Comparison of video-assisted CPR using the LINE application and telephone-assisted CPR: a randomized controlled simulation trial

BACKGROUND: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is associated with improved bystander CPR performance and outcomes in out-of-hospital cardiac arrest (OHCA). However, the optimal method for delivering DA-CPR-telephone-assisted CPR (T-CPR) versus video-assisted CPR (V-CPR)-remains unclear. The LINE application, a widely used messaging platform in Thailand, offers a video call feature that could support real-time CPR guidance. OBJECTIVE: To compare CPR quality metrics-including chest compression depth, chest compression rate, correct hand positioning, and high-quality CPR fraction-between V-CPR delivered via the LINE application and T-CPR in a simulated OHCA scenario. METHODS: In this randomized controlled trial, undergraduate students aged ≥ 18 years from non-health science faculties without prior CPR training were enrolled and paired by sex. Participant pairs were randomly assigned to receive dispatcher guidance via telephone (T-CPR) or video call using the LINE application (V-CPR). Participants performed CPR in a simulated OHCA scenario under real-time dispatcher guidance. CPR quality metrics were measured using a training manikin. RESULTS: A total of 192 participants (48 pairs per group) were randomized to T-CPR or V-CPR. Baseline characteristics were comparable between groups, and all V-CPR pairs successfully initiated video calls using the LINE application. Compared with the T-CPR group, the V-CPR group achieved greater chest compression depth (3.82 ± 0.85 cm vs. 3.34 ± 0.97 cm; P = 0.011) and a higher high-quality CPR fraction (median 0.47% [IQR 0.00-19.55%] vs. 0.00% [IQR 0.00-2.02%]; P = 0.028). Other metrics, including compression rate and hand positioning accuracy, were comparable between groups. No-flow time was longer in the V-CPR group (median 9 s vs. 6 s; P < 0.001). CONCLUSION: In this simulation-based trial, V-CPR using the LINE application improved chest compression depth compared with T-CPR but was associated with longer no-flow time. TRIAL REGISTRATION: Thai Clinical Trials Registry, TCTR20241022011. Registered on 19 October 2024. First posted publicly on 22 October 2024. https://www.thaiclinicaltrials.org/.