A Study on the Impact of a New Canton-Wide First Responder System in Zug, Switzerland, on Survival After Adult Cardiac Arrest-Examining Early Life-Saving Organized Help, Fast Defibrillation, and Improved Outcomes for Out of Hospital Cardiac Arrest

Condition(s) studied

Study summary

REVIVE Zug: Improving Emergency Response for Out-of-Hospital Cardiac Arrest

Out-of-hospital cardiac arrest (OHCA) represents one of the most time-critical medical emergencies, where rapid recognition and immediate intervention are decisive for survival and neurological outcome. Early activation of emergency services, prompt initiation of cardiopulmonary resuscitation, and rapid defibrillation using automated external defibrillators (AEDs) are key components of the chain of survival. In many regions, organized First Responder systems-such as fire services, police forces, and trained lay responders supported by dispatcher-assisted instructions-arrive at the scene before emergency medical services (EMS) and initiate life-saving measures.

Evidence from multiple EMS systems indicates that the early involvement of First Responders is associated with higher rates of return of spontaneous circulation (ROSC) and improved survival to hospital discharge with favorable neurological outcomes. Regions with well-established First Responder networks consistently report better OHCA outcomes compared with regions without such systems.

In the canton of Zug, a comprehensive First Responder system has recently been implemented alongside an established hybrid EMS response model. In this system, resuscitation efforts are led either by an Emergency Physician (EP) or by a highly trained Critical Care Paramedic (CCP), depending on operational availability. Both roles operate within clearly defined competencies and provide the full scope of advanced prehospital care. This hybrid leadership model offers a unique opportunity to examine whether the professional background of the team leader influences resuscitation outcomes in real-world clinical practice.

The REVIVE Zug study aims to evaluate the impact of the canton-wide First Responder system on outcomes following OHCA. Key outcomes of interest include ROSC rates, hospital admission after cardiac arrest, the occurrence of shockable rhythms at EMS arrival, and outcomes achieved before EMS arrival. In addition, the study explores whether team leadership by an EP or a CCP is associated with differences in resuscitation outcomes. Further analyses focus on time intervals within the chain of survival, such as time from cardiac arrest to arrival of organized help and time to first defibrillation, as well as on event timing and basic demographic characteristics.

The study is based on anonymized data from established EMS quality registries and the national Swiss Reca database. By comparing OHCA cases before and after implementation of the comprehensive First Responder system, the project seeks to provide robust, practice-oriented evidence to inform future development of prehospital emergency care systems in Switzerland and comparable settings.

Eligibility

Primary outcome measure(s)

• Return of Spontaneous Circulation (ROSC) prior to arrival of EMS. — Time Frame: From cardiac arrest onset (as recorded by bystander/witness or dispatch log) until EMS arrival on scene (time-stamped in EMS run sheet); assessed up to 60 minutes.
  Definition: Number and proportion of out-of-hospital cardiac arrest (OHCA) patients achieving ROSC prior to arrival of EMS.
• Hospital admission after OHCA — From cardiac arrest onset until documented handover at the ED or ICU (time-stamped in EMS/hospital record); assessed up to 24 hours.
  Definition: Number and proportion of OHCA patients who are admitted to the hospital (survived to hand-over at the emergency department or ICU).
• Occurrence of shockable rhythm at EMS arrival — Baseline (initial rhythm documented at EMS arrival on scene).
  Definition: Number and proportion of patients presenting with a shockable cardiac rhythm (ventricular fibrillation/pulseless ventricular tachycardia) upon first EMS assessment.

Trial sites (1)

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