). However, dispatchers cannot directly visualize the scene, which may limit the effectiveness of telephone instructions. Telemedicine-assisted CPR (TA-CPR), incorporating real-time video communication, has been proposed to address this limitation and potentially improve bystander CPR performance. Evidence regarding its effectiveness in real-world EMS systems remains limited. This study aimed to compare bystander CPR rates between TA-CPR and DA-CPR. METHODS: We conducted a pilot pragmatic cluster-randomized controlled trial involving adult patients with suspected non-traumatic OHCA. Monthly block randomization assigned CPR instruction protocols to either a TA-CPR protocol or a DA-CPR protocol. The primary outcome was bystander CPR rate. Secondary outcomes included ongoing bystander CPR at EMS arrival and protocol compliance. RESULTS: A total of 108 patients were included, with 55 managed using TA-CPR and 53 using DA-CPR. Patients in the TA-CPR group were younger (mean age 63.5 ± 16.2 vs. 68.9 ± 14.6 years), and a higher proportion presented with an initial shockable rhythm (20.0% vs. 9.4%). Bystander CPR occurred in 87.3% of TA-CPR cases and 92.5% of DA-CPR cases, with no statistically significant difference (p = 0.53). Ongoing bystander CPR at EMS arrival was also similar between groups (76.4% vs. 84.9%; p = 0.33). Protocol compliance was significantly lower in the TA-CPR group than in the DA-CPR group (69.1% vs. 92.5%; p < 0.01). CONCLUSION: TA-CPR did not increase bystander CPR rates compared with conventional DA-CPR in this real-world EMS setting.