Condition category
Circulatory System
Date applied
Date assigned
Last edited
Prospectively registered
Overall trial status
Recruitment status
No longer recruiting

Plain English Summary

Background and study aims
Cardiac arrest is the sudden stopping of heart function. It affects about 35,000 patients in UK hospitals per year. Less than 20% of cardiac arrest victims survive to leave hospital. Survival requires the delivery of high-quality cardiopulmonary resuscitation (CPR). However, in practice, the delivery of high-quality CPR is not always achieved.

Providing feedback (debriefing) to doctors and nurses about their performance at a cardiac arrest may be an effective way to improve the quality of CPR. In this study, we will compare the effectiveness of three different debriefing interventions.

Who can participate?
Participants will be patients, aged 18 and above, who have a cardiac arrest at one of the three hospitals which make up the Heart of England NHS Foundation Trust.

What does the study involve?
Following each cardiac arrest, staff will be offered debriefing about the quality of CPR provided at the cardiac arrest. The type of debriefing will be determined by the hospital site. At hospital one, staff will receive written feedback. At hospital two, individuals will receive spoken feedback. At hospital three, staff will participate in monthly debriefing meetings.
At each hospital, staff will use defibrillators equipped with technology that measures the quality of CPR provided at the cardiac arrest. This technology consists of a small device that is placed on the patient’s chest during their cardiac arrest. The device also provides immediate feedback about the quality of CPR through audio (e.g. ‘compress faster’) and visual prompts.
Patients who have a cardiac arrest will receive CPR provided by teams who have received debriefing. We will determine the effectiveness of each debriefing intervention by measuring and comparing CPR quality. Information collected during this study will be compared with data collected during a previous study.

What are the possible benefits and risks of participating?
There are no anticipated risks associated with taking part. Patients taking part may benefit from receiving a higher quality of CPR during their cardiac arrest. This study may be help us to determine which is the most effective debriefing method.

Where is the study run from?
The study is being run by the Heart of England NHS Foundation Trust (UK), where the study will be carried out.

When is the study starting and how long is it expected to run for?
The study will start in September 2013 and will run for 12 months.

Who is funding the study?
Funding has been provided by the Resuscitation Council (UK).

Who is the main contact?
Keith Couper

Trial website

Contact information



Primary contact

Mr Keith Couper


Contact details

Academic Department of Anaesthetics
Critical Care & Pain
Birmingham Heartlands Hospital
3 Bordesley Green East
Bordesley Green
B9 5SS
United Kingdom

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

A study of the use of debriefing to improve cardiopulmonary resuscitation delivery at in-hospital adult cardiac arrest: a non-randomised interventional process of care and treatment trial


Cardiopulmonary Resuscitation Debriefing study (CODE study)

Study hypothesis

Cardiac arrest is the sudden cessation of heart function. It affects approximately 35,000 patients in UK hospitals per year and inevitably leads to death, unless the patient receives prompt defibrillation and high quality cardiopulmonary resuscitation (CPR). However, the quality of the delivery of the delivery of these key interventions is highly variable.

The use of debriefing can be effective way to change clinician behaviour, and thereby improve care delivery. Debriefing offers clinicians the opportunity to engage in a facilitated discussion about their performance, and identify strategies for improvement. The 2010 International resuscitation guidelines recommended the use of debriefing following cardiac arrest. However, despite some promising early results, cardiac arrest debriefing remains in its infancy and the best way to deliver it has not yet been determined. Based on results from our previous work (systematic review, questionnaires, semi-structured interviews), we have developed new debriefing interventions: individual/small group debriefing, and written feedback.

This study will implement these debriefing strategies within Heart of England NHS Foundation Trust hospitals. The effectiveness of these interventions will be evaluated by measuring CPR quality at in-hospital cardiac arrests, using data that is automatically recorded by Trust defibrillators. The study will use data from another study, as the control period for this study. The primary outcome will be chest compression depth. This is a process outcome, that is associated with defibrillation success and cardiac arrest survival.

More details can be found at:

On 21/08/2013 the anticipated start date was changed from 15/06/2013 to 02/09/2013, and the target number of participants was changed from "Planned Sample Size: 300; UK Sample Size: 150 " to " Planned Sample Size: 520; UK Sample Size: 520".

Ethics approval

Added 21/08/2013: Oxford C Research Ethics Committee, 13/08/2013, Ref: 13/SC/0363.

Study design

Non-randomised interventional process of care and treatment trial

Primary study design


Secondary study design

Non randomised controlled trial

Trial setting


Trial type


Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet


Topic: Generic Health Relevance and Cross Cutting Themes; Subtopic: Generic Health Relevance (all Subtopics); Disease: Critical Care


Cardiopulmonary resuscitation: patients will receive cardiopulmonary resuscitation which will be provided by cardiac arrest teams who have received performance debriefing.

Intervention type



Not Applicable

Drug names

Primary outcome measures

Chest compression depth; timepoint(s): During cardiac arrest

Secondary outcome measures

Added 21/08/2013:

1. Process-based outcomes (all measured by the defibrillator during the cardiac arrest event):
1.1. Chest compression rate
1.2. No-flow time
1.3. Incidence of compression leaning
1.4. Peri-shock pause
1.5. Appropriateness of shocks
1.6. Time to first shock

2. Patient-based outcomes:
2.1. Return of spontaneous circulation (recorded at 20 minutes following the cardiac arrest event)
2.2. Survival to hospital discharge (measured at hospital discharge)
2.3. Neurological status at discharge (measured at hospital discharge using the cerebral performance category score)

Overall trial start date


Overall trial end date


Reason abandoned


Participant inclusion criteria

1. Male & female, lower age limit 18 years
2. Patients sustaining a cardiac arrest at Heart of England NHS Foundation Trust hospitals, which is attended by the hospital emergency team and where resuscitation is attempted.

Participant type


Age group




Target number of participants

Planned Sample Size: 520; UK Sample Size: 520

Participant exclusion criteria

Current exclusion criteria as of 21/08/2013:
1. Valid DNAR (Do Not Attempt Resuscitation) order

Previous exclusion criteria:
1. Valid DNAR (Do Not Attempt Resuscitation) order
2. Traumatic cardiac arrest

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

Academic Department of Anaesthetics
B9 5SS
United Kingdom

Sponsor information


Heart of England NHS Foundation Trust (UK)

Sponsor details

3 Bordesley Green East
Bordesley Green
B9 5SS
United Kingdom

Sponsor type

Hospital/treatment centre



Funder type

Research council

Funder name

Resuscitation Council (UK)

Alternative name(s)

Funding Body Type

Funding Body Subtype


Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data

Not provided at time of registration

Results - basic reporting

Publication summary

Publication citations

Additional files

Editorial Notes